Resistance of Uropathogens at Governmental Hospitals in the Gaza Strip
Date
2020-12-20
Authors
Sameh Attiah Mohammed Alkhodari
سامح عطية محمد الخضري
Journal Title
Journal ISSN
Volume Title
Publisher
Al-Quds University
Abstract
Misuse and overuse of antimicrobials are considered the main causes of uropathogenic resistance. World Health Organization encouraging countries to implement antimicrobial stewardship programs, for appropriate use of drugs that could minimize drug resistance across time. The overall aim of this study is to determine the occurrence of uropathogens, to explore the pattern of their resistance to antimicrobials and test for difference among gender, age groups, and hospitals. In addition, the study assessed the effect of the implementation of the microbiology standard operating procedure (SOP) and the level of adherence by the laboratories of four governmental hospitals in the Gaza Strip.
A retrospective study (from 1/1/2019 to 31/12/2019) examined 11,890 urine culture records of the Microbiology Department of European, Al-Shifa, Al-Nassr, and Al-Durra Hospitals. All data were tabulated and analyzed. Data analysis was performed using SPSS edition 22. Variables were compared using cross-tabulation the statistical tests of significance were performed; chi-square (X2) test, independent T-test, one-way ANOVA test, P-value ≤ .05 was considered statistically significant. Three focus groups, three key informants, seven individual interviews have been conducted and fifteen laboratory technicians responded to a questionnaire. All of them from the microbiology department at the governmental hospitals in the Gaza strip. A semi-structured question the effect and level of adherence to the participants was used.The study was initiated after obtaining a permission from the Helsinki Committee.
The findings showed that E. coli was the most common uropathogens in Gaza Strip (59.9%) followed by Klebsiella spp. (24.9). The prevalence of UTI in females is higher than males (71%), however, resistance of isolates to antimicrobials is higher in males. In addition, there is general increased resistance of the isolates against tested antibiotics, which limits the empirical treatment options.
Penicillin is no longer suitable for UTI treatment because the microorganism’s resistance against this antibiotic group is closed to 90%. Resistance to ampicillin (92.4%), amoxicillin (91.1%), followed by co-trimoxazole (68.2%), cefalexin (64.9%), doxycycline (61.9%), nalidixic acid (53.6%), cefuroxime (53.0%), ceftriaxone (48.9%), ceftazidime (43.1%), ciprofloxacin (36.9%), gentamicin
(25.8%). The least resistance was demonstrated against amikacin (3%) and meropenem (8%). The adherence to the SOP by the staff is high but not perfect and requires follow up by laboratory administration. Furthermore, there is no integration between the physician protocol and laboratory SOP. In conclusion, the resistance of uropathogens varied from one hospital to another, among gender and among age groups. Factors contributing to the increasing resistance in general and at Al-Shifa Hospital in particular should be investigated in further studies. There is a need for an antimicrobial stewardship program to prevent exacerbation of the problem, and decrease MDR in the community. In addition, SOP needs more follow up and integration with all of the other hospital departments.
Keywords: Uropathogens, Antimicrobial resistance, Urinary tract infection, Gaza strip, Palestine