Antimicrobial resistance of bacteria isolated at the European Gaza Hospital before and after the Great March of Return protests: a retrospective study

Abstract

BackgroundThe emergence of antimicrobial resistant pathogens is a serious health threat that leads to increased mortality. In 2019, the European Gaza Hospital released medical reports that indicated high multiresistant bacterial isolates during the period of Great March of Return (GMR) Gaza Strip border protests in 2018–19. We investigated resistance to commonly used antibiotics of bacteria isolated at the European Gaza Hospital in the Gaza Strip for 6 months before and 6 months after the GMR. MethodsThis was a retrospective study done in European Gaza Hospital, which covers three of the five governorates in Gaza Strip. We obtained routine microbiology laboratory results from pus and swab cultures recorded between Aug 1, 2017, and Aug 1, 2018. Data were cross-tabulated and assessed with the χ2 test in SPSS version 26.0. Ethics approval was obtained from the Palestinian Ministry of Health. Data were anonymised and, therefore, consent was waived for this study. Result628 clinical isolates were analysed, 310 (49%) from before and 318 (51%) from after the GMR. 192 (31%) samples were recovered from people injured during the GMR. The predominant Gram-positive isolate recovered was Staphylococcus aureus (144 [23%] of 628 samples). Among Gram-negative bacteria, Pseudomonas aeruginosa was the most common (138 [22%] of 628 samples), followed by Klebsiella sp (113 [18%]), and Acinetobacter sp (56 [9%]). Increases in resistance to antibiotics among non-injured patients were seen after the GMR compared with before. For example, resistance to amikacin was 30% before the GMR and 70% after (percentage increase 133%), to doxycycline was 35% and 65%, respectively (increase 87%), and to gentamicin was 16% and 84%, respectively (increase 421%). Striking increases in resistance were also seen among isolates from injured patients, ranging from 4% to erythromycin to 300% to aztreonam and nalidixic acid when compared with isolates from non-injured patients. InterpretationThe increase in resistance of bacterial isolates after the GMR might have been due to infections with new bacterial strains that spread easily among patients because of limited human resources, huge numbers of casualties, and improper infection control measures. Regulation of antibiotic prescriptions and use should be enforced to reduce the emergence of resistance. The indiscriminate use of antibiotics should be discouraged through awareness campaigns. FundingNone.