Multicenter Surveillance of Antimicrobial Resistance among Gram-Negative Bacteria Isolated from Bloodstream Infections in Ghana

Abstract

Background: Antimicrobial resistance (AMR) in Gram-negative bacteria-causing bloodstream infections (BSIs), such as Klebsiella pneumoniae and non-typhoidal Salmonella (NTS), is a major public health concern. Nonetheless, AMR surveillance remains scarce in sub-Saharan Africa, where BSI treatment is largely empirical. The aim of the study was to determine the distribution and AMR patterns of BSI-causing NTS, K. pneumoniae, and other Gram-negative bacteria in Ghana. Methods: A cross-sectional study was conducted between April and December 2021 at eleven sentinel health facilities across Ghana as part of a pilot study on the feasibility and implementation of the human sector AMR surveillance harmonized protocol in sub-Saharan Africa. Gram-negative bacteria recovered from blood specimens of febrile patients were identified using MALDI-TOF and evaluated for antimicrobial resistance using the BD Phoenix M50 analyzer and Kirby-Bauer disc diffusion. The Department of Medical Microbiology at the University of Ghana served as the reference laboratory. Results: Out of 334 Gram-negative blood isolates, there were 18 (5.4%) NTS, 85 (25.5%) K. pneumoniae, 88 (26.4%) Escherichia coli, 40 (12.0%) Acinetobacter baumannii, 25 (7.5%) Pseudomonas aeruginosa, and 77 (23.1%) other Gram-negative bacteria. As a composite, the isolates displayed high resistance to the antibiotics tested—amoxicillin (89.3%), tetracycline (76.1%), trimethoprim-sulfamethoxazole (71.5%), and chloramphenicol (59.7%). Resistance to third-generation cephalosporins [ceftriaxone (73.7%), cefotaxime (77.8%), and ceftazidime (56.3%)] and fluoroquinolones [ciprofloxacin (55.3%)] was also high; 88% of the isolates were multidrug resistant, and the rate of extended-spectrum beta-lactamase (ESBL) production was 44.6%. Antibiotic resistance in K. pneumoniae followed the pattern of all Gram-negative isolates. Antibiotic resistance was lower in NTS blood isolates, ranging between 16.7–38.9% resistance to the tested antibiotics. Resistance rates of 38.9%, 22.2%, and 27.8% were found for cefotaxime, ceftriaxone, and ceftazidime, respectively, and 27.8% and 23.8% for ciprofloxacin and azithromycin, respectively, which are used in the treatment of invasive NTS. The prevalence of multidrug resistance in NTS isolates was 38.9%. Conclusions: Multicenter AMR surveillance of Gram-negative blood isolates from febrile patients was well-received in Ghana, and the implementation of a harmonized protocol was feasible. High resistance and multidrug resistance to first- or second-choice antibiotics, including penicillins, third-generation cephalosporins, and fluoroquinolones, were found, implying that these antibiotics might have limited effectiveness in BSI treatment in the country. Continuation of AMR surveillance in Gram-negative blood isolates is essential for a better understanding of the extent of AMR in these pathogens and to guide clinical practice and policymaking.

Role of CTX-M-15 gene in spread of extended-spectrum beta-lactamases among immunocompetent patients in Ghana

“…However, while the pooled prevalence provides a useful estimate of ESBL carriage across Africa, individual studies may reveal variations and provide more localised data because the prevalence of ESBL carriage varies widely between different countries, regions, and populations. For example, the ESBL faecal carriage prevalence in our current study is significantly lower than the ESBL levels reported for other patient hosts in Ghana by Obeng-Nkrumah et al in 2013 (49.3%; n = 148/300), 1 Feglo et al in 2013 (48.4%, n = 77/159), 24 Feglo and Adu-Sarkodie in 2016 (57.8%, n = 234/405), 25 Falgenhauer et al in 2019 (61%, n = 33/54), 26 Donkor et al in 2022 (44.6%, n = 145/334), 27 and Mahazu et al in 2022 (62.2%, n = 102/164). 28 It is worth noting that variations in study populations can also influence ESBL carriage rates.…”

An Assessment of the Current Level of Implementation of the Core Elements of Antimicrobial Stewardship Programs in Public Hospitals in Ghana

“…We also believed it was necessary to evaluate the barriers and facilitators of ASPs among hospital in Ghana to guide policies and strategies toward achieving the Ghana NAP goals to fight the rising rate of AMR and its impact on the healthcare system. [43][44][45][46] With respect to the 7 core elements of implementing sustainable ASPs. 15,21 leadership commitment emphasizes the necessity of a health facility having dedicated time, financial and human resources as well as prioritizing AMS activities to enhance appropriate antibiotic use.…”

“…We also believed it was necessary to evaluate the barriers and facilitators of ASPs among hospital in Ghana to guide policies and strategies toward achieving the Ghana NAP goals to fight the rising rate of AMR and its impact on the healthcare system. 43 - 46 …”

In Vitro effects of petroleum ether, dichloromethane, methanolic and aqueous leaf extracts of Eucalyptus grandis on selected multidrug-resistant bacteria

“…Treatment of infections is now hampered by a sustained high prevalence of multidrug resistance among circulating bacterial strains [ 1 – 14 ]. Infection with antibiotic resistant bacteria, such as multidrug resistant (MDR) Mycobacterium tuberculosis , vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus (MRSA), exert broad-ranged impacts that transcend health [ 15 – 19 ].…”