Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Isolated from NICUs of Gaza Strip Hospitals

The title of my proposed research is Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Isolated from NICUs of Gaza Strip Hospitals. Carbapenemase producing Gram-negative rods are a worldwide clinical concern.

Several genes, plasmid mediated or chromosomal, have been reported to encode these β-lactamases which are often easily spread by mobile genetic elements.

The global spread of carbapenem resistant Enterobacteriaceae has limited the physicians’ antimicrobial treatment options of infected patients and have been responsible for high patients’ morbidity and mortality in many parts of the world.

The ever-expanding role of extended-spectrum-β-lactamase-harboring and carbapenem-resistant Enterobacteriaceae in causing serious infections poses a grave public health threat because these organisms also tend to be multidrug resistant, for which very few antibiotic options remain available.

Rapid detection of such pan resistant organisms offers one of the best solutions to improve patient screening and hospital infection control practices as well as curb inappropriate antibiotic use.

Recently, the emergence of the first plasmid-mediated colistin resistance mechanism, MCR-1, in Enterobacteriaceae was reported in China from human, animal and environmental isolates.

The spread of this plasmid (mcr-1), into carbapenem-resistant Enterobacteriaceae (CRE) clinical isolates poses a significant threat to global health. It was reported in three CRE E. coli clinical isolates in China.

Follow-up reports have revealed worldwide spread of the mcr-1 gene by plasmid transfer to diverse species and strains of Enterobacteriaceae, including MDR strains. In May 2016, the US CDC reported the first human mcr-1 positive E. coli isolate detected in the United States.

Significance: Hospitalized patients especially in intensive care units (ICUs) are highly susceptible to nosocomial infections, particularly neonates at NICUs. The environmental and work conditions of the NICUs impose another risk factor, and can be the major cause of infection.

The prevalence of many nosocomial infections in our hospital ICUs has been reported in the last decade, where few of them have been documented.

A study conducted in 2005 revealed a ratio of 4.1% nosocomial infections in admitted patients in the European hospital in Southern Gaza strip.

Some outbreaks have been documented; an outbreak of Acinetobacter baumannii infection in NICU of Al-Shifa hospital in 2004. Moreover, another outbreak of Serratia marcescens was reported in 2005.

In our previous studies, we documented a moderate percentage of contamination in public and private hospital general operating theaters, which may increase the risk factors for developing surgical-site infections.

Moreover, in our recent work we discovered a specific clonal complex of methicillin resistant Staphylococcus aureus harboring toxic shock syndrome toxin (TSST-1) that are endemic in our hospitals. The morbidity and mortality rates are high among these outbreaks.

This is particularly due to isolation of multi-drug resistant bacteria that have weak response to most of antibiotics used.

This project is of utmost importance due to the global increase of highly resistant members of the Enterobacteriaceae family in the light of the completely unknown situation in Palestine and the unavailability of molecular diagnostic and typing techniques. Moreover, the data will help to understand the worldwide spread of carbapenemase-producing Enterobacteriaceae.