Adham Abu Taha, PhD Dept. of Pharmacology and Toxicology, College of Pharmacy, An-Najah National University, Nablus, Palestine Antimicrobial resistance among bacterial pathogens isolated from UTIs

Introduction  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 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: 69 Females: 306 Results

Which Bacteria ?

Frequency of uropathogens Gram negative MicroorganismNumber% E. coli Pseudomonas aeruginosa Proteus mirabilis275.6 Klebsiella spp Enterobacter spp Gram positive S. aureus123.2 S.saprophyticus215.6 Enterococcus spp.30.8 Total number375100

Gender Microorganism Females n=306 Males n=69 E. coli192 (62.7%)51(73.9%) Klebsiella spp.12 (3.9%)0 Pseudomonas48 (15.7%)6 (8.7%) Enterobacter spp.9 (2.9%)0 Proteus mirabilis18 (5.9%)3 (4.3%) S. aureus6 (2.0%)6 (8.7%( Enterococcus3 (1%)0 S.saprophyticus18 (5.9%)3 (4.3%) Distribution 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) Antibiotic Resistance ( %) TMP-SXT37 F29.6 AMP65.4 NA37 CIP17.2 AMC12.3 CTX11.1 CRO 11.1 TE 55.6 CN 14.8 Antibiotics resistance of E. coli

Antimicrobial resistance (%) of E. coli in selected countries USA 4 Israel 3 Turkey 2 S. Gaza 1 Nablus 37ND49.1ND65.4AMP TMP-SXT F 2.5ND CIP Ampicillin (AMP), trimethoprim-sulfamthoxazole (TMP-SXT), nitrofurantoin (F), ciprofloxacin (CIP), not done (ND) 1 Astal, et al, J Biomed Biotechnol. 2005; 2005(3): 238–241 2Kurtuepe et al, Jpn. Jornal of infect. Dis 58, 159 – 161, Colodher 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 Palestine Antibiotics were the most commonly prescribed medications

Types of stored medications Palestinian households Drug Classification (ATC system) Total N=5505 % Alimentary tract and metabolism Musculoskeletal system Respiratory system Anti-infective agents for systemic use Nervous system Dermatologicals Cardiovascular system Blood and blood forming organs Sensory organs Genito urinary system and sex hormones961.7 Int J Clin Pharmacol Ther Jan;48(1): Storage, utilization and cost of drug products in Palestinian households. Sweileh WMSweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Bani Shamseh FF, Khalaf HS.Sawalha AFZyoud SHAl-Jabi SWBani Shamseh FFKhalaf HS

Spread of antibiotic resistance Superbug

Recommendations 1.Surveillance program of antibiotic resistance 2.Local guidelines 3.Responsible use of antibiotics

Acknowledgment Mr. Jum ’ a Hashash- Nablus medical supplies Mr. Fadi Sulieman

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