Infections with bacteria producing extended-spectrum beta-lactamases (ESBLs) are increasing across Africa. This study reports on ESBL-producing Enterobacteriaceae as significant causes of infections and antibiotic resistance at Korle-Bu Teaching Hospital in Accra, Ghana. Of 300 isolates examined, 49.3% produced ESBLs. The prevalence of ESBLs was significantly high among isolates from neonates (28 of 43, 65.1%; relative risk = 1.62, 95% confidence interval = 1.33–2.13, P = 0.002) and adult patients > 65 years of age (36 of 51, 70.5%; relative risk = 1.89, 95% confidence interval = 1.41–2.40, P = 0.001). A marked increase in minimum inhibitory concentrations of ESBL-positive species was noticed compared with those for the other strains. Using these concentrations, we found that 26 (17%) ESBL producers were resistant to two or more antibiotics (aminoglycosides, fluoroquinolones, sulfonamide, and carbapenems) whereas 5 (3.2%) non–ESBL producers were multidrug resistant. Regular ESBL detection and evaluation of antibiotic resistance may help reduce the spread of ESBLs and antibiotic resistance in Ghana.

Sixty-one cases of neonatal septicaemia (NNS) identified by positive blood cultures during surveillance of infection at King Fahd Hospital of the University in Khobar, Saudi Arabia from September 1983-September 1988 were studied to evaluate the local pattern of pathogens and the risk factors for sepsis using a case control analysis. The incidence of NNS was 4.9 per 1000 live births (LB). Among inborn infants, birth weight specific sepsis rate ranged from 2 per 1000 liveborns among infants with birth weight > or = 2500 g to 150 per 1000 liveborns in those weighing < or = 1500 g. Factors significantly associated with septicaemia were foetal distress, low Apgar score at 5 min, and requirement for mechanical ventilation and umbilical catheterization. Similar findings were obtained with infants whose mothers had pre-eclampsia. Staphylococci were the major Gram-positive isolate occurring in both 'early' (< or = 48 h) and 'late' (448 h) onset septicaemia. The study highlights the importance of knowledge of local epidemiology of NNS to formulate antibiotic policy. It also suggests the need for reporting birth weight specific rates and for a larger case control study of risk factors for NNS.

We conclude that pneumococcal carriage among the study children is high and the carried strains have a high level of resistance (> 50%) to several antibiotics. Ceftriaxone is a suitable antibiotic for treating pneumococcal infections in Ghana, and the use of this antibiotic coupled with the pneumococcal vaccination is expected to significantly reduce the burden of pneumococcal disease in the country.

BackgroundAntibiotic resistance due to the presence of extended-spectrum beta-lactamases (ESBLs) among Enterobacteriaceae is a worldwide problem. Data from Ghana regarding this resistance mechanism is limited. This study was designed to investigate the presence of TEM-type ESBL genes, their locations and their conjugabilities in clinical isolates of enterobacteria collected from the Korle-Bu Teaching Hospital in Ghana.MethodsStudy isolates were characterized with respect to ESBL phenotype, TEM-type ESBL gene detection, location of the ESBL gene(s) and conjugability of the ESBL phenotype using nalidixic acid-resistant Escherichia coli K-12 as recipient. Phenotyping was by Kirby Bauer disk diffusion using cefpodoxime, ceftazidime, cefotaxime and their combinations with clavulanate. Gene detections were by PCR using blaTEM primers.ResultsOverall, 37.96 % of 137 clinical isolates showed ESBL phenotype. The ESBLs occurred mostly in Klebsiella spp. (42.3 %) and then Escherichia coli (34.6 %). The TEM gene was detected in 48.1 % of ESBL-positive isolates and was determined to be plasmid-borne in 24 of 25 blaTEM detections. Overall, 62.7 % of TEM-producing isolates transferred the ESBL phenotype by conjugation.ConclusionsThe results highlight the presence of TEM-type ESBLs in the Korle-Bu Teaching Hospital and show considerable risk of environmental contamination through the urine of infected persons. An inhibition zone chart was generated which indicates the possible presence of complex beta-lactamase types. The data points to the fact that the ESBL-producing bacteria may disseminate this resistance mechanism via conjugation.