Antibiotic Resistance in Providencia spp. in Iran: A Comprehensive Review of Patterns, Mechanisms, and Public Health Implications

Background: The genus Providencia, a member of the Enterobacteriaceae family, has emerged as a significant pathogen in human infections, particularly in immunocompromised individuals and hospital settings. With increasing global reports of antimicrobial resistance in Providencia species, understanding the resistance patterns and mechanisms in specific geographic regions is critical. This review evaluated the antibiotic resistance status of Providencia spp. in Iran, summarizing findings from existing literature to identify trends, gaps, and implications for public health and clinical practice. Methods: For this purpose, Google, PubMed, and Scopus databases were searched, along with conducting a systematic review of peer-reviewed articles, clinical case reports, and surveillance studies to assess the antibiotic resistance profiles of Providencia in Iran. Studies published from ۲۰۰۰ to ۲۰۲۴ were included in this review, with a focus on Providencia resistance to critical antibiotics such as carbapenems, cephalosporins, fluoroquinolones, and the like, which are multidrug resistant (MDR) or pandrug resistance (PDR) Providencia based on CLSI performance guidelines for antimicrobial susceptibility testing. The data were analyzed to identify prevalent resistance genes, mechanisms, and regional variations. Results: The findings revealed a concerning rise in MDR among Providencia isolates in Iran, with resistance to carbapenems, fluoroquinolones, aminoglycosides, and extended-spectrum beta-lactams frequently reported. Regional studies highlight variability in resistance rates, likely reflecting differences in antimicrobial stewardship and healthcare practices. Emergency PDR Providencia is a serious health threat due to its intrinsic resistance to some antibiotics, such as colistin, and tigecycline, which are used for other MDR Enterobacteriaceae species. Accordingly, understanding regional resistance patterns is helpful in choosing the appropriate treatment option. Conclusion: Given the high rate of carbapenem resistance, this is likely substantiated by other studies conducted in Asia that have identified various carbapenemases, including VIM, IMP, NDM-۱ MBL, OXA-۴۸, and KPC, which underscores the urgent need for effective antimicrobial stewardship and surveillance strategies to combat the spread of these resistant pathogens.