Article Info – ACM_21-009 – Annals of Clinical Microbiology

Multidrug-Resistant Gram-Negative Bacterial Infections in a Tertiary-Care Hospital in Northern Ghana: A Three-Year Retrospective Analysis

Kennedy Mensah Osei^1,4 , Heekang Choi² , David Eklu Zeyeh¹ , Salifu Alikamatu¹, Esther Owusu Boateng¹ , Vandarith Nov⁴ , Le Phuong Nguyen^2,3 , Khadija Kubura¹, Bernard Bobzah¹, Dongeun Yong^2,3

¹Department of Laboratory, Tamale Teaching Hospital, Tamale, Ghana
²Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
³Brain Korea 21plus Programfor Medical Science, Yonsei University College of Medicine, Seoul, Korea
⁴Department of Global Health Security, Yonsei University Graduate School of Public Health, Seoul, Korea

Corresponding author : zdondavid@gmail.com

March 2022
The Annals of Clinical Microbiology 2022 25(1):1-11
Received Date: April 19, 2021
Revised Date: January 30, 2022
Accepted Date: March 03, 2022
DOI: 10.5145/ACM.2022.25.1.1
Citation

ABSTRACT

Background: A variety of clinically important pathogens have developed multidrug resistance (MDR), which threatens global public health. This study aimed to determine the incidence, patterns, and trends of MDR of gram-negative bacterial isolates in clinical specimens in the Tamale Teaching Hospital, Ghana.
Methods: This retrospective study analyzed gram-negative bacterial isolates and antimicrobial susceptibility test (AST) results of patients who visited the Tamale Teaching Hospital laboratory between 2017 and 2019.
Results: A total of 2,779 gram-negative bacterial isolates and their phenotypic AST results were analyzed. From these, 1,297 gram-negative bacteria (46.7%) were isolated from urine samples, while the rest were isolated from sputum (20.9%), wound (14.3%), and swabs (11.7%) samples, etc. Escherichia coli (23.8%) was the most common gram-negative pathogen found predominantly in the urine samples (33.2%). All gram-negative bacteria isolated between 2017 and 2019 showed high MDR. Klebsiella pneumoniae gradually increased its MDR from 84.0% in 2017, 89.5% in 2018, to 95.1% in 2019. On the other hand, the MDR rates in Pseudomonas aeruginosa were approximately 65.8%, varying from 59.5% in 2017 to 78.7% in 2019. Among tested antimicrobials, amikacin was the most effective. Resistance to amikacin in Enterobacter spp., E. coli, and K. pneumoniae in vitro were 16.2%, 11.8%, and 17.7%, respectively.
Conclusion: The study has shown that the high levels of MDR in gram-negative bacteria isolated may be associated with the infections recorded at the Tamale Teaching Hospital. The major gram-negative pathogens isolated have resistance to penicillins, cephalosporins, and fluoroquinolones. Aminoglycosides can offer high antibiotic activity to overcome gram-negative bacterial resistance. Further studies will be needed to decide policy direction on infection prevention and control, and antimicrobial stewardship programs

Keywords

Gram-negative bacteria, Multidrug resistance, Tamale Teaching Hospital, Ghana

Figures & Tables

Table 1. The number of cultured gram-negative bacterial isolates distributed among age, sex, and specimen

Characteristic	Age (yr)								Total
Characteristic	<10	10-19	20-29	30-39	40-49	50-59	60-69	≥ 70	Total
Sex
Female	162	91	402	300	163	82	81	126	1,407
Male	156	73	123	159	132	138	170	421	1,372
Specimen
Aspirates & fluids^*	6	8	13	18	12	6	7	4	74
Blood	52	4	4	5	5	4	3	2	79
Sputum	20	32	56	61	101	76	86	148	580
Stool	1		3	6	2				12
Swabs^†	12	21	152	99	28	5	5	2	324
Tissue	2	2		1					5
Urine	195	56	213	183	84	99	113	354	1,297
Wound	30	41	84	76	63	30	37	37	398
Total	318	164	525	459	295	220	251	547	2,779
^*Abscess, ascitic fluid, aspirates, pleural efusions, CSF, semens. ^†Vaginal swab, endocervical swab, rectal swab, urethral swab, ear swab, eye swab, buccal swab, throat swab.