The production of diverse and extended spectrum β-lactamases among Escherichia coli and ESKAPE pathogens is a growing threat to clinicians and public health. We aim to provide a comprehensive analysis of evolving trends of antimicrobial resistance and β-lactamases among E. coli and ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acine to bacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) in the Arabian region. A systematic review was conducted in Medline PubMed on papers published between January 2000 and February 2020 on countries in the Arab region showing different antibiotic resistance among E. coli and ESKAPE pathogens. A total of n = 119,144 clinical isolates were evaluated for antimicrobial resistance in 19 Arab countries. Among these clinical isolates, 74,039 belonged to E. coli and ESKAPE pathogen. Distribution of antibiotic resistance among E. coli and ESKAPE pathogens indicated that E. coli (n = 32,038) was the predominant pathogen followed by K. pneumoniae (n = 17,128), P. aeruginosa (n = 11,074), methicillin-resistant S. aureus (MRSA, n = 4370), A. baumannii (n = 3485) and Enterobacter spp. (n = 1574). There were no reports demonstrating Enterococcus faecium producing β-lactamase. Analyses revealed 19 out of 22 countries reported occurrence of ESBL (Extended-Spectrum β-Lactamase) producing E. coli and ESKAPE pathogens. The present study showed significantly increased resistance rates to various antimicrobial agents over the last 20 years; for instance, cephalosporin resistance increased from 37 to 89.5%, fluoroquinolones from 46.8 to 70.3%, aminoglycosides from 40.2 to 64.4%, mono-bactams from 30.6 to 73.6% and carbapenems from 30.5 to 64.4%. An average of 36.9% of the total isolates were reported to have ESBL phenotype during 2000 to 2020. Molecular analyses showed that among ESBLs and Class A and Class D β-lactamases, bla_CTX-M and bla_OXA have higher prevalence rates of 57% and 52.7%, respectively. Among Class B β-lactamases, few incidences of bla_VIM 27.7% and bla_NDM 26.3% were encountered in the Arab region. Conclusion: This review highlights a significant increase in resistance to various classes of antibiotics, including cephalosporins, β-lactam and β-lactamase inhibitor combinations, carbapenems, aminoglycosides and quinolones among E. coli and ESKAPE pathogens in the Arab region.

Several studies in the Arab region have recognized the rate of nosocomial infections caused by Pseudomonas aeruginosa which produce β-lactamase and identified their emergence and prevalence in the region. This article seeks to review molecular studies on these β-lactamase producing Pseudomonas aeruginosa during the period 2010 to 2018 in several countries of the Arab region in order to analyze the trend of rising prevalence of disease causing drug resistant Pseudomonas aeruginosa in the Arab region. The data available from selected clinical studies during the period 2010 to 2018 on β-lactamase producing P. aeruginosa in the Arab region obtained from reliable scientific databases was analyzed and evaluated. Significant changes have been found in resistance of Pseudomonas aeruginosa towards certain antibiotics of the β-lactam class. There is an increasing trend in the occurrence of resistance genes in β-lactamase producing P. aeruginosa. This review shows that there is increasing prevalence of β-lactamase producing P. aeruginosa in some countries in the Arab region. This is a major cause of concern as this implies that more and more instances of multidrug resistance are emerging in this area. This leads to an overall negative impact on the health concerns and amounts to increasing difficulty in combating disease. It is recommended that awareness about antibiotic use and abuse be made a priority and measures of curbing unchecked use of prescription antibiotics be put into place. Effective screening methods to detect cases of resistance at their onset may be developed.