Detection of multidrug-resistant bacteria in the occupied Palestinian territory: a cross-sectional study

Abstract

Background Antimicrobial resistance is a worldwide threat to public health. WHO has created several resolutions and strategies on this subject at the World Health Assembly. In May, 2015, WHO published a global action plan to mitigate antimicrobial resistance, including tracking and global surveillance focusing on improving awareness and understanding of this issue. The aim of this study was to screen for carbapenem-resistant bacteria in the occupied Palestinian Territory, to investigate the mechanisms behind the resistance, and to assess the scope of this difficulty in the area.Methods During 6 weeks in 2012, we collected all available Gram-negative isolates taken from inpatients and outpatients in hospital laboratories at Al-Shifa Hospital and five additional hospitals in the West Bank to screen for carbapenem resistance. Resistant isolates were identified with MALDI-TOF, mapped for their resistance pattern, and further analysed for mechanism of resistance by multiplex PCR and gene sequencing. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to type bacteria to compare the resistant isolates locally and internationally.Findings Of the 248 Gram-negative isolates we collected, 21 (8%) showed significant in-vitro resistance to carbapenems and several other antibiotics. These 21 were identified as 15 isolates of Acinetobacter baumannii and six of Pseudomonas aeruginosa. Carbapenemase gene investigations showed intrinsic OXA-51 group in all isolates and one isolate from Gaza was positive for NDM-2. Of the six P aeruginosa isolates, one VIM-4 and three VIM-2 producers were recorded and MLST reported three new sequence types named ST1562, ST1563, and ST1564.Interpretation We identified a high ratio of multidrug-resistant bacteria in the occupied Palestinian territory, to our knowledge the first documented isolates showing production of NDM-2 and VIM carbapenemases as a contributing mechanism. These findings emphasise the importance of this growing health threat in the occupied Palestinian territory and the need for further investigation and adequate surveillance of antibiotic resistance.

Antimicrobial resistance of bacterial isolates from the clinical and hospital environment in Gaza Strip, Palestine: A review over 20-year

“…This gene confers carbapenem resistance to bacteria. Several studies confirmed the emergence of carbapenem resistant strains of bacteria [32,34,36,39]. One study showed that carbapenem resistant bacteria were having cabapenemase OXA-51 gene group in all isolates and one isolate from Gaza was positive for NDM-2 [40].…”

“…The study of Rida et al [39] focused on carbapenem resistance among GNB isolated from clinical and environmental hospital samples. The study tested 210 clinical samples, 150 environmental swabs, and 110 air samples.…”

“…was the mostly resistant to carbapenems (14.4%), This article is available at: www.iajaa.org 10 followed by E. coli 9.8% in addition, 23.3% were positive for carbapenemases production. All Enterobacteriaceae isolates had MDR index higher than 0.2, while those of Pseudomonas had an average of 0.2 [39]. Another study detected the multi-resistance pattern of bacteria recovered from clinical samples in Palestine (Gaza Strip and the West Bank), Out of 248 GNB isolated, 21 (8%) were resistant to carbapenems and other antibiotics [40].…”