IPROC iproc Iproceedings 2369-6893 JMIR Publications Toronto, Canada v8i1e37246 10.2196/37246 Abstract Abstract Antimicrobial Resistant Bacteria in Health Care Facilities: Exploring Links With Water, Sanitation, and Hygiene in Gaza, Palestine Khader Yousef Abushomar Reem MPH 1
Joint PhD Program Islamic University of Gaza and Al Azhar University Al Remal Gaza, 860 Occupied Palestinian Territory 970 597912917 reemabushomar@gmail.com
https://orcid.org/0000-0001-8606-1725 Zeitoun Mark 2 Abu Sittah Ghassan 3 Abu Fayad Antoine 4 Abbara Aula 5 El Achi Nassim 6 Elmanama Abdelraouf 7 Joint PhD Program Islamic University of Gaza and Al Azhar University Gaza Occupied Palestinian Territory Water Security Research Centre University of East Anglia Norwich United Kingdom Conflict Medicine Program Global Health Institute, American University of Beirut Beirut Lebanon American University of Beirut Beirut Lebanon Department of Infection Imperial College London United Kingdom School of Geography and the Environment University of Oxford Oxford United Kingdom Islamic University of Gaza Gaza Occupied Palestinian Territory Corresponding Author: Reem Abushomar reemabushomar@gmail.com Jan-Dec 2022 1 3 2022 8 1 e37246 11 2 2022 15 2 2022 ©Reem Abushomar, Mark Zeitoun, Ghassan Abu Sittah, Antoine Abu Fayad, Aula Abbara, Nassim El Achi, Abdelraouf Elmanama. Originally published in Iproceedings (https://www.iproc.org), 01.03.2022. 2022

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 Background

Antimicrobial resistance (AMR) is a growing global phenomenon; however, its link to water, sanitation, and hygiene (WASH) remains underexplored, particularly in health care facilities where humanitarian crises prevail.

 Objective

This study aimed to identify AMR bacteria in samples collected from WASH services in 2 hospitals in Gaza and to investigate the presence of AMR genes.

 Methods

A hospital-based cross-sectional study to detect and identify antimicrobial resistance bacteria was conducted. Random samples from water, wastewater, soap, and surface swabs (n=345) were collected from Al-Shifa and European Gaza hospitals and screened for the presence of Enterobacteriaceae, Pseudomonas, Enterococcus, and Staphylococcus aureus. Antimicrobial susceptibility, extended spectrum beta-lactamase (ESBL) production, carbapenem resistance, and AMR genes were investigated.

 Results

High levels of bacterial contamination were detected in water and surface swab samples with an overall percentage of 34.1%. Moreover, 22% of the identified Enterobacteriaceae was positive for ESBL, and 14% was positive for modified Hodge test. Over 2/3 of isolated Enterobacteriaceae in water and wastewater samples was found to be resistant to amikacin, ceftazidime, ceftriaxone, and imipenem. All Enterobacteriaceae isolates from swab samples were found to be resistant to piperacillin-tazobactam, amikacin, ceftazidime, and ceftriaxone; 13.8% of S. aureus in water samples was methicillin resistant. The prevalence of ESBL genes among Enterobacteriaceae isolates was 25% OXA, 19.4% SHV, 2.8% KPC, 66.7% TEM, 41.7% blaCTXM, and 5.6% blaCTXM-3. For carbapenem-resistant gene (MDM), the prevalence among Enterobacteriaceae was 11.1%, and among Pseudomonas was 12.5%. The antibiotic susceptibility profile was also presented for Pseudomonas, Enterococcus, and S. aureus.

 Conclusions

The results underline the level of contamination with AMR bacteria in WASH samples and highlight the need to consider the safety of WASH service at health care facilities as an essential aspect in the fight against the spread of AMR and to interrupt nosocomial transmission.

 antimicrobial resistant bacteria antimicrobial resistance genes health care facilities wastewater water sanitation hygiene WASH

Potential transmission of antimicrobial resistant bacteria.