Prevalence and Trends of Colistin-Resistant Acinetobacter Baumannii in the Middle East: A Systematic Review and Meta-Analysis

Background/Objectives: The aim of this study was to synthesize the prevalence and temporal trends of colistin-resistant A. baumannii isolates in the Middle East and compare the resistance rates across different countries and clinical specimen types. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Electronic searches of the PubMed, Scopus and Google Scholar databases were conducted to identify English-language studies that included at least 100 A. baumannii isolates. Two independent reviewers screened and assessed the articles and extracted the data from the eligible studies. The data were synthesized using qualitative and quantitative methods. Quantitative synthesis was conducted using R software 4.6.1 with a random-effects binomial generalized linear mixed model (GLMM). Results: Eighty-eight eligible studies were included in the analysis. The pooled prevalence of colistin-resistant A. baumannii in the Middle East was 1.1% (95% confidence interval [CI]: 0.60–2.00). Lebanon had the lowest prevalence (0.0%), followed by Iran (0.6%; 95% CI: 0.20–1.80), Saudi Arabia (1.5%; 0.30–6.80), and Türkiye (1.6%; 95% CI: 0.60–4.10). The highest pooled prevalence was observed in Egypt (18.6%; 95% CI: 2.80–64.30). The pooled prevalence was 2.5% (95% CI: 0.50–10.90) during 2000–2010, 0.7% (95% CI: 0.40–1.50) during 2011–2019, and 4.0% (95% CI: 0.70–19.3) during 2020–2024, representing an observed 1.6-fold difference between the estimates for 2000–2010 and 2020–2024. Respiratory samples had the highest prevalence of colistin-resistant A. baumannii (8.0%; 95% CI: 2.00–26.90), followed by blood samples (3.7%; 95% CI: 1.2–10.40), and urine (1.3%; 95% CI: 0.00–7.23). Samples from wounds/swabs/pus/tissue had the lowest rate of colistin resistance (0.6%; 95% CI: 0.1–6.00). Conclusions: The prevalence of colistin-resistant A. baumannii in the Middle East remains low, with variation across countries, clinical specimen types, and study periods. Continued surveillance of antimicrobial resistance, strengthening of infection prevention and control measures, and antimicrobial stewardship programs are needed to monitor and address colistin resistance in the region.