Multidrug-resistant bacteria amid health-system collapse in Gaza

Gaza’s health-care system has faced widespread destruction during the ongoing Israeli military invasion that began in October, 2023, leading to a proliferation of disease outbreaks. During this time, one of Gaza’s only functioning microbiology services has been a small laboratory at Al-Ahli Arab Hospital in Gaza City, which retained power largely via diesel generators and battery inverters. The hospital, which is one of the only hospitals in Gaza that has remained partly operational, has treated large volumes of traumatic injuries despite frequent airstrikes in the northern two governorates of the Gaza Strip, and has been evacuated for periods between airstrikes. We reviewed every specimen collected and processed from the hospital’s wards or emergency theatre between Nov 1, 2023, and Aug 31, 2024. 1317 primary samples—67·3% (886/1317) of which were from pus or wound swabs, 28·2% (372/1317) from urine, and 4·5% (59/1317) from other sample types (including sterile fluids)—were cultured within 1 h of collection on blood and MacConkey agar. Isolates were confirmed with Gram stain and analytical profile index testing and were tested against some of 24 antimicrobial agents by Kirby–Bauer disc diffusion (appendix), with zones interpreted with the Clinical and Laboratory Standards Institute’s M100 (32nd edition).