Background. Bloodstream infections are among the top causes of morbidity and mortality in people of all ages, especially in immunocompromised patients in sub-Saharan Africa. This study aimed at describing the epidemiology of bloodstream infections and antimicrobial susceptibility pattern over a nine-year period at St. Dominic Hospital, Akwatia, in the Eastern Region of Ghana. Method. This study retrospectively analysed data from 4,489 patients who were referred to the Laboratory Department for blood culture and sensitivity testing from January 2009 to December 2017. Sociodemographic data included age, gender, and patients’ department. Blood culture results were retrieved from archival records in the laboratory. The authorities of St. Dominic Hospital granted approval for the study. Results. The incidence of bloodstream infection over the 9 years was 51.4 positive cultures per 100,000 hospital attendance. Staphylococcus aureus was the leading causative agent of bacteraemia for the first two scalar years (2009–2011 (38.9%) and 2012–2014 (42.2%)) while coagulase-negative staphylococcus (CoNS) (50.5%) was predominant for the last scalar year (2015–2017), followed by Staphylococcus aureus (169/587 (28.8%)). The highest incidence of bloodstream infections was recorded in the wet seasons (months of May (8.9 per 10,000 persons) and October (10.1 per 10,000 persons)). The bacterial isolates demonstrated high resistance to tetracyclines (390/531 (73.4%)), penicillins (1282/1669 (76.8%)), and sulphonamides (450/499 (90.2%)). Conclusion. Bloodstream infection and antimicrobial resistance are high in patients seeking healthcare in Akwatia. This therefore calls for concerted efforts aimed at reducing the incidence in the study area.

The study was aimed at comparing the estimation of the burden and trends (2012–2016) of Human Immunodeficiency Virus (HIV) and Syphilis infections by the national Sentinel Survey vis-à-vis the use of population-based studies at a single urban site (Municipal Hospital) in Ho, the Volta Region of Ghana. Using blood donors as a proxy of the asymptomatic adult population, a retrospective analysis of secondary data on HIV and Syphilis testing was conducted using Ho Municipal Hospital's archives comprising 4,180 prospective blood donors. Published reports from the National Sentinel Survey for the Ho Sentinel Site comprising 2,452 pregnant women from 2012 to 2016 were used. The cumulative prevalence of HIV and Syphilis infections in the population-based survey was 4.78% and 2.58% while the epidemiology was estimated at 2.75% and 0.24% by the Sentinel Survey for the five-year under review. The new HIV and Syphilis infections were 3.78% and 2.46% in the population-based survey compared to 2.64% and 0.23% in the Sentinel Survey. Gender cumulative prevalence and the yearly trend was found to be higher in the general population compared to the pregnant women. The use of pregnant women to estimate the HIV and Syphilis epidemiology might not be representative of the general population.

Background The balance between the choices of UTI diagnostic tools in most primary care settings has been settled for by the more rapid, less labour-intensive dipstick. This study aimed to evaluate the effectiveness of dipstick for diagnosing UTI. Method A total of 429 urine samples were collected from patients suspected of UTI; cultured on cysteine-lactose-electrolyte-deficient (CLED) agar, blood agar, and MacConkey agar; and incubated at 37°C overnight. Urine cultures with bacteria count ≥105 cfu/ml were classified as “positive” for UTI. A dipstick was used to screen for the production of nitrite (NIT) and leucocyte esterase (LE), following the manufacturer's instructions. Biochemical reactions of nitrite and leucocyte esterase > “trace” were classified as “positive.” A quantitative urine culture was used as the gold standard. Results The highest sensitivity value and negative predictive value were recorded for the combined “NIT+ or LE+” dipstick results. The highest specificity value, positive predictive value, positive likelihood ratio, and negative likelihood ratio were recorded for “nitrite-positive and leucocyte esterase-positive” results. Combined “nitrite-positive or leucocyte-positive” result was relatively the best indicator for accurate dipstick diagnosis, with AUC = 0.7242. Cohen's kappa values between dipstick diagnosis and quantitative culture were <0.6. Conclusion Combined performance of nitrite and leucocyte esterase results appeared better than the solo performance of nitrite and leucocyte esterase. However, little confidence should be placed on dipstick diagnosis; hence, request for quantity culture should be encouraged in the primary healthcare settings.

Background: Malaria cases continue to rise despite sustained efforts directed at eliminating the burden among Ghanaians. This study was aimed at describing the spectrum of malaria burden in a four-year (2013-2016) retrospective review among clients seeking care at the Sefwi-Wiawso Municipal Hospital in the Western Region of Ghana. Materials and Methods: The study analyzed secondary data extracted on 32,629 patients who were referred to the Laboratory for malaria testing from January 2013 to December 2016. Socio-demographic data included age and gender, department of test requisition and malaria results were obtained from the archived Daily Malaria Logbook records. Approval for the study was granted by the authorities of the Sefwi-Wiawso Municipal Hospital. Results: The overall confirmed malaria case was 8629 (26.5%), among under five 1,384 (58.7%), pregnant women 4451 (20.3%) and 14.1% among asymptomatic population. Significant gender disparity in the confirmation of suspected malaria cases was observed with males recording higher rate (45.8%) than females (36.7%). The peak of the malaria epidemic was observed in the wet season (195 cases per month), compared to the dry season (133 cases per month). Conclusion: Cases of malaria is increasing with high rates among vulnerable groups in the Western Region. There is the need to intensify efforts to reduce the burden in the study area especially among vulnerable groups.

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Background Antimicrobial resistance (AMR) is a major public health challenge with its impact felt disproportionately in Western Sub-Saharan Africa. Routine microbiology investigations serve as a rich source of AMR monitoring and surveillance data. Geographical variations in susceptibility patterns necessitate regional and institutional tracking of resistance patterns to aid in tailored Antimicrobial Stewardship (AMS) interventions to improve antibiotic use in such settings. This study focused on developing a cumulative antibiogram of bacterial isolates from clinical samples at the Cape Coast Teaching Hospital (CCTH). This was ultimately to improve AMS by guiding empiric therapy. Methods A hospital-based longitudinal study involving standard microbiological procedures was conducted from 1st January to 31st December 2020. Isolates from routine diagnostic aerobic cultures were identified by colony morphology, Gram staining, and conventional biochemical tests. Isolates were subjected to antibiotic susceptibility testing using Kirby-Bauer disc diffusion. Inhibitory zone diameters were interpreted per the Clinical and Laboratory Standards Institute guidelines and were entered and analysed on the WHONET software using the “first isolate only” principle. Results Overall, low to moderate susceptibility was observed in most pathogen-antibiotic combinations analysed in the study. Amikacin showed the highest susceptibility (86%, n = 537/626) against all Gram-negatives with ampicillin exhibiting the lowest (6%, n = 27/480). Among the Gram-positives, the highest susceptibilities were exhibited by gentamicin (78%, n = 124/159), with clindamycin having the lowest susceptibility (27%, n = 41/154). Among the Gram-negatives, 66% (n = 426/648) of the isolates were identified phenotypically as potential extended-spectrum beta-lactamase producers. Multiple multidrug-resistant isolates were also identified among both Gram-positive and Gram-negative isolates. Low to moderate susceptibility was found against first- and second-line antibiotics recommended in the National standard treatment guidelines (NSTG). Laboratory quality management deficiencies and a turnaround time of 3.4 days were the major AMS barriers identified. Conclusions Low to moderate susceptibilities coupled with high rates of phenotypic resistance warrant tailoring NSTGs to fit local contexts within CCTH even after considering the biases in these results. The cumulative antibiogram proved a key AMS programme component after its communication to clinicians and subsequent monitoring of its influence on prescribing indicators. This should be adopted to enhance such programmes across the country.

Typhoid fever is rare in the developed world, but in Kwaebibirem District of Ghana, Salmonella infections are very common. Typhoid and paratyphoid fevers in addition to gastroenteritis are frequently reported. The reservoir, prevailing Salmonella species and their antimicrobial susceptibility patterns are not known, but in Ghana treatment of these infections are mostly empirical. 464 samples (270 stool and 194 blood) were collected from patients and 188 water samples were collected from different water sources in Kwaebibirem District and cultured for Salmonella at St. Dominic Hospital, Akwatia. Salmonella prevalence of 11.6% (54/464) among patients and 2.7% (5/188) from dug-out wells were obtained. Total viable bacterial count in the water samples averaged 2.56 x10 3 -1.2 x 10 13 per milliliter. Five (5) out of 51 (9.8%) dug-out wells yielded Salmonellae upon culture. Typhoidal Salmonellae [11% (6/54)] and 68.6% (38/54) non-typhoidal Salmonellae were isolated from patients. The most affected age group ranged 6-15years with prevalence of 42.6% (23/54). The most frequent isolated was Salmonella Typhi 20% (11/54) followed by Salmonella Enterica, 29.6% (16/54). The Salmonella isolates were all susceptible to the cephalosporins (cefoxitin, cefotaxime, cefepime) the carbapenems (imipenem and meropenem) the quinolones (norfloxacin and ciprofloxacin) and the aminoglycoside (amikacin). Their resistant proportions to other drugs were ampicillin (69.5%), piperacillin (69.5%) and co-trimoxazole (76.3%). Salmonella infections were common in Kwaebibirem District, and home owned dug-out wells posed risk of Salmonella transmission to the people.