Multidrug-resistant Pseudomonas isolated from water at primary health care centers in Gaza, Palestine: a cross-sectional study

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• Detected resistant Pseudomonas in water sources at primary healthcare centers in Gaza. • Water systems in health centers may contribute to the nosocomial spread of resistant bacteria. • Water quality and infection control are vital in healthcare settings within warzones. • Water, sanitation, and infection control conditions have likely deteriorated since October, 2023. Water contaminated with drug-resistant Pseudomonas spp. poses a serious risk for nosocomial transmission, especially in patients with wounds or implants prone to biofilm formation. This is particularly concerning in Gaza, where the ongoing war since October 2023 has severely impacted healthcare and water infrastructure, increasing the risk of infection in overcrowded health facilities. This study aimed to investigate the antibiotic resistance profile, Multiple Antibiotic Resistance Index (MARI), and genetic determinants of Pseudomonas spp. isolated from water in Primary Healthcare Centers (PHCs). A total of 64 water samples were collected from five PHCs across Gaza (April–August 2022). Isolates were identified using standard microbiological techniques. Antibiotic susceptibility was tested via the Kirby-Bauer disk diffusion method; MARI was calculated, and PCR was used to detect NDM genes. Pseudomonas spp. were isolated from 59.4% of samples (desalinated: 48.3%; municipal: 68.6%). High resistance was observed to imipenem (84%) and piperacillin (84%), followed by aztreonam (31.6%) and gentamicin (28.9%). The average MARI was 0.4. NDM genes were detected in a subset of isolates. The presence of multidrug-resistant, NDM-producing Pseudomonas in both RO and municipal water highlights the urgent need for water safety, screening, and infection control in conflict-affected healthcare settings.