Molecular epidemiology of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae from three tertiary hospitals in southern Ghana.

Abstract

Antimicrobial resistance is fast becoming a global concern in both healthcare settings and in the community due to the rapid emergence of multi drug resistant organisms. High proportions of enterobacteria have developed resistance to the commonly prescribed antimicrobial drugs. Comprehensive data upon which to advocate control interventions are scanty. Hence this study determined the Molecular Epidemiology of ESBL producing enterobactericeae from three Tertiary Hospitals in Southern Ghana. A total of 167 non repetitive isolates consisting of 51 E. coli strains, 43 K. pneumoniae, 16 P. mirabilis, 21 P. aeruginosa ,12 A. baumannii and 24 other unspecified organisms were collected and tested for their antimicrobial susceptibility, ESBL production by double synergy method and the ESBL genotypes were determined by PCR. Major beta-lactams to which resistance was found in this study included Ampicillin (94.7%), Cefuroxime (81.6%), Cefamandole (71.9%), Ceftriaxone (69.4 %,), Augmentin (66.7%), Cefpodoxime (78.1%), Cefotaxime (78.9%). All these beta-lactams registered more than 50% resistance. ESBL percent prevalence were; 6.7% for Acinetobacter baumannii followed by 8.3% Proteus mirabilis, 15.0% Pseudomonas aeruginosa, 18.3% Klebsiella pneumoniae and 40% for E. coli. Other isolates recorded 11.7%. ESBL genotypes (TEM, SHV and CTX-M) were found in 118 out of 167 ESBLs phenotypically identified. The overall prevalence of ESBL detected was (71.51 %). The high prevalence of ESBL calls for immediate intervention strategies to prevent further spread. Training of laboratory personnel on phenotypic testing of ESBLs in addition to training clinical staff and prescribers on ESBL issues are advocated.