Antibiogram of bacterial isolates from clinical specimens during 2018-2020 at Al-Aqsa hospital, Gaza, Palestine


  • Abdelraouf A Elmanama Islamic University-Gaza
  • Islam El-Aydi Shuda`a Al-Aqsa hospital Ministry of Health, Gaza Palestine
  • Mariam Al-Reefi Medical Laboratory Sciences Department Faculty of Health Sciences Israa University of Gaza Palestine
  • Naema Ferwana Shuda`a Al-Aqsa hospital Ministry of Health, Gaza Palestine



Antimicrobial resistance, Healthcare-associated infections, Gaza, Palestine


Background: The increased resistance of microorganisms to widely prescribed antibiotics in current medical practice has become a major challenge. Healthcare-associated infections (HAIs) are complications of healthcare and linked with high morbidity and mortality. This study aims to investigate the susceptibility pattern of bacteria isolated from different bacterial infections to commonly used antimicrobials from Al-Aqsa hospital in Gaza Strip, Palestine.

Methods: A total of 8062 various clinical specimens were collected from August 2018 to February 2020 and sent to Al-Aqsa medical microbiology laboratory for bacteriological culture. Specimens were processed based on the recommended microbiology procedures. The modified Kirby-Bauer disc diffusion method was used for antimicrobial susceptibility testing on Muller Hinton agar (MHA) as per the Clinical Laboratory Standards Institute (CLSI) guideline.

Results: Enterobacteriaceae were the most frequent of all isolated pathogens (58.3%), followed by Staphylococcus spp (24.6%), Pseudomonas and Non-fermenters (6.9%), Streptococcus and Enterococcus (6.2%), and others (4.0). E. coli was the most frequent of all isolated pathogens (38.2%), followed by Coagulase Negative Staphylococci (14.9%), Klebsiella spp (14.2%), and Staphylococcus aureus (9.4%). The resistance of Gram-negative isolates for Piperacillin, Cephalexin, Cefuroxime, Cefotaxim, Ceftazidim, Ceftriaxone, Cefazolin, Co Trimoxazole, Nalidixic acid, Aztreonam, Amoxicillin/clavulanic acid, Meropenem and Techoplanin was between 62% and 92%. On the other hand, Gram-positive isolates (Staphylococcus spp) were found susceptible to Cloxacillin (65.0%), Erythromycin (47.3%), Clindamycin (81.7%), Levofloxacin (100.0%), Rifampicin (95.2%) and Vancomycin (89.2%).

Conclusion: High rates of resistance were found among bacterial pathogens isolated from Al-Aqsa hospital. Regular antimicrobial resistance surveillance should be a continuous process to provide up-to-date information to physicians with local antimicrobial resistance data.

Keywords: Antimicrobial resistance, Healthcare-associated infections, Gaza, Palestine.



Abebe, M., Tadesse, S., Meseret, G., & Derbie, A. (2019). Type of bacterial isolates and antimicrobial resistance profile from different clinical samples at a Referral Hospital, Northwest Ethiopia: five years data analysis. BMC research notes, 12(1), 1-6.

Al-Refi, M. R. (2017). Antimicrobial, Anti-biofilm, Anti-Quorum Sensing and Synergistic Effects of Some Medicinal Plants Extracts.

Beyene, G., & Tsegaye, W. (2011). Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital, southwest ethiopia. Ethiopian journal of health sciences, 21(2), 141-146.

Derbie, A., Hailu, D., Mekonnen, D., Abera, B., & Yitayew, G. (2017). Antibiogram profile of uropathogens isolated at Bahir Dar regional health research laboratory centre, northwest Ethiopia. The Pan African Medical Journal, 26.

Elmanama, A. A., Abu Sedo, N. M., Alshami, S. E., & Al-Reefi, M. (2020). Evaluation of Infection Control Adherence Among Health Care Workers at Hemodialysis Units.

Elmanama, A. A., Al-Aydi, I. M., & Al-Reefi, M. R. (2020). Biofilm formation and methicillin resistance of Staphylococcus aureus isolated from clinical samples. The International Arabic Journal of Antimicrobial Agents, 10(1).

Elmanama, A. A., Al-Reefi, M. R., Ahmad, B. R. A. H., Al Najjar, L., & Eita, S. S. A. (2020). Antifungal susceptibility pattern of Candida spp. isolated from vaginal discharge of pregnant women. IUG Journal of Natural Studies, 28(1).

Elmanama, A. A., Al-Reefi, M. R., Albayoumi, M. A., Marouf, A. M., & Hassona, I. F. (2018). High Prevalence of Antimicrobial Resistance among Gram Negative Bacteria Isolated from Poultry. The International Arabic Journal of Antimicrobial Agents, 8(3).

Elmanama, A. A., Al-Reefi, M. R., Shamali, M. A., & Hemaid, H. I. (2019). Carbapenem-resistant Gram-negative bacteria isolated from poultry samples: a cross-sectional study. The Lancet, 393, S21.

Elmanama, A. A., Alreqeb, A. A., Kalloub, H. K., Al-Reefi, M. R., Musallam, R. J., Radi, S. A., & Harara, Z. M. (2018). Bacterial Etiology of Urinary Tract Infection and their Antimicrobial Resistance Profiles. Journal of Al Azhar University-Gaza (Natural Sciences), 20(2), 81-98.

Elmanama, I. A., Elmanama, A. A., Al Zaharna, M. M., & Al-Reefi, M. R. (2020). In vitro Anticancer Activity Effect of Extracellular Metabolites of Some Bacterial Species on HeLa Cell Line. IUG Journal of Natural Studies, 28(2).

Frieden, T. R., Ethier, K., & Schuchat, A. (2017). Improving the health of the United States with a “Winnable Battles” initiative. Jama, 317(9), 903-904.

Gottlieb, T., & Nimmo, G. R. (2011). Antibiotic resistance is an emerging threat to public health: an urgent call to action at the Antimicrobial Resistance Summit 2011. Med J Aust, 194(6), 281-283.

Hijazi, N., Elmanama, A. A., & Al-Hindi, A. (2009). Vancomycin-resistant enterococci in fecal samples from hospitalized patients and non-hospitalized individuals in Gaza City. Journal of Public Health, 17(4), 243-249.

Kumburu, H. H., Sonda, T., Mmbaga, B. T., Alifrangis, M., Lund, O., Kibiki, G., & Aarestrup, F. M. (2017). Patterns of infections, aetiological agents and antimicrobial resistance at a tertiary care hospital in northern Tanzania. Tropical Medicine & International Health, 22(4), 454-464.

Leverstein-van Hall, M. A., M. Blok, H. E., T. Donders, A. R., Paauw, A., Fluit, A. C., & Verhoef, J. (2003). Multidrug resistance among Enterobacteriaceae is strongly associated with the presence of integrons and is independent of species or isolate origin. The Journal of infectious diseases, 187(2), 251-259.

Lowy, F. D. (2003). Antimicrobial resistance: the example of Staphylococcus aureus. The Journal of clinical investigation, 111(9), 1265-1273.

Magiorakos, A.-P., Srinivasan, A., Carey, R., Carmeli, Y., Falagas, M., Giske, C., Harbarth, S., Hindler, J., Kahlmeter, G., & Olsson-Liljequist, B. (2012). Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection, 18(3), 268-281.

Mikomangwa, W. P., Bwire, G. M., Kilonzi, M., Mlyuka, H., Mutagonda, R. F., Kibanga, W., Marealle, A. I., Minzi, O., & Mwambete, K. D. (2020). The Existence of High Bacterial Resistance to Some Reserved Antibiotics in Tertiary Hospitals in Tanzania: A Call to Revisit Their Use. Infection and drug resistance, 13, 1831.

Mnyambwa, N. P., Mahende, C., Wilfred, A., Sandi, E., Mgina, N., Lubinza, C., Kahwa, A., Petrucka, P., Mfinanga, S., & Ngadaya, E. (2021). Antibiotic susceptibility patterns of bacterial isolates from routine clinical specimens from Referral Hospitals in Tanzania: A prospective hospital-based observational study. Infection and drug resistance, 14, 869.

Moremi, N., Claus, H., & Mshana, S. E. (2016). Antimicrobial resistance pattern: a report of microbiological cultures at a tertiary hospital in Tanzania. BMC infectious diseases, 16(1), 1-7.

Mukhtar, A. M., & Saeed, H. A. (2011). Profile of antibiotic sensitivity and resistance of some pathogenic bacteria isolated from clinical specimens in Sudan. J Sci Technol, 12, 14-19.

Mulu, W., Abera, B., Yimer, M., Hailu, T., Ayele, H., & Abate, D. (2017). Bacterial agents and antibiotic resistance profiles of infections from different sites that occurred among patients at Debre Markos Referral Hospital, Ethiopia: a cross-sectional study. BMC research notes, 10(1), 1-9.

Organization, W. H. (2012). The evolving threat of antimicrobial resistance: options for action. World Health Organization.

Qadi, M., Alhato, S., Khayyat, R., & Elmanama, A. A. (2021). Colistin Resistance among Enterobacteriaceae Isolated from Clinical Samples in Gaza Strip. Canadian Journal of Infectious Diseases and Medical Microbiology, 2021.

Rossi, F. (2011). The challenges of antimicrobial resistance in Brazil. Clinical infectious diseases, 52(9), 1138-1143.

Tadesse, S., Kahsay, T., Adhanom, G., Kahsu, G., Legese, H., & Derbie, A. (2018). Prevalence, antimicrobial susceptibility profile and predictors of asymptomatic bacteriuria among pregnant women in Adigrat General Hospital, Northern Ethiopia. BMC research notes, 11(1), 1-6.

Wayne, P. (2016). Clinical and Laboratory Standards Institute (CLSI), Performance Standards for Antimicrobial Susceptibility Testing, CLSI supplement M100S. In: Clinical and Laboratory Standards Institute., Wayne, PA.

Wi, T., Lahra, M. M., Ndowa, F., Bala, M., Dillon, J.-A. R., Ramon-Pardo, P., Eremin, S. R., Bolan, G., & Unemo, M. (2017). Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action. PLoS medicine, 14(7), e1002344.