Infectious Diseases Prevention and Control

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https://hdl.handle.net/20.500.11888/18810

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    RADIOLOGY DEPARTMENT: A POTENTIAL SOURCE OF MULTIDRUG-RESISTANT MICROORGANISMS, A CROSS-SECTIONAL STUDY AT TERTIARY CARE HOSPITAL, PALESTINE
    (2023-03-22) Zena Mohammad Saleem Odeh
    Globally, healthcare facilities face a great challenge in the form of hospital-acquired infections (HAIs). Aside from the morbidity and mortality they cause, these illnesses are also extremely costly. Research on infection transmission in the medical area has been considerable, but not so much in the radiology department. This study aims to identify the presence of multidrug-resistant (MDR) microbes on surfaces that are frequently touched in Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), plain X-ray examination rooms, and portable radiography that are susceptible to contamination, as well as to investigate the potential dangers of contracting MDR organisms to patients and healthcare providers. In this study, 160 swab samples were collected from the radiology department at a tertiary care hospital in Palestine during May and June 2022. Samples were obtained from 80 predefined surfaces twice within and outside of CT and MRI examination rooms, as well as from US and Plain X-ray machines and portable X-ray machines. Samples were taken at 7:00 a.m. using cotton swabs following the regular cleaning procedure. Bacterial colony-forming units (CFUs) per square centimeter (cm2) were calculated after swabbing a 100 cm2 surface. Nearly all of the surfaces tested had bacterial CFUs. The highest contamination rate was found on keyboards ranging from (1.2-8) CFU/cm2, the sides of patient tables (1.2-20) CFU/cm2, knee coil (2.4-3) CFU/cm2, and patient leg supports (1.2-8) CFU/cm2. Noticeable increase in the contamination was noticed in June comparing to May and this was consistent with the increase in: number of isolated patients in the hospital, the workload in the radiology department and number of patients referred to the hospital. In our study, none of the examined sites showed contamination with MDR gram negative bacteria like Extended-Spectrum Beta-lactamases producing Enterobacterales (ESPL) or Carbapenemase-Producing Enterobacterales (CPE). On the other hand, methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin resistant Enterococcus (VRE) were detected. All of the radiology department equipment and sites could be a source of bacterial infection including MDR; so, obligatory and committed disinfection protocol must be revised and implemented in the morning and between patients. Keywords: Radiology Department, MDR, Hospital-acquired infection, Bacterial nosocomial infection, Contamination.
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    BACTERIOLOGIC PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF SEPTICEMIA IN NEONATAL INTENSIVE CARE UNITS, PALESTINE (2019-2021)
    (2022-12-29) Bayan Asem Mohammad Ibrahim
    Background: Neonatal sepsis (NS) is a public health concern worldwide because of its high morbidity and mortality, in addition to the growing resistance towards World Health Organization (WHO) recommended empiric regimens. The aim of this study is to evaluate the matching status of WHO empiric antibiotic regimens with the causative pathogens of NS at three tertiary care hospitals in Palestine. Methods: This is a retrospective study where records of neonates with suspected NS admitted to neonatal intensive care units of three tertiary care units in the period of January 2019 to December 2021 were extracted from the Ministry of Health electronic database. Univariate analysis and multivariate logistic regressions were performed for factors associated with culture-proven NS, generating odds ratios and confidence intervals. Results: Out of 6090 suspected cases of NS, 884 (14.5%) cases had positive blood cultures. The prevalence rate of NS was 9 per 1000 live births and 4 per 1000 live births for early-onset sepsis, with an overall mortality prevalence of (17.2%). The predominantly isolated organisms were 499/884 (56.4%) Coagulase-negative Staphylococcus (CoNS), 119/884 (13.5%) Klebsiella pneumonia, and 66/884 (7.5%) Streptococcus spp. Moreover, most of the isolated bacteria (79.6%) didn’t match any of the WHO empiric regimens and the probability of matching for both WHO regimens among EOS was found 2.4 times the matching probability among LOS by doing multiple logistic regressions. (21.6%) of the Isolated bacteria (excluding CoNS) were multi-drug resistant (MDROs). Antibiotic susceptibility for Gram-negative bacteria was high among amikacin (63%), meropenem (70%), piperacillin-tazobactam (65.6%), and colistin (100%). Alternately, it was low for ampicillin (7.1%), cefotaxime (21.8%), and ceftazidime (29%). On the other hand, Gram-positive bacteria were sensitive to vancomycin (99.8%), and (81%) of Gram-positive other than Staphylococcus spp. were sensitive to ampicillin. Conclusions: The culture-proven NS prevalence rate is 10 folds the rate of high-income countries, and the majority of isolated pathogens were resistant to empiric WHO regimens. Hence, a careful review of empiric treatment for NS is warranted. Moreover, strict infection control and antimicrobial stewardship programs should be implemented to slow down the emergence of resistant organisms among the neonatal population. Keywords: Aantibiotic susceptibility; Empiric regimens; Neonatal sepsis; Prevalence rate of NS.
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    ASSESSING THE PREVALENCE OF PHARMACEUTICAL RESIDUES IN WADI ZOMAR CATCHMENT AREA IN PALESTINE: RISK ASSESSMENT FOR REUSE AND IMPACT ON HUMAN HEALTH
    (2023-06-08) Ala'a Monther Hassan Jaddou
    Abstract The occurrence of various classes of antibiotics and pharmaceuticals (PhCs) in the environment and their contribution to Antimicrobial resistance (AMR) development is questionable. AMR is recognized as a major health threat. Discharges from wastewater treatment plant (WWTP) is considered to be the major source contributing to the vast bulk of different pharmaceuticals in the environment. The researcher intends to investigate the prevalence of pharmaceutical residues in diverse aquatic matrices with more attention to the removal capacity of West Nablus WWTP with respect to the detected pharmaceuticals. Method: 2 raw wastewater, 2 treated wastewater, and 2 surface wastewater run-offs were collected in two grab sampling campaigns. An additional ground water sample was collected using a Passive Organic Chemical Integrative Sampler (POCIS). All samples were analyzed using LC-MS/MS. The Risk Quotient (RQ) was used for Measured Environmental Concentration (MEC) of detected antibiotics against Predicted No-Effect Concentration ((PNEC) to evaluate the risk for antibiotic resistance development according to the detected antibiotics residues. Sulfamethoxazole, Trimethoprim, Diclofenac, and Carbamazepine were the most frequently detected in all water samples. West Nablus WWTP delivered a significant removal efficiency in both campaigns. However, it was noticed that there was a significant spatial difference between the WWTP effluent discharge point and the Anabta-Zomar point of sampling directly after the rainy season. Ofloxacin residual concentration in immediate WWTP effluent discharges and surface run-offs along the sampling point is found to pose risk for AMR development in the environment. Groundwater is found to be polluted with Carbamazepine, Diclofenac, Ciprofloxacin, and Sulfamethoxazole. The local status indicates the need for further in-depth investigation regarding the risk of antibiotics to the environment and its role in the emergence of AMR concerning the detected antibiotics. Additional wastewater treatment methodologies are needed for better removal yield. Groundwater pollution requires urgent ecotoxicological studies for both human and animal health and environmental life forms. Keywords: Antibiotics; Antimicrobial resistance; Bacteria; Environment; Health; Pharmaceuticals; Wastewater; WWTP.
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    TRENDS IN ANTIBIOTICS RESISTANCE OF BACTERIAL PATHOGENS IN A TERTIARY CARE HOSPITAL: A RETROSPECTIVE STUDY FROM PALESTINE
    (2023-06-22) Ayman Dawoud
    Antibiotic resistance has become a major public health problem worldwide, resulting in more severe infections and longer hospital stays. The goal of this study is to detect changes in resistance rates to first-line and last-resort antibiotics in Nablus, Palestine. A retrospective assessment of data gathered from a tertiary care hospital's microbiology department between January 2018 and December 2021. The resistance rate of the bacterial isolates was the outcome of interest. Microsoft Excel 2019 was used to depict trends from 2018 to 2021, and statistical analysis was performed using the Statistical Package for Social Science (SPSS) version 26. A total of 4659 isolates, of six highly virulent and antibiotic resistant bacterial pathogens were included in our study. The most common source for these organisms was urine (34.6%) followed by swabs from different parts of the body (30.7%), (13%) from respiratory samples, (10.1%) from blood culture samples, (7.6%) from body fluid samples, and (4%) from tissue samples. The most commonly isolated organism of the ESKAPE family was Escherichia coli (27%), followed by Klebsiella pneumoniae (15.5%), Enterococcus faecalis (14.6%), P. aeruginosa (13.0%), S. aureus (10.6%), Enterococcus faecium (10.2%), and Acinetobacter baumannii (9.0%) Over the four years period of study, ampicillin and penicillin showed the highest rates of resistance ranging from 55-75. Resistance of E. coli to amoxicillin/clavulanic acid decreased significantly while carbapenem-resistant E. coli and K. pneumoniae increased. For K. pneumoniae there is a significant increase in resistance to trimethoprim-sulfamethoxazole and a significant decrease in resistance to norfloxacin. Enterococcus Spp. showed an increase to last-resort antibiotics i.e., linezolid and vancomycin. P. aeruginosa demonstrated a significant decrease in resistance. Our study showed that antibiotic resistance is a major concern in Palestine because our country has limited resources. Policy-makers in the country should take the proper measures to slow down the development of resistance. Among the steps that should be taken into consideration is instituting antibiotic stewardships in all hospitals, putting forward legislation to stop dispensing antibiotics without prescriptions and increasing the public awareness of antibiotic resistance. Keywords: Antimicrobial Resistance; First-Line; Last-Resort Antibiotics; Nablus; Palestine; Stewardship Programs; Surveillance.
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    EPIDEMIOLOGY AND ANTIMICROBIAL SUSCEPTIBILITY OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS ISOLATES: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL IN PALESTINE BETWEEN 2020-2021
    (2023-06-14) Hala Zidan Masri
    Increased rates of resistance of Staphylococcus aureus (S. aureus) to different classes of antibiotics, makes the researchers think about studying the antimicrobial profile of it, and other risk factors that may be associated with infection. The goals of our study are to determine the prevalence of methicillin-resistant S. aureus (MRSA) among Palestinian patients, and to identify risk factors, susceptibility patterns, and to determine the most suitable antibiotics to be used empirically. Data of positive S. aureus cultures from patients’ specimens during the time period between January 2020 and December 2021 was collected from An-Najah National University Hospital, Nablus-Palestine, classified to methicillin-sensitive S. aureus (MSSA) or MRSA by using Vitek 2 system which is available in the hospital. Each isolate was tested for susceptibility to each oxacillin, cefuroxime, amoxicillin, piperacillin-tazobactam clindamycin, erythromycin, gentamycin, levofloxacin, linezolid, moxifloxacin, ciprofloxacin, quinopristin/dalfopristin, rifampicin, tetracycline, tigecycline, trimethoprim-sulfamethoxazole (TMP-SMX), and vancomycin by Vitek2 system. Other information related to patients and other comorbidities were collected from the hospital information system. 126 (49.6%) of 254 patients with S. aureus were infected with MRSA, with no significant association with various age groups and gender. Prevalence of MRSA was highest in pediatric unit followed by emergency room, 61.1% and 59.6% respectively, followed by surgical unit with MRSA prevalence of 52.7%. There is a significant difference in MRSA and MSSA distribution in the kidney unit (p-value = 0.009). Lung diseases are the co-morbidities which are associated with MRSA. Skin and soft tissues, and pus/wound specimen are associated with MRSA infection. All isolated were still susceptible to vancomycin. The prevalence of MRSA seemed to be similar to other Asian countries. Vancomycin is the most suitable option to be used empirically for serious MRSA infections. Keywords: Methicillin-resistant Staphylococcus aureus, resistance, risk factors, susceptibility pattern.