A review of colistin-resistant isolates in the Middle East: mechanisms, epidemiology, and dissemination from different sources in humans, animals, foodand soil.

is a normal gut inhabitantthat can cause various diseases ,such as intestinal, urinary tract, bladder infections and systemic infections in humans and animals. The alarming increase in profiles for extended-spectrum β-lactamase-  and carbapenemase-producing isolates is a serious problem throughout the world. Colistin is known as a lastresort agent for the treatment of Gram-negative bacterial infections. Inappropriate use of colistin and other classes of antibiotics combined with inadequate infection control, especially in developing countries, can lead to serious public health complications. The global increase in colistin resistance has been reported in many parts of the world, ,including the Middle East. Colistin is used to treat infections caused by extensively drug-resistant Gram-negative bacteria. There are few reliable epidemiologic data on colistin-resistant isolates, and information on colistin-resistant from Asia, the largest, most populous, and most diverse continent in the world, is generally limited compared with Europe and the United States.  The data in this review article were compiled from related articles associated with isolated colistin-resistant () isolates from humans, animals, and food-producing animals. In the Middle East, colistin-resistant isolates were reported from Turkey, Egypt, Saudi Arabia, Algeria, Iran, Iraq, Bahrain, Qatar, Oman, Kuwait, Israel, and Lebanon between 2010 and 2023. While colistin resistance is most commonly observed in isolates, data have shown that mcr genes are the most common genes associated with colistin resistance in isolatescompared to mutations in , , and genes.