Background: Staphylococcus aureus including methicillin resistant S. aureus (MRSA) is one of the most effective biofilm-forming organisms, biofilm contribute in protecting the microorganism from host defenses and prevent the effective penetration of antimicrobial agents. Biofilm formation is considered as an important contributing factor for the initiation and establishment of chronic infection by S. aureus and known as a major obstacle in the treatment of S. aureus infections is their ability to develop resistance to antimicrobials. Aims : To screen clinical Staphylococcus aureus including MRSA isolates for their biofilm forming abilities and their association with antimicrobial resistance. Methods: A total of 196 clinical isolates of S. aureus were obtained from different sample sources using standard microbiological techniques from three major hospitals in Gaza strip. Biofilm formation of these isolates was determined by tissue culture plate (TCP) method and tube adherence method (TM). Antimicrobial susceptibility test was performed using the modified Kirby–Bauer disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. MRSA was detected using the cefoxitin disk test. Results: Biofilm formation was observed in 174 (88.8 %) and in 145 (74.0%) isolates of S. aureus via TCP method and TM, respectively. The highest resistance percent was for penicillin (92.9%), followed by cefoxitin (80.6%) and oxacillin (67.9%), while the lowest resistance percent was for linezolid and ceftaroline (1%). Among the 196 isolates 71.4% (N=140) were classified as MDR with a MAR index (≥ 0.2). A total of 158 isolates (80.6%) were identified as MRSA distributed as 90.4%, 79.4% and 70.9% from Al-Shifa, Al-Nasser pediatrics and Al-Aqsa hospitals respectively. Large proportions (82.1%) of biofilm producers were identified as MRSA. Biofilm-producing MRSA exhibited a higher percent (90.5%) when compared with the biofilm non-producer MRSA (9.5%). Importantly, 89.2% of biofilm-producing S. aureus were multidrug resistant. Conclusions: S. aureus isolates possessed high biofilm-forming ability. Biofilm-producing strains have very high tendency to exhibit antimicrobial resistance, multidrug resistance and methicillin resistance. Regular surveillance of biofilm formation by S. aureus and their antimicrobial resistance profile may lead more success in treating S. aureus infections.   Keywords: Biofilm, MDR, MRSA, TCP, TM, Gaza strip, Palestine.

Background Gram-negative bacteria are a common cause of human infections and can be transmitted through food handling and food consumption. Infection with carbapenemase-producing Gram-negative bacteria is becoming a worldwide threat, and is hard to cure because the broad-spectrum carbapenem antibiotics are considered a last resort for treatment. This research aimed to determine carbapenem resistance among Gram-negative bacteria from poultry samples.Methods Samples from chicken litter, water, chicken feed, and intestinal content (220 samples in total) were collected during 2017 from representative slaughter houses, farms, and homes from four different randomly selected locations in the Gaza Strip. Samples were cultured and all isolates were identified using conventional techniques. The Clinical and Laboratory Standards Institute disk diffusion method was used to determine antimicrobial susceptibility to 15 antimicrobial agents. Carbapenemase was detected by the modified Hodge test. The multiple antibiotic resistance (MAR) index for each isolate was also calculated. Permission was obtained from the Ministry of Agriculture, and verbal consent was obtained from owners of the establishments.Findings Escherichia species were the most frequently isolated bacteria (48 of 122; 39%), followed by non-lactose fermenting Enterobacteriacae (36 of 122; 30%) and other lactose fermenting Enterobacteriacae (32 of 122; 26%). The lowest frequency was for non-fermenting Gram-negative bacilli (six of 122; 5%). Most isolates were resistant to most antimicrobial agents tested except for meropenem and amikacin (3% were resistant to meropenem and amikacin), and 41 isolates (34%) were resistant to imipenem. From 122 tested isolates, 42 carbapenem-resistant isolates (36%) were detected. There was no significant difference in resistance to carbapenem or other drugs among isolates from the four locations. None of the three meropenem-resistant isolates and only five of the 41 imipenem-resistant isolates (12%) were positive for carbapenemase production. Most of the tested isolates (115 of 122 isolates; 94%) were resistant to five or more of the tested antimicrobials, and were regarded as multi-drug resistant according to MAR index results.Interpretation Resistance to carbapenems as well as to other antimicrobials was high, as indicated by the MAR index. This might be due to the lack of regulation of the use of antimicrobials in poultry. The responsible authorities should take note of these findings and implement an immediate antimicrobial resistance monitoring programme for poultry. Cross-contamination prevention measures should also be promoted and implemented.

Vaginal candidiasis is common fungal infections among pregnant women. The aim of this study is to determine antifungal susceptibility pattern of Candida spp. isolated from vaginal discharge and to investigate possible risk factors associated with Candida infection. One hundred high vaginal swabs were collected from pregnant women complaining from abnormal discharge from various clinics in Gaza city, during 2019. Samples were plated on Sabouraud Dextrose Agar supplemented with chloramphenicol. Candida isolates were identified to the Genus level based on cultural and morphological characteristic. The susceptibility to seven antifungals was determined using disc diffusion method. Demographic, environmental, behavioral and other possible risks factors associated with vaginal candidiasis were recorded through an interview with patients before collecting the vaginal swabs and after obtaining a verbal consent. Data analysis was done using the SPSS software. Candida spp. was isolated from 43% of vaginal swabs of pregnant women with discharge. Variations existed in the susceptibilities of the different Candida isolates to antifungals. Amphotericin B the most effective with 0% resistance followed by itraconzaol and nystatin with 9.4% resistance. Resistance to miconazole, ketoconazole, voriconazole and fluconazole was 11.6%. Statistically significant symptoms associated with positive Candida spp. cultures among pregnant women included; redness of vaginal area, secretions, yeast-like smell, urinary urgency, low sexual desire, itching and irritation (p ≤ 0.05). No statistical significance difference with regard to burning urinary sensation and painful intercourse. Candida spp. was isolated from 43% of vaginal swabs from pregnant women. Risks factors should be minimized by patient education and routine testing of pregnant women.

Background: Food is fundamental for everyone’s life. Therefore, the safety of food we consume is a priority. Gram-negative bacteria are important and common cause of human infections and could be transmitted through food handling and consumption. Carbapenemase-producing Gram-negative (CRGN) bacteria are becoming a global threat. Infections caused by CRGN are hard to cure because the carbapenems are last resort drugs for treatment. The main objective of this research is to determine the occurrence of Carbapenem-resistance among Gram-negative bacteria from poultry samples. Results:  Two hundred twenty samples (chicken litters, water, chicken feed, and intestinal content) were collected from slaughterhouses, farms, and homes from different locations in Gaza strip. Samples were cultured onto MacConkey and Blood agar plates. Gram negative isolates were identified using conventional techniques. Disk diffusion method (based on CLSI recommendations) was used to determine the antimicrobial susceptibility against 14 antimicrobials including two carbapenems (Meropenem and imipenem). Carbapenemase production was detected by the Modified Hodge Test (MHT). The Multiple Antibiotic Resistance (MAR) index for each isolate was calculated. Escherichia species were the most frequent isolates (39.5%), followed by non-lactose fermenting Enterobacteriaceae (29.5%), other lactose fermenting Enterobacteriaceae (29%). The lowest frequency was for non-fermenting Gram-negative bacilli (4.8%). Most isolates were resistant to most antimicrobial agents tested. A prominent exception was observed with meropenem, and amikacin with only 4% resistance. 41 isolates (34.7%) were resistance to imipenem. High level of intermediate results was detected for imipenem (45.2%). Among 124 isolates, 44 carbapenem-resistant (35.5%) were detected. None of the five meropenem resistant isolates and only five out of the 43 imipenem resistance isolates tested positive for carbapenemase production. Most isolates showed resistance to three or more antibiotics and are regarded as multidrug resistant strains. MDR isolates were present in 117 isolates (94.3%) with MARI index (higher than 0.3). Conclusion: Resistance to carbapenems as well as to other antimicrobials was high among GNB isolates as indicated by the MAR index. Concerned authorities should consider these alarming finding and implement an immediate monitoring program for poultry. Cross contamination, prevention measures should also be promoted and implemented.

No abstract