Multidrug-resistant gram-negative bacterial infections the Tamale Teaching Hospital in Northern Ghana: a three-year retrospective analysis

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 gramnegative bacterial resistance. Further studies will be needed to decide policy direction on infection prevention and control, and antimicrobial stewardship programs.

Occurrence and significance of fluoroquinolone-resistant and ESBL-producingEscherichia coliandKlebsiella pneumoniaecomplex of the rectal flora in Ghanaian patients undergoing prostate biopsy

“…Evidence shows that antimicrobial resistance (AMR) in Ghana is on the increase, with high levels of MDR to routinely used antibiotics observed mainly in Gram-negative organisms. 15 , 16 Previous prospective studies have shown high levels of ESBL-producing Enterobacterales in both carriage and clinical isolates. 17–19 The ESBL-positive bacteria, particularly the CTX-M producers, are resistant to most β-lactam antibiotics and are usually associated with co-resistance to aminoglycosides, fluoroquinolones, sulphonamides and tetracyclines.…”

Designing phage cocktails to combat the emergence of bacteriophage-resistant mutants in multidrug-resistant Klebsiella pneumoniae

“…The emergence of multidrug-resistant (MDR) bacteria poses an enormous threat to global public health ( 1 , 2 ). We have combatted MDR bacteria by developing novel antibiotics whenever new MDR bacteria emerge.…”