Adham Abu Taha, PhDAdham Abu Taha, PhD

Dept. of Pharmacology and Toxicology, College of Pharmacy, Dept. of Pharmacology and Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine An-Najah National University, Nablus, Palestine

Antimicrobial resistance Antimicrobial resistance among bacterial among bacterial

pathogens isolated from pathogens isolated from UTIsUTIs

IntroductionIntroduction

Among the 10 leading causes of death, infections are considered the number one in

the low income countries and the fourth killer in the developed countries.

Most of the infections are caused by bacteria

Antibiotics are the only drugs for these bacterial diseases

• Urinary Tract Infection (UTI) is the most common infectious diseases diagnosed in outpatients.

• Reporting of antimicrobial susceptibility testing is usually achieved in 48 h.

• The treatment decision is empirical, being influenced by available data reflecting antibiotic resistance.

• Knowledge of the antimicrobial resistance patterns of common uropathogens is essential to provide clinically appropriate and cost effective therapy.

Aims of studyAims of study

1. To determine the frequency of the uropathogens

2. To determine the susceptibility of these isolates to commonly used and newer antimicrobial agents.

• A prospective study was conducted on bacteria isolated from the urine of patients with UTI in the city of Nablus, Palestine.

Specimens: 375

Females

Males

81.6 %

18.4%

Males: 69Females: 306

ResultsResults

Which BacteriaWhich Bacteria? ?

Frequency of uropathogensFrequency of uropathogens Gram negative

Microorganism Number %E. coli 243 64.8Pseudomonas aeruginosa 51 14.4Proteus mirabilis 27 5.6Klebsiella spp. 12 3.2Enterobacter spp. 15 2.4

Gram positiveS. aureus 12 3.2S.saprophyticus 21 5.6Enterococcus spp. 3 0.8

Total number 375 100

   Gender  

MicroorganismFemalesn=306

Malesn=69

   E. coli 192 (62.7%) 51(73.9%) Klebsiella spp. 12 (3.9%) 0Pseudomonas 48 (15.7%) 6 (8.7%) Enterobacter spp. 9 (2.9%) 0Proteus mirabilis 18 (5.9%) 3 (4.3%) S. aureus 6 (2.0%) 6 (8.7%(Enterococcus 3 (1%) 0S.saprophyticus 18 (5.9%) 3 (4.3%)

Distribution of uropathogensDistribution of uropathogens

ampicillin (AMP), Amoxicillin-clavulinic acid (AMC), trimethoprim-sulfamthoxazole (TMP-SXT), nitofurantoin (F), ciprofloxacin (CIP), gentamycin (CN), cefataxime (CTX), ceftriaxone (CRO), naladixic acid (NA), and tetracycline (TE)

AntibioticAntibiotic Resistance (Resistance (%)%)

TMP-SXT 3737

F 29.629.6

AMP 65.465.4

NA 3737

CIP 17.217.2

AMC 12.312.3

CTX 11.111.1

CRO 11.111.1

TE 55.655.6

CN 14.814.8

Antibiotics resistance of Antibiotics resistance of E. coliE. coli

 Antimicrobial resistance (%) of Antimicrobial resistance (%) of E. coliE. coli in selected countriesin selected countries

  NablusNablus S. Gaza S. Gaza 1 1 Turkey Turkey 22 Israel Israel 33 USAUSA 4 4

AMPAMP 65.4 ND 49.1 ND 37

TMP-SXTTMP-SXT 37 71.4 41.5 26 16.1

FF 29.6 7.1 8.8 1 0.7

CIPCIP 17.2 15.0 24.5 ND 2.5

Ampicillin (AMP), trimethoprim-sulfamthoxazole (TMP-SXT), nitrofurantoin (F), ciprofloxacin (CIP), not done (ND)

1 Astal, et al, J Biomed Biotechnol. 2005; 2005(3): 238–2412Kurtuepe et al, Jpn. Jornal of infect. Dis 58, 159 – 161, 20053Colodher et al, I. J. of Antimicrobial agents, 8 , 189 – 192, (2001)4Karl Lowsky et al, Antimicrobial agents and chemotherapy, 2540n- 2545, (2002)

Antibiotic use in PalestineAntibiotic use in Palestine

Antibiotics were the most commonly prescribed medications

Types of stored medications Palestinian householdsTypes of stored medications Palestinian households

Drug Classification (ATC system) Total

N=5505

%

Alimentary tract and metabolism 1020 18.53

Musculoskeletal system 783 14.2

Respiratory system 749 13.6

Anti-infective agents for systemic use 641 11.6

Nervous system 632 11.5 Dermatologicals 477 8.7

Cardiovascular system 410 7.4Blood and blood forming organs 267 4.9Sensory organs 265 4.8Genito urinary system and sex hormones 96 1.7

Int J Clin Pharmacol Ther. 2010 Jan;48(1):59-67.Storage, utilization and cost of drug products in Palestinian households.Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Bani Shamseh FF, Khalaf HS.

Spread of antibiotic resistance Spread of antibiotic resistance

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erbu

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RecommendationsRecommendations

1. Surveillance program of antibiotic resistance

2. Local guidelines3. Responsible use of antibiotics

AcknowledgmentAcknowledgment

• Mr. Jum’a Hashash- Nablus medical supplies

• Mr. Fadi Sulieman

Help prevent Help prevent antibiotic antibiotic resistanceresistance

Thank YouThank You