Carbapenems Resistance among Gram Negative Bacteria Isolated from Poultry Samples in Gaza - Palestine

Abstract

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.