Background: Infections resulting from multidrug-resistant Enterobacterales (MDRE) pose
a growing global threat, presenting challenges in treatment and contributing significantly to
morbidity and mortality rates. The main objective of this study was to characterize
phenotypically and genetically of MDRE isolated from clinical samples in the West Bank,
Palestine.
Methods: A cross-sectional study was conducted in October 2023 on clinical bacterial
isolates collected from five governmental hospitals in the West Bank, Palestine. The
isolates obtained from the microbiology laboratories of the participating hospitals,
underwent identification and antibiotic susceptibility testing (AST) using the VITEK® 2
Compact system. MDRE was determined by the Vitek2 Compact system. A modified
carbapenem inactivation method (mCIM) was employed to identify carbapenemase-
producing Enterobacterales (CPE). Resistance genes were detected by real-time PCR.
Results: Out of the total 1380 collected isolates, we randomly selected 600 isolates for
analysis. Our analysis indicated that 287 (47.83%) were extended-spectrum beta-lactamase

producers (ESBLE), and 102 (17%) as carbapenem-resistant Enterobacterales (CRE)
isolates. A total of 424 isolates (70.67%) were identified as multidrug-resistant
Enterobacterales (MDRE). The most prevalent ESBL species were Klebsiella pneumoniae
(n=124; 43.2%), Escherichia coli (n=119; 41.5%) and Enterobacter cloacae (n=31; 10.8%).
Among the CRE isolates, 85 (83.33%) were CPE. The most frequent CRE species were K.
pneumoniae (n=63; 61.7%), E. coli (n=25; 24.5%) and E. cloacae (n=13; 12.8%).
Additionally, 47 (7.83%) isolates exhibited resistance to colistin, with 38 (37.62%) being
colistin-resistant CRE and 9 (3.14%) being colistin-resistant ESBLE while sensitive to
carbapenems. ESBLE exhibited varied resistance patterns across different none ꞵ-lactam
antibiotic classes. We noticed that 11 isolates (6 K. pneumoniae and 5 E. cloacae)
demonstrated sensitivity to carbapenems by phenotype but carried silent CPE genes (1
blaOXA48, and 6 blaNDM, 4 blaOXA48, blaNDM).
Conclusion: This study showed the high burden of the ESBLE and CRE among the
samples collected from the participating hospitals. The most common species were K.
pneumoniae and E. coli. There was a high prevalence of blaCTXm. Adopting both
conventional and molecular techniques is essential for better surveillance of the emergence
and spread of MDRE infections in Palestine.

Conference Title

13th International Palestinian Conference for Laboratory Medicine (IPCLM‑13)

Conference Country

Palestine

Conference Date

Aug. 21, 2025 - Aug. 23, 2025

Conference Sponsor

The Palestinian Medical Technology Association (PMTA)

Additional Info

Conference Website