Antimicrobial‑Resistance Patterns in Tertiary Hospitals in the Gulf Region: A Systematic Review

Abstract

Background:
Antimicrobial resistance (AMR) presents a critical threat to healthcare systems globally, with tertiary hospitals serving as high-risk hubs for the emergence and spread of resistant pathogens. In the Gulf Cooperation Council (GCC) region, surveillance remains fragmented despite growing evidence of high resistance burdens. This systematic review aimed to synthesize data on the prevalence and patterns of antimicrobial-resistant organisms in tertiary-care settings across Gulf countries.
Methods:
We conducted a systematic review following the PRISMA 2020 guidelines. A comprehensive search of PubMed and other databases was performed to identify studies published between January 2000 and December 2024. Eligible studies were cohort studies or clinical trials conducted in tertiary hospitals within the GCC region and reporting antimicrobial resistance outcomes. Two reviewers independently screened articles, extracted data, and assessed risk of bias using the Newcastle–Ottawa Scale and Cochrane tools.
Results:
A total of nine studies met the inclusion criteria. CRE incidence ranged from 2 to 10.8 cases per 1,000 admissions. MRSA prevalence ranged from 17% to 45%, with higher rates observed in maternity and paediatric wards. Risk factors consistently associated with resistant infections included ICU admission, prior antibiotic use, and comorbid conditions. The most common resistance genes were bla_OXA-48-like in Kuwait and bla_NDM-1 in the UAE. Stewardship interventions showed mixed results, with national antibiotic-prescription policies reducing overall usage but not reversing resistance trends in all settings.
Conclusions:
AMR is widespread in Gulf tertiary hospitals and varies substantially across countries and settings. Coordinated surveillance systems, rapid molecular diagnostics, and unified stewardship strategies are urgently needed to contain resistance and guide empirical treatment protocols.