EVALUATION OF ANTIBIOTIC RESISTANCE AT A TERTIARY CARE HOSPITAL IN PALESTINE: A THREE- YEAR RETROSPECTIVE STUDY
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Date
2022-08-15
Authors
Aya Ayed Abu-Diak
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Abstract
Background: Antimicrobial resistance is now one of the most critical medical threats worldwide. Historical facts and diverse data collected over the years have proved that something urgent should be done to control this growing phenomenon. The problem arises from the overuse and misuse of antibiotics. This has made —in some circumstances— the treatment of a simple infection a complicated process. Therefore, many countries around the world have found themselves compelled to devote efforts to control this antibiotic overuse and misuse in the hope of controlling it and its clinical, economic and societal consequences. Against this background, this study has sought to assess the frequency and antibiotic susceptibility patterns of the most common bacterial pathogens and candida isolated at An-Najah National University Hospital (NNUH) in Nablus, Palestine, between 2018–2020.
Methodology: A retrospective cross-sectional study was done to assess antimicrobial resistance patterns of the pathogens isolated from patients in different hospital wards during the study period (2018–2020), using sensitivity reports saved into the computerized database of NNUH microbiology lab. Data was then collected, coded and imported to Statistical Package for Social Sciences (SPSS) version 21 for further analysis. Descriptive statistics were run to generate frequency and percentages, tables and graphs. Approval was obtained from the university’s Institutional Review Board.
Results: Out of 5, 585 clinical cultures, 46.9% were Gram-Negative Bacteria (GNB), 37.9% were Gram-Positive Bacteria (GPB) and 15.2% were candida. The most frequent Enterobacteriaceae was ESBL E. coli (15.6% of GNB) followed by E. coli (14%), ESBL k. pneumoniae (7.7%), k. pneumoniae (5.5%). P. aeruginosa and A. baumannii were the most obtained Non-Fermenting Gram Negative Bacilli (NFGNB). For GBP, the most frequent isolate was Coagulase-negative Staphylococci (CoNS), representing an isolation rate of 38.8% of GPB in total, followed by E. faecalis (18.6%), S. aureus (8.2%), and VRE E. faecium (7.5%). Clinical specimens were mostly collected from 27.7% of the urine samples. This was followed by wound specimens (19.6%) and blood specimens (19.2%). The total in-patients from all wards was 3, 895 cases (N%=69.7%). Of these, the surgical ward (SW) was the most prominent (14.6%) followed by the Intensive Care Unit (ICU): 10.7%. A. baumannii showed high resistance (over 85%) for ceftazidim, cefipim, gentamycin, ciprofloxacin, levofloxacin, piperacillin, and imipenem. ESBL E. coli. ESBL k. pneumoniae showed nearly complete resistance to ampicillin and cephalosporin agents. MRSA S. aureus was also nearly completely resistant to penicillin, oxacillin, amoxicillin\clavulinic acid, cefuroxime. VRE E. faecium showed full resistance to penicillin, amoxicillin\clavulinic acid, ampicillin, vancomycin, levofloxacin, ciprofloxacin, and erythromycin.
Conclusions: High rates of resistance were observed during the study period for most isolated bacteria species. Efforts need to be made on enhancing appropriate control and monitoring measures to stop the overuse and misuse of antibiotics and limit the prevalence of Multi-Drug Resistant Organisms (MDRO).
Keywords: Antibiotics; resistance; Palestine; MDRO.