Abstract
BackgroundAntimicrobial 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. MethodsDuring 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. FindingsOf 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. InterpretationWe 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. FundingDanish Ministry of Health and Prevention—the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP).
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