High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017-2021

Int J Environ Res Public Health. 2022 Dec 9;19(24):16556. doi: 10.3390/ijerph192416556.

Abstract

Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials.

Keywords: Access, Watch and Reserve (AWaRE) classification; Ghana; MDS Lancet Laboratories; antimicrobial resistance (AMR); multi-drug resistance (MDR); urinary tract infection; uropathogens.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents* / therapeutic use
  • Cross-Sectional Studies
  • Drug Resistance, Bacterial
  • Escherichia coli
  • Escherichia coli Infections* / drug therapy
  • Ghana / epidemiology
  • Humans
  • Klebsiella
  • Microbial Sensitivity Tests
  • Urinary Tract Infections* / drug therapy
  • beta-Lactamases

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • beta-Lactamases