Short communication Detection of NDM-2-producing Acinetobacter baumannii and VIM-producing Pseudomonas aeruginosa in Palestine Isabella Sjo ¨ lander a,b, *, Frank Hansen c , Abdelraouf Elmanama d , Rasha Khayyat e , Alaeddin Abu-Zant e , Ayman Hussein e , Adham Abu Taha e , Anette M. Hammerum c , Oana Ciofu b a Hudiksvall Hospital, Hudiksvall, Sweden b University of Copenhagen, Department of International Health, Immunology and Microbiology, Unit of Bacteriology, Costerton Biofilm Center, Copenhagen, Denmark c Statens Serum Institut, Copenhagen, Denmark d Medical Laboratory Sciences Department, Islamic University, Gaza, Palestine e An-Najah National University, Faculty of Medicine and Health Sciences, Department of Bio-Medical Sciences, Division of Microbiology and Immunology, Palestine 1. Introduction Carbapenemase-producing Gram-negative bacteria are a worldwide clinical concern. Several genes, either chromosomal or plasmid-mediated, have been reported to encode these b- lactamases, which are often easily spread by mobile genetic elements. Palestine is a territory closely located to areas where carbapenemase-producing isolates have been identified. Recent studies, for example, have shown NDM-2-producing Acinetobacter baumannii in Tel Aviv, Egypt and the United Arab Emirates [1,2]. There is a lack of documentation on the presence of these genes in isolates from the Palestinian Authority. The aim of this study was to screen for carbapenem-resistant Gram-negative bacteria in Palestine and to characterise the carbapenemase-producing isolates. 2. Materials and methods For the 6-week period from 12 February to 23 March 2012, six hospital laboratories (five in the Northern West Bank and one in Gaza) were asked to collect all Gram-negative isolates from inpatients and outpatients. All collected isolates were tested for susceptibility to meropenem by disc diffusion using 10 mg meropenem disks according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) [3]. Isolates show- ing a meropenem zone of inhibition of <23 mm were identified to Journal of Global Antimicrobial Resistance 2 (2014) 93–97 A R T I C L E I N F O Article history: Received 4 October 2013 Received in revised form 8 November 2013 Accepted 9 November 2013 Keywords: MLST Carbapenemases Palestine Acinetobacter baumannii NDM Pseudomonas aeruginosa VIM A B S T R A C T The aim of this study was to screen for carbapenem-resistant Gram-negative bacteria in Palestine and subsequently to identify and investigate the mechanisms of resistance. For a period of 6 weeks, all Gram- negative isolates were collected from six Palestinian hospital laboratories and were tested for susceptibility using 10 mg meropenem disks. Isolates showing resistance to meropenem were further investigated. The presence of carbapenemases was assessed by PCR. In addition, antimicrobial susceptibility testing, an efflux pump inhibitor assay and pulsed-field gel electrophoresis (PFGE) were performed. Isolates producing carbapenemases were further investigated by multilocus sequence typing (MLST). In total, 248 Gram-negative isolates were collected from the six laboratories. Among the 248 tested isolates, 15 Acinetobacter baumannii and 6 Pseudomonas aeruginosa were resistant to meropenem. One A. baumannii from Gaza produced NDM-2 and belonged to ST103. Thirteen of the carbapenem- resistant A. baumannii isolates possessed the intrinsic upregulated bla OXA-66 gene and one isolate carried bla OXA-51 . All but one of the OXA-66-producing A. baumannii belonged to ST2; the remaining isolate belonged to ST183. One of the carbapenem-resistant P. aeruginosa was classified as VIM-4-producing and three were VIM-2-producing isolates. The three VIM-2-producing isolates belonged to three new sequences types (ST1562, ST1563 and ST1564). All of the carbapenemase-producing isolates were multiresistant non-fermenters. To the best of our knowledge, this is the first report on NDM-producing A. baumannii and VIM-producing P. aeruginosa from Palestine. ß 2013 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved. * Corresponding author at: Gustav III:s va ¨g 37, 168 30 Bromma, Sweden. Tel.: +46 70 483 27 97. E-mail address: isabella.sjolander@gmail.com (I. Sjo ¨ lander). Contents lists available at ScienceDirect Journal of Global Antimicrobial Resistance jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/jg ar 2213-7165/$ – see front matter ß 2013 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jgar.2013.11.002