Background:The polymyxins including colistin are the "last resort" antibiotics for treatment of infections with carbapenem resistant Enterobacteriaceae. Recently, transferable colistin resistance mediated by the mcr-genes has been described in Enterobacteriaceae. The testing of colistin susceptibility is challenging. The aim of the work is to detect the occurence of mcr-1 and mcr-2 genes in phenotypically colistin-resistant carbapenem resistant Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates using conventional polymerse chain reaction (PCR). Methods: One hundred and sixteen carbapenem-resistant E.coli and K.pneumoniae isolates were collected from patients admitted to different wards of Suez Canal University Hospitals (SCUHs) in Ismailia. Urine, endotracheal aspirates, blood, pus and sputum specimens were collected from different patients. Minimal inhibitory concentration (MIC) by broth microdiluton method was done to assess phenotypic colistin resistance. The colistin resistant E.coli and K.pneumoniae isolates were tested by conventional PCR to detect plasmid mediated mcr-1 and mcr-2 genes. Chi-square test was applied and p-value < 0.05 was considered statistically significant. Results: Forty three isolates out of 116 carbapenem resistant isolates (37.1%) were colistin resistant as shown by MIC by broth microdiluton method. The 43 colistin resistant E.coli and K.pneumoniae isolates were tested by conventional PCR to detect plasmid mediated mcr-1 and mcr-2 genes. Two mcr-2 genes and one mcr-1 gene were detected. Conclusion: Results revealed that the prevalence of colistin resistance among carbapenem-resistant E.coli and K.pneumoniae in SCUHs is concerning; further limiting potential therapeutic options. Plasmid mediated colistin resistance genes mcr-1 and mcr-2 is emerging in SCUHs which refer to a problem in the hospital as by horizontal transfer of this plasmid, the resistance can spread to many isolates in the hospital.

Antimicrobial resistance (AMR) is considered as a global health and development threat. During COVID-19 pandemic, there has been an increase in antimicrobial resistance. Health care providers (HCPs) play the main role in facing antibiotic resistance because they have the authority to prescribe antibiotics during clinical practice as well as in promoting patients’ compliance with therapies and avoid self-medication. So, this study will serve as an important source of information in context with Covid19 pandemic in Egypt. The data was collected using a validated standardized self-administered online questionnaire compromised of four sections: socio-demographic data of the HCPs, the general knowledge on antibiotics and AMR, the HCP attitude towards antibiotic prescription and AMR and the practice in applying the appropriate antibiotic prescription. Most of HCPs (93.7%) recorded good knowledge level about antibiotic prescription and antimicrobial resistance with mean score of knowledge13.21 ± 1.83. About 79% of HCPs recorded a positive attitude towards proper antibiotic prescription with mean score of attitudes 63.02 ± 7.68. Fifty four percent of HCPs demonstrated a good level of practice with mean score of practice 9.75 ± 2.17. In conclusion, HCPs in our study have a good level of knowledge and attitude about antibiotics. However lower level of proper practice towards the problem of AMR in COVID19 era was noticed. Implementation of effective policies and guidelines is crucial to evaluate the antimicrobial use especially in the COVID-19 era to reduce the unintended consequences of the misuse of antibiotics and its impact on AMR.

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