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Background: Carbapenem antibiotics consider the primary treatment choice for serious Pseudomonas aeruginosa infection. Hence, the evolution of carbapenem resistance mediated by acquiring genes encoding class b enzymes is of global concern. The purpose of this article research is to explore the prevalence, drug resistance profiles, and metallo-β-lactamases (MβLs) production in extensively drug-resistant carbapenem-resistant P. aeruginosa (XDR-CRPA). Methods: P. aeruginosa isolates were collected and identified according to conventional methods. Antibiotic resistance patterns were determined by single disk diffusion. Minimum inhibitory concentrations (MICs) of (imipenem, meropenem, ceftazidime, piperacillin/tazobactam, levofloxacin, and gentamicin) were determined for CRPA. A subset of the isolates collection consisting of the XDR-CRPA with the highest MICs to imipenem and meropenem were selected for the phenotypic screening of carbapenemases and MβLs production capability using the modified carbapenem inactivation (mCIM) and imipenem-EDTA combined disk (MβL-CD) methods, respectively. Then, molecular analysis, including identification by the specific primer of 16S rRNA and detection of MβL genes using polymerase chain reaction (PCR) was performed to the XDR selected isolates. Results: Among 100 P. aeruginosa isolated throughout this period, 59% exhibited reduced susceptibility rates to carbapenems. A total of 20.3% and 57% of CRPA isolates were MDR and XDR, respectively. MIC values of the CRPA revealed that these isolates exhibited high MIC50 and MIC90 to the six selected antibiotics. The findings of the (mCIM) assay displayed identical concordance results with the MβL-CD. Molecular investigation technique assured that 10 (90.9%) and 2 (18.1%) of the 11 XDR selected isolates are positive for blaNDM-1 and blaVIM-1 genes, respectively. Polymyxin B and colistin followed by aztreonam were the most effective antibiotics used for curing infections caused by XDR Pseudomonas aeruginosa. Conclusion: The prevalence of high XDR-CRPA in our study is a critical problem. Our present study found that the blaNDM-1 was present at a significant frequency among the selected XDR isolates, highlighting the need for establishing strict antimicrobial policies to avoid the prompt spread of these isolates. [ABSTRACT FROM AUTHOR]