Statement of the problem

The emergence of VRE in hospitalized patients is a significant international concern. It threatens to compromise effective treatment of infections caused by multi-resistant gram-positive bacteria, particularly in seriously ill hospitalized patients, who may need treatment with vancomycin where other antibiotics have failed.

 

Objectives

The overall objectives of this research were to generate knowledge of the occurrence and epidemiological role of enterococci in Gaza City and of their possible threat to human health due to Vancomycin resistance development. 

This work attempted to achieve the following specific objectives:

1. To investigate the carrier rates of VRE in hospitalized patients and non-                      hospitalized individuals in Gaza city.

2. Study the risk factors associated with VRE.

3. To identify VRE species

4. To assess antibiotic resistance patterns of the isolated enterococci

5. To evaluate physician proper use of vancomycin.

 Hypothesis

Hospitalized patients and non-hospitalized individuals, have no VRE within their normal intestinal microbiota.

 Significance

Uncontrolled and wide spread of antibiotic use in Gaza is expected to have a drastic effect on the globally escalating problem of antibiotic resistance. Vancomycin also known as the “last bullet in the arsenal of medicine” is used in local hospitals in the treatment of hard to treat gram positive infections and other purposes. This may induce resistance emergence in gram positive bacteria most especially enterococci. VRE have caused hospital outbreaks worldwide and have been dramatically amplified in recent years because of a widespread abuse and misuse of antibiotics, which has led to a burst of resistant infections and caused a worldwide healthcare problem.

Increasing number of immunocompromised individuals as a result of ageing populations, and advances in surgery and cancer chemotherapy, malnourished children, have all increased the spread and risk of infection. Thus, there is a necessity for combat antibiotic resistance. Treatment for illness caused by VRE is difficult due to resistant to most antibiotics.

Resistance costs money, livelihoods and lives and threatens to undermine the effectiveness of health delivery programmes. The economic and health costs of resistance, serious enough in the industrialized world, are often made more severe in developing countries. The economic, health and infrastructure systems of these countries, resulting in irregular supply and availability of drugs and often a dependence on unofficial sources, have led to extensive and inappropriate use of drugs, resulting in infections from strains far more resistant than those currently encountered in industrialized countries.

There is no available data about the epidemiology and spread of vancomycin resistance enterococci. Hence, this research was in part an attempt to determine the occurrence of vancomycin-resistant enterococci in fecal samples from hospitalized patients and non-hospitalized controls in Gaza City.