Bacterial Profile and Antimicrobial Resistance Patterns in Infected Diabetic Foot Ulcers in Gulf Cooperation Council Countries (2005–2025): A Systematic Review and Meta-Analysis of Observational Studies

<title>Abstract</title> <p> Diabetic foot ulcers (DFUs) are substantially increasing in parallel with the rapidly rising prevalence of diabetes mellitus (DM) worldwide. The regional epidemiological data of infected diabetic foot ulcers and their antimicrobial resistance (AMR) patterns are essential for optimal management of these health challenges. This systematic review and meta-analysis aimed to determine the pooled prevalence of bacterial profiles and antimicrobial resistance patterns of infected DFUs in Gulf Cooperation Council (GCC) countries. A comprehensive search of the literature was conducted on PubMed/MEDLINE, Web of Science, Embase (via Ovid), and Google Scholar databases. Critical appraisal was performed using the Joanna Briggs Institute tool for prevalence studies. A single-arm meta-analysis was conducted using RStudio to estimate the pooled prevalence of bacterial pathogens and their AMR rates using a random-effects model. The I² statistic and Cochran's Q test were used to assess the heterogeneity. P-values less than 0.05 were considered statistically significant. Sixteen studies comprising 3260 participants were included; the mean number of bacterial isolates per study was 196.1 ± 265.9. The pooled prevalence of the most common bacterial isolates obtained from DFU were <italic>Staphylococcus aureus</italic> (29%, 95% CI: 20–40%), <italic>Pseudomonas aeruginosa</italic> (16%, 95% CI: 13–20%), and <italic>Escherichia coli</italic> (14%, 95% CI: 10–19%). The highest pooled antibiotic resistance rate was observed for ampicillin (67%), followed by tetracycline (59%), gentamicin (58%), and ciprofloxacin (52%). In contrast, resistance rates were relatively low for carbapenem antibiotics. Our findings provide evidence to help guide appropriate antibiotic selection and infection prevention strategies in the GCC region. Given the high microbial diversity and antimicrobial resistance observed, locally informed stewardship efforts and evidence-based alternative therapeutics may be warranted, particularly in light of the growing global antimicrobial resistance challenge. </p>