dissemination of carbapenemases producing gram negative bacteria in the middle east

the emergence and spread of carbapenemase-producing bacteria, that hydolyze most β-lactams, including carbapenems, are a major concern of public health system worldwide, particularly in the middle east area. since the plasmids harboring resis- tance genes could be spread across other bacterial populations, detection of carbapenemase-producing organisms has become more problematic. these organisms produce different types of enzymes including the most prevalent types including kpc, vim, imp, ndm, and oxa-48. carbapenemase producers are mostly identified among escherichia coli, klebsiella pneu- moniae, pseudomonas aeruginosa and acinetobacter baumannii. this study reviewed almost all papers, which conducted in the middle east. in order to decrease the spread of resistance, the regional cooperation has been emphasized by the middle east countries. the highest resistance, which is mediated by kpc has been observed in afghanistan, saudi arabia and jordan followed by ndm in pakistan and oxa in turkey and pakistan. it is important to mention that the spread of these types have been reported sporadically in the other countries of this area. this review described the widespread carbapenemases in the middle east area, which have been identified in an alarming rate.