3^rd Edition of Infectious Diseases World Conference 2027

Abstract

Antimicrobial resistance is a major threat that affects the human health globally. In Palestine, there is a scarcity of research about antimicrobial resistance in general and lack of regulations over antibiotic prescription and dispensation, in addition, to poor adherence to infection prevention and control measures due to multiple reasons and most importantly lack of awareness about antimicrobial resistance and stewardships programs.

The study aims to identify the epidemiology, prevalence, and antibiotic resistance for CRE and the genes responsible for carbapenemase production over five years from 2019 to 2023 in a tertiary hospital among immunocompromised patients through retrospective data collection from the microbiology, molecular, and infection prevention and control units.

Of the 2904 non- repetitive Enterobacterales positive cultures, 599 isolates (20.6%) were CRE with an increase in the overall prevalence over years.­ Out of 599 CRE isolates, 421 (70.2%) were carbapenemase-producers (CP-CRE). bla NDM was the most prevalent gene (82.4%) followed by bla OXA-48 (13.1%),the rest were bla VIM (1.7%) and 1.4% for each bla KPC and bla NDM+ OXA-48 genes. Klebsiella followed by Escherichia were the most common isolated bacterial genera. Most of CRE were isolated from surveillance anal swab cultures, followed by urine cultures, skin cultures, blood, and sputum cultures. CRE isolates were found almost equally in males and females. In addition; CRE was distributed among all age categories, however; the majority of CRE isolates were most seen among adults. Majority of the patients had solid tumors as a primary diagnosis followed kidney diseases. CRE was distributed in all Palestinian geographic regions, however; Gaza Strip followed by the middle region have higher prevalence of CRE compared to other regions. Majority of CP-CRE were linked to patients who were referred from public hospitals, followed by non-governmental organizations.

In addition, our multiple regression analysis revealed that some independent variables as patient demographics, geographic region, study year, some bacterial genera have significant impacts on carbapenemase gene types.

Our study also explored antibiotic resistance patterns among different bacterial genera and at molecular level according to carbapenemase gene types. Carbapenemase gene types differed in terms of resistance to different antibiotics. Klebsiella have shown higher resistance to ertapenem, ceftazidime, imipenem, amikacin, and gentamycin compared to Escherichia.

Overall; this is the first study in Palestine that looks at the molecular level over 5 years for 5 species of CRE using administrative data from a leading hospital in infectious diseases. In addition, it provides valuable insight into the prevalence, distribution, and resistance patterns of CRE that highlight the importance of having a national antimicrobial stewardship program and infection prevention and control programs in Palestine.