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

• Main Authors: Eric S. Donkor (Author), Khitam Muhsen (Author), Sherry A. M. Johnson (Author), Fleischer C. N. Kotey (Author), Nicholas T. K. D. Dayie (Author), Patience B. Tetteh-Quarcoo (Author), Edem M. A. Tette (Author), Mary-Magdalene Osei (Author), Beverly Egyir (Author), Nicholas I. Nii-Trebi (Author), Godfred Owusu-Okyere (Author), Alex Owusu-Ofori (Author), Yonatan Amir (Author), Saritte Perlman (Author), Perdita Hilary Lopes (Author), Adjo Mfodwo (Author), Nicola C. Gordon (Author), Louise Gresham (Author), Mark Smolinski (Author), Dani Cohen (Author)
• Format: Book
• Published: MDPI AG, 2023-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/antibiotics12020255; 2079-6382
• Keywords: Gram-negative bacteria; non-typhoidal <i>Salmonella</i>; <i>Klebsiella pneumoniae</i>; bloodstream infections; antibiotic resistance; multidrug resistance; Therapeutics. Pharmacology; RM1-950
• Source: Antibiotics, Vol 12, Iss 2, p 255 (2023)

Background: Antimicrobial resistance (AMR) in Gram-negative bacteria-causing bloodstream infections (BSIs), such as <i>Klebsiella pneumoniae</i> and non-typhoidal <i>Salmonella</i> (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, <i>K. pneumoniae</i>, 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%) <i>K. pneumoniae</i>, 88 (26.4%) <i>Escherichia coli</i>, 40 (12.0%) <i>Acinetobacter baumannii</i>, 25 (7.5%) <i>Pseudomonas aeruginosa</i>, 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 <i>K. pneumoniae</i> 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.