Antimicrobial Resistant Coliforms in Tap Water with Low Free Residual Chlorine Levels in Two Hospitals: Case Study in Gaza, Palestine

Abstract

Universal access to safe water, whether at households or health centres, is central to achieving the sixth sustainable development goal by 2030. A hospital-based survey was conducted to screen for antimicrobial resistance among coliforms in samples collected from tap water (n = 54) at surgical wards in Gaza and to investigate the association with free residual chlorine and pH levels. Total coliforms (TC) were detected in 48.1% (26/54) of tested samples and FCs were detected in 25.9% (14/54). Free residual chlorine test ranged from zero to 0.2 mg/l (average: 0.08 mg/l), of which more than half of the samples (53.7%) 29/54 showed no free residual chlorine. The mean value of free residual chlorine in samples tested positive for growth on m-Endo (0.03) was lower than the mean for negative samples (0.14). The pH values were within the acceptable range (average: 7.6) and there was a statistically significant variation between the mean of pH values for samples tested positive on m-Endo (7.29) and that tested negative (7.84). Among coliform positive samples, 23.1% (6/26) had coliform isolates with resistance patterns. More than two-thirds of antimicrobial resistant (AMR) isolates were resistant to amikacin, ceftazidime, ceftriaxone, and imipenem. Moreover, 50% of the isolates were resistant to piperacillin-tazobactam. One-third (33.3%) of isolates were resistant to cefoxitin, and fosfomycin, 16.7% were resistant to ciprofloxacin, and nitrofurantoin. Intermediate resistance was shown in 16.7% of the isolates to cefoxitin and ciprofloxacin. The ESBL and carbapenem resistance genes detected in isolates were TEM (66.7%), NDM (33.3%), OXA (25%), blaCTXM (16.7%), and blaCTXM-3 (16.7%). The finding highlighted the level of contamination with AMR coliform in samples collected from tap water and pointed out the importance of managing water safety through identifying the main source of contamination, in addition to maintaining proper water disinfection at healthcare facilities for the patient, staff and environmental safety.