BackgroundFilarial pathologies such as lymphedema may be associated with complications such as chronic non-healing wounds. Nonetheless, the role of bacterial population colonizing the lymphedematous legs has been posited to worsen the conditions of those living with the infection. These bacteria are usually composed of staphylococcal species partly because they are commensals. Thus, this present study sought to type the methicillin-resistant Staphylococcus aureus (MRSA) prevalence among individuals presenting with filarial lymphedema, particularly as MRSA tends to affect treatments options.MethodsWe recruited individuals (n = 321) with stages I–VII of lymphedema in a cross-sectional study in the Ahanta West district of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were later identified using Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry.ResultsA total of 192 Staphylococci species were isolated, with an overall prevalence of 39.7% (95% CI: 35%–44%; N = 483). S. hominis was the most prevalent species (23.95%), followed by S. haemolyticus (20.83%), S. epidermidis (15.10%), S. aureus (10.41%), and S. saprophyticus (9.32%). The remaining 20.34% were distributed among S. wanneri, S. sciuri, S. pasteuri, S. xylosus, S. simulans, S. cohnii, S. caprae, S. lugdunensis, and S. capitis. MRSA, containing mecA gene, was detected in 21 out of 31 Staphylococci isolates tested, with an overall prevalence of 68% (95% CI: 51%–84%). In addition, a virulent gene, Panton–Valentine leukocidin (PVL), which is usually associated with S. aureus, was detected in 20/31 (64.5%) S. aureus in the study.ConclusionThese results suggest that MRSA species may pose a challenge to the treatment of filarial lymphedema with antibiotics particularly, as doxycycline is currently being piloted in some endemic areas to treat the infection. Thus, intensive antimicrobial resistance surveillance should be conducted in endemic areas by health authorities to forestall the dilemma of multidrug resistance not only against lymphatic filariasis (LF) infection but other diseases.

Introduction. Antimicrobial resistance is a growing international problem resulting from the enzyme β-lactamase production by bacteria, to degrade antibiotics, especially β-lactam antibiotics. In Brong Ahafo Regional Hospital, Sunyani, these antibiotics are heavily depended upon for the treatment of serious infections, but unfortunately high proportions of bacterial isolates in the hospital, have been found to be resistant to the commonly prescribed antibiotics. This study aims to determine the prevalence of ESBL-producing E. coli so as to determine if ESBL are responsible for the high antimicrobial resistance seen at the Brong-Ahafo Regional Hospital, Sunyani. Methods. The study was a cross sectional study, involving 51 E. coli isolates from urine samples of both in-and out-patients between January and December, 2014. Antimicrobial susceptibility profiles of the isolates were determined by the Kirby Bauer disc diffusion method against 12 antibiotics. The isolates were screened for ESBL production, and then confirmed by the combined disc method. The isolates were tested for the presence of ESBL blaCTX-M and blaTEM by conventional PCR. Results. Non-repeat 1,302 midstream urine samples were cultured from which 200 different pathogens were isolated. Of the 200 isolates 51 were E. coli. Isolates obtained from Community isolates were 16(37.2) and isolates from in-patients were 27(62.8). Resistant strains were detected to all the 12 antimicrobials tested. Low proportions were sensitive to cephalosporins (cefotaxime and ceftazidime), both recording 8/51(15.7%), and quinolones (nalidixic acid and ciprofloxacin), 7/51(13.7%) and 8/51(15.7%) respectively. The isolates had varied susceptibility to aminoglycosides, with European Scientific Journal March 2017 edition vol.13, No.9 ISSN: 1857 -7881 (Print) e -ISSN 1857 366 low sensitivity of 1/32(2.0%) to gentamicin, but a high proportion of 47/51(92.2%) was sensitive to amikacin. High proportion of the isolates [43/51(84.3%)] were ESBL phenotype, and was found to be significantly associated (p<0.001) with antimicrobial resistance among the isolates. The most prevalent ESBL genotype was BlaTEM with 26 (66.7%) and blaCTX-M 28(71.8%), but 9(23.1%) ESBL phenotypes tested negative for both blaTEM and blaCTX-M genes. 22 (56.4%) of the isolates had both blaTEM and blaCTX-M genes. Conclusion. High proportions of E. coli isolates from urine in Sunyani produce ESBLs. Both blaTEM and blaCTX-M were prevalent and linked to the high levels of drug resistance found in the locality. Increased antibiotic stewardship and stringent infection control measures along with the testing for ESBL must be instituted in the hospital.

Background: Lymphatic Filariasis (LF), a neglected tropical disease, has been speculated to be complicated by secondary bacteria, yet a systematic documentation of these bacterial populations is lacking. Thus, the primary focus of this study was to profile bacteria diversity in the progression of filarial lymphedema among LF individuals with or without wounds.Methods: A cross-sectional study design recruited 132 LF individuals presenting with lymphedema with or without wounds from eight communities in the Ahanta West District in the Western Region, Ghana. Swabs from the lymphedematous limbs, ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were subsequently profiled using Matrix-assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry.Results: Of the 132 LF participants recruited, 65% (85) had filarial lymphedema with no wounds. In total, 84% (235) of the bacterial isolates were identified. The remaining 16% (46) could not be identified with the method employed. Additionally, 129(55%) of the strains belonged to the phylum Firmicutes, while 61 (26%) and 45 (19%) represented Proteobacteria and Actinobacteria, respectively. Generally, irrespective of the samples type (i.e., wound sample and non-wound samples), there was a sharp increase of bacteria diversity from Stages 1 to 3 and a drastic decrease in these numbers by Stage 4, followed by another surge and a gradual decline in the advanced stages of the disease. The Shannon Diversity Index and Equitability for participants with and without wounds were (3.482, 0.94) and (3.023, 0.75), respectively. Further, Staphylococcus haemolyticus and Escherichia coli showed resistance to tetracycline, chloramphenicol, and penicillin.

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Background Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates. Results Of the sixty (60) participants, fifty-four (n = 54, 90%) were within 31–60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged (in months) seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli. and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively. Conclusion The findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.

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Background: Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimates put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease, is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA in particular, worsens the prognosis of patients, but also leads to the usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance, thereby exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes coding for resistance in multi-drug resistant (MDR) bacteria isolates. Results: Amoxacillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics by participants for self-medication. This is representative of the resistance profiles of the bacteria isolates. Penicillin and erythromycin were respectively the highest and least antibiotic that Staphylococcus aureus was resistant to. All Escherichia coli isolates were sensitive to meropenem, while they were all resistant to antibiotics such as tetracycline and ampicillin. Pseudomonas aeruginosa were least resistant to ciprofloxacin, gentamicin and ceftazidime. The incidence of multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant E. coli and carbapenem resistant P. aeruginosa are respectively 15.38% (n=4), 40% (n=2) and 25% (n=2) in LF patients. Extended-spectrum betalactamase [ESBL] (blaxCTX-M) and mecA genes were implicated in the resistance mechanism of E. coli and MRSA, respectively. Conclusion: Our findings have shown presence of MDR isolates from filarial pathology patients presenting with chronic wounds and; thus, the need to prioritize antimicrobial resistance of multi-drug resistant bacteria into treatment strategies optimizing the morbidity management protocols. The findings in this study can potentially guide the choice of antibiotics for treating individuals presenting with filarial pathologies with wounds.

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