Infectious Diseases Prevention and Control
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- ItemEPIDEMIOLOGY OF ACINETOBACTER BAUMANNII INFECTIONS AMONG PATIENTS ADMITTED TO THREE INTENSIVE CARE UNITS IN PALESTINE: A RETROSPECTIVE CHART REVIEW STUDY(An-Najah National University, 2024-10-30) Arjan, ShadenBackground: Multidrug-resistant (MDR) strains of Acinetobacter baumannii pose significant treatment challenges. This study aimed to evaluate the sociodemographic and clinical characteristics of patients with A. baumannii infections in medical intensive care units (ICUs) across three hospitals in the West Bank, Palestine. It also sought to determine the prevalence of multidrug-resistant and extensively drug-resistant strains and assess patient survival and mortality rates. Methods: A retrospective cohort design was conducted from 2019 to 2020, spanning a period of two years, and including patients from adult medical ICUs from three hospitals of the north (NICU), the center (CICU), and the south (SICU) of in the West Bank, Palestine. Data on infections acquired during ICU stays or present at admission were analyzed using patient medical records, where sociodemographic, clinical, and treatment-related information, including comorbidities, infection history, diagnostic results, therapies, device usage, and outcomes such as ICU length of stay and mortality, were collected, and prevalence was calculated. Results: The study encompassed 231 patients, with 136 (58.9%) from CICU Hospital, 56 (24.2%) from SICU Hospital, and 36 (16.9%) from NICU Hospital. The median patient age was 63 years. Prevalence rates of A. baumannii infections were 11.5% at CICU Hospital, 6.5% at NICU Hospital, and 5.3% at SICU Hospital, with an overall rate of 8.2%. Of the patients, 46 (19.9%) had infections upon admission, while 185 (80.1%) developed infections during their ICU stay. The isolates included 154 (66.7%) extensively drug-resistant (XDR), 61 (26.4%) multidrug-resistant (MDR), and 16 (6.9%) non-resistant strains. Factors associated with increased mortality included recent ICU admission (2.65 times more likely), heart failure (4.95 times more likely), and central line catheter use (3.46 times more likely). Higher white blood cell counts, lower platelet counts, longer ICU and mechanical ventilation durations, and shorter hospital stays, shorter therapy were linked to survival. Conclusions: This study provides a comprehensive understanding of A. baumannii infections in the medical ICUs, highlighting the critical need for multidisciplinary infection control, especially for critically ill patients with comorbidities. The rise of drug-resistant bacteria underscores the importance of antimicrobial stewardship and infection control. Findings suggest a need for ongoing research and collaboration to address this growing hospital-acquired issue effectively.
- ItemQUINOLONE RESISTANCE AMONG ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE BACTERIA ISOLATED AT RAFIDIA AND AN-NAJAH NATIONAL UNIVERSITY HOSPITALS IN NABLUS DISTRICT: PROSPECTIVE CROSS-SECTIONAL STUDY(An-Najah National University, 2024-10-24) Khatatbeh, MarahBackground: Among several bacterial genera, quinolone resistance has become more prevalent in recent years. This was clear among common nosocomial pathogens such as Escherichia coli and Klebsiella pneumoniae. While quinolones are a valuable part of the current antimicrobial treatment options, growing quinolone resistance poses a threat to their continued efficacy. Objectives: First, this study aimed to determine the prevalence of resistance of E. coli and K. pneumoniae to quinolone antibiotics (ciprofloxacin and levofloxacin) at two major hospitals in Nablus District, Rafidia and An-Najah National University Hospital. Second, the association of resistance to these antibiotics with various demographic and clinical findings was examined. Third, mechanisms of quinolone resistance among E. coli and K. pneumoniae were determined through resistance gene detection by PCR. Methodology: A cross-sectional study design was selected. A total of 219 bacterial isolates (169 isolates of E. coli and 50 isolates of K. pneumoniae) were collected from the first of June 2023 to the last day of September 2023, from all patients infected with those bacterial species. The included bacteria in this study were isolated from patients admitted to the two mentioned Hospitals during the study period. Types of bacteria were already identified by the VITEK 2 system (BioMérieux) in the two mentioned hospitals. Resistance of the included bacteria to ciprofloxacin and levofloxacin was determined by the disk diffusion method. In addition, multiplex PCR was used for detection of resistant genes in order to determine quinolone resistance mechanisms among 118 resistant strains. The detected mechanisms and genes were target modification (qnrA, qnrB, and qnrS genes), enzymatic modification (aac(6’)-Ib-cr gene), and efflux pump mechanism (QepA, OqxA, and OqxB genes). Association of quinolone resistance with clinical symptoms, demographic information, and other risk factors were evaluated. Results: Relatively high frequencies of ciprofloxacin resistance (46.1%) and levofloxacin resistance (47.9%) were found among E. coli isolates. Higher resistance frequency of ciprofloxacin (70%) and levofloxacin (68%) among K. pneumoniae isolates were detected. Escherichia coli and K. pneumoniae ciprofloxacin resistant bacteria isolated at An-Najah National University Hospital (60% and 92.9%, respectively) were significantly higher (P= 0.000 and P= 0.001, respectively) than that of the isolates obtained from Rafidia Hospital (37.3% and 40.9%, respectively). Ciprofloxacin resistance among E. coli isolated from the general surgery unit was significantly higher than that of the emergency ward (54.5%; P=0.002) and the outpatients (36.9%; P= 0.016). However, E. coli levofloxacin resistance frequency in the intensive care unit was significantly higher than that of the outpatients (49.2%; P=0.018), emergency (45.5%; P=0.022), and general surgery (42.9%; P=0.037). Escherichia coli isolation rate from urine (80%) was significantly higher than that of wound swabs (76.3%; P=0.013). Furthermore, K. pneumoniae isolation rate from urine (20%) was significantly higher than that of wound swabs (23.7%; P=0.036). Escherichia coli ciprofloxacin resistance was significantly higher (P=0.008) in male isolates (53.6%) than in female isolates (36.3%). Escherichia coli isolated from patients over 65 years of age had the highest levofloxacin resistance frequency (62.5%), which was also significantly (P= 0.007) higher than that of the 40–65-year age group. Escherichia coli ciprofloxacin resistant bacterium isolated from patients with urinary catheters (91.7%) had a significantly higher frequency than that of hypertension patients (85.5%; P=0.013), diabetes mellitus patients (84.8%; P=0.017), cancer patients (81.9%; P=0.022), and hepatic cirrhosis patients (64.1%; P=0.028). However, K. pneumoniae ciprofloxacin resistant bacterium isolated from hepatic cirrhosis patients (77.8%) had a significantly higher frequency than that of hypertension patients (65.2%; P=0.003), cancer patients (61.9%; P=0.019), and diabetes mellitus patients (58.9%; P=0.032). Frequency of levofloxacin resistant E. coli isolated from diabetes mellitus patients (89.1%) was significantly higher than that of hypertension patients (76.3%; P=0.013), cancer patients (73.6%; P=0.016), patient with the urinary catheter (77.8%; P=0.021), and hepatic cirrhosis patients (51.3%; P=0.028). On the other hand, levofloxacin resistant K. pneumoniae isolated from diabetes mellitus patients (71.8%) had a significantly higher frequency than that of hypertension patients (56.5%; P=0.009), cancer patients (52.4%; P=0.016), hepatic cirrhosis patients (59.3%; P=0.023), and patient with the urinary catheter (48%; P=0.031). With respect to the quinolone resistance mechanisms, the efflux pump among E. coli isolates was the most predominant (43.3%) with OqxA (23.5%) being the most common gene, followed by enzymatic modification by Aac(6’)-Ib-cr enzyme (29.6%) and target modification mechanism (26%) in which the QnrS gene was the most common (13.6%). Similarly, the efflux pump mechanism of quinolones resistance among K. pneumoniae isolates was also the most common (37.8%) with the OqxA gene exhibiting the highest frequency (27%), followed by enzymatic modification by Aac(6’)-Ib-cr enzyme (32.4%) and target modification mechanism (29.7%) with QnrS and QnrB being the most commonly detected genes (10.8%). Conclusion: Our findings showed high rates of ciprofloxacin and levofloxacin resistance among E. coli and K. pneumoniae isolates, also a high percentage of the efflux pump mechanism with OqxA being the most common gene, followed by enzymatic modification by Aac(6’)-Ib-cr enzyme and target modification mechanism in which the QnrS gene was the most common. We emphasize that it is necessary to perform an antibiotic susceptibility test before choosing a prescription. Monitoring the rates of resistance in the nations clinical facilities should be a greater priority for the relevant government health departments.
- ItemRADIOLOGY DEPARTMENT: A POTENTIAL SOURCE OF MULTIDRUG-RESISTANT MICROORGANISMS, A CROSS-SECTIONAL STUDY AT TERTIARY CARE HOSPITAL, PALESTINE(2023-03-22) Zena Mohammad Saleem OdehGlobally, 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.
- ItemBACTERIOLOGIC PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF SEPTICEMIA IN NEONATAL INTENSIVE CARE UNITS, PALESTINE (2019-2021)(2022-12-29) Bayan Asem Mohammad IbrahimBackground: 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.
- ItemASSESSING 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 JaddouAbstract 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.