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Colistin Resistance among Enterobacteriaceae Isolated from Clinical Samples in Gaza Strip
Mohammad Qadi1, Safaa Alhato2, Rasha Khayyat1
1Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, P.O.Box. 7, Nablus, Palestine, State of Palestine.
Abstract:
Bacterial infections, especially drug-resistant infections, are a major global health issue. The emergence of multidrug-resistant (MDR) strains of Enterobacteriaceae and the lack of new antibiotics have worrisome prospects for all of humanity. Colistin is considered the last-line drug for MDR Gram-negative bacteria (GNB), and it is often used for treatment of respiratory infections caused by MDR-GNB. In recent years, there has been a marked increase in the incidence of colistin-resistant infections. The main objective of this study was to investigate the presence of colistin resistance among clinical GNB isolated from Gaza Strip hospitals. Clinical Enterobacteriaceae isolates (100) were obtained from microbiology laboratories of the hospitals of different geographical locations in Gaza Strip Governorate over a period of six months. Samples were cultured, and bacterial identification was performed by standard microbiological procedures. Enterobacteriaceae isolates were tested for their antimicrobial susceptibility by the disk diffusion method and the MIC method for colistin. Varying degrees of susceptibility were observed for the isolates against the tested antimicrobials even within members of the same antimicrobial class. Amikacin was the most effective drug (74%), followed by chloramphenicol (48%), fosfomycin, and gentamicin (45%). High resistance was recorded against trimethoprim (85%) and tetracycline (83%). Only 59% of the tested isolates were interpreted as susceptible, while 41% was classified as resistant. The highest resistance to colistin was found to be among the Proteus spp. (63.2%), followed by Serratia spp. (57.1%). The lowest resistance was observed among Klebsiella isolates (31.6%). Only 39.0% of meropenem-resistant Enterobacteriaceae was susceptible to colistin, while 45.8% of imipenem-resistant Enterobacteriaceae was susceptible to colistin. The overall resistance to colistin was high (41%) among tested clinical isolates. Furthermore, 89% was MDR. These limit and complicate treatment options for the infections caused by Enterobacteriaceae in Gaza Strip. This calls for immediate actions to control and monitor the use of antimicrobials in general and colistin in particular.
Insights
Drug-resistant bacterial infections are a major threat. This study found high colistin resistance (41%) and multidrug resistance (89%) in Gaza Strip clinical isolates, complicating treatment options.
Area of Science:
- Clinical microbiology and infectious diseases.
- Antimicrobial resistance surveillance.
- Public health and global health security.
Background:
- Bacterial infections, particularly those caused by multidrug-resistant (MDR) strains, pose a significant global health challenge.
- Colistin is a critical last-line antibiotic for treating infections caused by MDR Gram-negative bacteria (GNB).
- There is a concerning rise in colistin-resistant infections, necessitating urgent investigation.
Purpose of the Study:
- To determine the prevalence of colistin resistance among clinical Gram-negative bacteria (GNB) isolated from hospitals in the Gaza Strip.
- To assess the antimicrobial susceptibility patterns of these clinical isolates.
- To evaluate the implications of resistance for treatment options.
Main Methods:
- One hundred clinical Enterobacteriaceae isolates were collected from Gaza Strip hospitals over six months.
- Standard microbiological procedures were used for bacterial identification.
- Antimicrobial susceptibility testing was performed using the disk diffusion method, with colistin Minimum Inhibitory Concentration (MIC) determined.
Main Results:
- High resistance rates were observed for trimethoprim (85%) and tetracycline (83%). Amikacin showed the highest efficacy (74%).
- Overall colistin resistance was 41%, with highest resistance in Proteus spp. (63.2%) and Serratia spp. (57.1%).
- Multidrug resistance (MDR) was prevalent, affecting 89% of isolates. Only 39% of meropenem-resistant and 45.8% of imipenem-resistant Enterobacteriaceae were susceptible to colistin.
Conclusions:
- The study reveals a high prevalence of colistin resistance and MDR among clinical Enterobacteriaceae in the Gaza Strip.
- These resistance patterns severely limit available treatment options for bacterial infections in the region.
- Immediate actions are crucial for antimicrobial stewardship, focusing on monitoring and controlling the use of antimicrobials, especially colistin.
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