Background/Objectives: Understanding the patterns of inappropriate antibiotic prescribing is crucial to design antimicrobial stewardship interventions. This systematic review evaluated the prevalence and types of inappropriate antibiotic prescribing among dialysis patients. Methods: Four electronic bibliographic databases including PubMed, Embase, Scopus, and CINAHL, were searched. Supplementary search was conducted using Google Scholar and by manually checking the reference list of selected studies. Selected studies include those published in the English language since inception of the databases until October 2024. Two independent reviewers screened, selected, and extracted the data for qualitative synthesis. Results: Of the 784 records identified from the databases, 13 studies fulfilled the eligibility criteria. Eight of the studies (42.6%) were from the USA. Antibiotic prescribing rate ranging from 16 to 75.5% was reported among dialysis patients, with vancomycin (6.5–100%), piperacillin-tazobactam (2.4–44.5%), meropenem (2.1–25.8%), metronidazole (2.1–16.4%), cefazolin (4.3–13.6%), and ceftriaxone (1.3–10.8%) being the most commonly prescribed antibiotics. The studies showed that 20–65.7% of prescriptions are inappropriate, mostly due to inappropriate dosing (25.5–100%), lack of an indication (5.5–73.9%), and inappropriate choice/spectrum (23.6–69.7%). Conclusions: Antibiotic prescribing among dialysis population is higher than the rate reported among hospitalized patients. High rate of broad-spectrum antibiotic prescribing coupled with the high rate of inappropriate antibiotic prescribing indicate the need for the implementation of antimicrobial stewardship programs in dialysis settings.

Background: Understanding antimicrobial prescribing practices is a prerequisite for developing effective antimicrobial stewardship programs. A comprehensive analysis of point-prevalence studies of antimicrobial prescribing among hospitalised patients in the Middle East Region is currently lacking. Objectives: To determine the pooled point-prevalence of antimicrobial prescribing among hospitalised patients in the Middle East Region, and to assess the indications, classes and types of antimicrobial agents prescribed. In addition, this study evaluated the quality indicators of antimicrobial prescribing. Methods: This systematic review and meta-analysis adhered to the PRISMA 2020 Statement. Electronic bibliographic search was conducted on PubMed, Scopus and Google Scholar using antimicrobial/antibiotic prescribing, antimicrobial/antibiotic use, point-prevalence and the names of countries in the Middle East as search terms. Primary literature published in English language describing the point-prevalence and types of antimicrobial prescribing in inpatients from the inception of the databases to December 2025 were included. Data were synthesised using qualitative and quantitative methods. RevMan version 5.4 was used for a random-effect meta-analysis. Results: Thirty-one eligible studies out of 1515 identified studies were included with most studies conducted in Saudi Arabia ( n = 7) and Turkey ( n = 6). The pooled point-prevalence of antimicrobial prescribing was 58.6% (95% confidence interval [CI]: 51.89–65.36) with the pooled point-prevalence ranging from 82.9% (95% CI: 64.86–100.96) in Iraq to 43.5% (95% CI: 23.22–63.77) in the UAE. The pooled rate of combination therapy and parenteral antimicrobial prescribing was 40.8% and 82.2%, respectively. The indications for antimicrobial prescribing were community-acquired infections (40.5%), surgical antimicrobial prophylaxis (SAP) (21.3%), hospital-acquired infections (17.7%) and medical prophylaxis (9.4%). Third generation cephalosporin (22.4%), penicillin beta-lactamase inhibitor combination (14.4%) and carbapenems (10.3%) were the most prescribed class of antibiotics. The pooled prevalence of Access, Watch and Reserve antibiotics prescribing was 30.0%, 56.2% and 6.9%, respectively. Reason for antimicrobial prescription and stop/review date was documented in 69.0% and 40.7% of the prescriptions, respectively. Prolonged duration of SAP was common among the patients (79%). Conclusion: Antimicrobial prescribing among hospitalised patients in the Middle East was high and varied between countries. There was a high rate of watch and reserve antibiotics prescribing. Prolonged duration of SAP was common. The results indicate the need to strengthen antimicrobial stewardship programs in inpatient settings to improve the quality use of antimicrobial agents in the region.

Background/Objectives: The prescription of aerosolized antimicrobial agents for lower respiratory tract infections varies significantly among clinicians. This study investigated the practices and perceptions of clinicians regarding aerosolized antimicrobial therapy. Methods: A cross-sectional study was conducted among infectious diseases (ID) and critical care clinicians (physicians and clinical pharmacists) in eight acute care hospitals in Qatar using a validated and pretested self-administered online questionnaire. Data was collected between September and October 2025, and analyzed using the Statistical Package for the Social Sciences (SPSS). Results: The majority of the respondents were physicians (70.5%), and about one-third (31.8%) had more than 15 years of work experience. A vast majority (97.7%) had previously prescribed or recommended aerosolized antimicrobial agents. Some respondents (34.1%) reported using aerosolized antimicrobial agents at least once every three months. The indications for aerosolized antimicrobial prescribing were for the treatment of bacterial infections (86.4%) and prophylaxis against bacterial infections (38.6%). Aerosolized antimicrobials were used for the treatment of ventilator-associated pneumonia (68.2%), cystic fibrosis (61.4%) and ventilator-associated tracheobronchitis (34.1%). Gentamicin (88.6%) and colistin (72.7%) were the most frequently used aerosolized antimicrobial agents. The majority (88.6%) of the respondents combined aerosolized antimicrobial agents with systemic antimicrobial agents, 65.9% of whom combined different antimicrobials for aerosolized and systemic routes. Pseudomonas aeruginosa (97.7%) and Acinetobacter baumannii (56.8%) were the most common microorganisms treated with aerosolized antimicrobial agents. Most respondents (61.4%) did not provide pre-treatment prior to aerosolized antimicrobial therapy. However, 38.6% used bronchodilators for pre-treatment. Bronchospasm (79.5%) and hypoxemia (20.5%) were the adverse effects reported by the respondents. Some respondents (40.9%) strongly agreed/agreed that aerosolized antimicrobial therapy improves clinical and microbial cure rates. While 81.8% strongly agreed/agreed that aerosolized antimicrobial therapy reduces systemic toxicity. Practices and perceptions varied significantly between ID and critical care specialties, and between physicians and pharmacists. Conclusions: Clinicians need training on aerosolized antimicrobial therapy for lower respiratory tract infections. Immunosuppression, renal function and infections due to multidrug-resistant organisms were reported by clinicians as factors that influenced their decision to use aerosolized antimicrobial therapy. A protocol for the administration of aerosolized antimicrobial therapy is recommended.

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.