Regional Heterogeneity in Carbapenemase Gene Epidemiology (OXA-48, NDM, and IMP) Among Gulf Cooperation Council Countries: A Comparative Mini-Review

Carbapenemase-producing Pseudomonas aeruginosa and Klebsiella pneumoniae are a leading cause of difficult-to-treat infections in the Gulf Cooperation Council (GCC) region, yet the contribution of the three principal carbapenemase gene families (blaOXA-48, blaNDM, and blaIMP) is often assumed to be uniform across neighboring countries. This mini-review synthesizes facility-level, national, and genomic surveillance data from the United Arab Emirates (UAE), Qatar, Oman, Kuwait, Bahrain, and Saudi Arabia, anchored by a recent cohort from University Hospital Sharjah, UAE. blaOXA-48-like genes were the most frequently reported family regionally (51.7% in a 720-genome Arabian Peninsula study), but this dominance was not universal: OXA-181 predominated in Kuwaiti ICU isolates (89.3%), blaNDM-1 co-occurred in 95.8% of a small Bahraini series, and UAE national surveillance (2010–2021) found blaOXA-48 rare, in contrast to 65–67% at Sharjah. Saudi data showed a comparable regional gradient, and the dominant determinant shifted over time in Oman and Kuwait. High-risk clones, including hypervirulent ST383, circulated across countries, while carbapenemase-positive P. aeruginosa carried mainly VIM- and GES-type enzymes. Heterogeneity, at facility as well as country level, is the defining feature of GCC carbapenemase epidemiology; acute-care laboratories therefore need molecular panels covering blaOXA-48-like, blaNDM, blaVIM, blaIMP, and blaKPC, and facility-level antibiograms warrant at least annual review.