Analysis of Antibiotic Resistance Patterns and Distribution of Staphylococcus aureus in the Middle East: A Systematic Review and Meta-Analysis.

BACKGROUND: Antimicrobial resistance (AMR) is one of the most critical health concerns of the 21st century, leading to increased mortality, prolonged hospital stays for patients, and higher healthcare costs. Despite urgency of AMR issue, comprehensive and comparative data on AMR in the Middle East region remain limited. This study aimed to systematically review and synthesize country-level data on MRSA prevalence and resistance rates to seven commonly reported antibiotics, with the goal of identifying knowledge gaps and supporting evidence-based antimicrobial stewardship policies and clinical decision-making. METHODS: A comprehensive literature search was conducted across four electronic databases: PubMed, Web of Science (WOS), Scopus, and Google Scholar. The search included articles published from January 2015 to September 24, 2024. Search terms covered Staphylococcus aureus, AMR, and Middle Eastern countries. Ultimately, 217 studies with a combined sample size exceeding 32,090 were included in the analysis. RESULTS: In Iran, the highest and lowest pooled resistance rates were for penicillin G and vancomycin, respectively. For MRSA, the highest pooled resistance was observed in Iraq and the lowest in Turkey. Vancomycin pooled resistance was also the highest in Iraq. Gentamicin resistance was highest in Yemen and lowest in Cyprus and Kuwait. The highest pooled resistance rates for gentamicin, cotrimoxazole, and ciprofloxacin were all observed in Yemen. CONCLUSIONS: Factors contributing to high AMR rates include ineffective antibiotic stewardship, self-medication, prescription errors, inappropriate dosing, and excessive antibiotic use in agriculture. The findings highlight the urgent need for stricter antibiotic regulations, improved stewardship, and public awareness across the Middle East.