Prevalence of carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacteriaceae in a teaching hospital in Ghana

Abstract

AbstractBackgroundCarbapenem-resistant Enterobacteriaceae (CRE) and Extended-spectrum beta-lactamase (ESBL) production among Gram-negative Enterobacteriaceae is an increasing global challenge because of the high morbidity and mortality associated with their infections, especially in developing countries where there may not be many antibiotic treatment options. Despite these challenges, there are few studies in Ghana that have described the burden of CRE. This study aimed to determine the prevalence of carbapenem-resistant Enterobacteriaceae isolated from patients at the Cape Coast Teaching Hospital (CCTH) in the Central region of Ghana.Methodology/Principal findingsEnterobacteriaceae isolates were collected from April to July 2019 at the bacteriology unit of CCTH using a consecutive sampling method. Isolates were identified by standard microbiological techniques and confirmed using API 20E. Kirby Bauer disc diffusion method was used to determine the antibiogram of isolates. Isolates were also subjected to ESBL testing using the single-disc combination method. Carbapenem resistant isolates were identified by the Kirby Bauer disc diffusion method and then subjected to genetic confirmation using polymerase chain reaction (PCR). Of the 230 isolates comprising E. coli (40.9%), Citrobacter spp. (32.6%), K. pneumoniae (9.1%), P. mirabilis (6.1%), P. vulgaris (5.2%), Enterobacter spp (3.5%)., K. oxytoca (2.2%), and Serratia marcenses (0.4%). Majority of the isolates were from urine 162(70.4%) and wound samples. The isolates showed high resistance to ampicillin 171 (74.3%) and cefuroxime 134(58.3%). The prevalence of MDR was 35.2% (81) with E. coli 40(42.6%) being the majority that exhibited MDR. Out of the 230 isolates, 113(49.1%) were ESBL producers with E. coli 54(57.5%) accounting for the majority while Serratia marcenses was the least. Out of the 13 (5.7%) CRE isolates which showed resistance towards carbapenem in the disc diffusion method, 11 expressed the blaNDM-1 gene whilst all isolates which showed resistant CRE expressed the blaOXA-48 gene.ConclusionThe prevalence of carbapenem resistance and ESBL- producing Enterobacteriaceae pathogens among patients at the CCTH, Cape coast of Ghana is high, and effective infection prevention and control measures should be implemented at the hospital to prevent the rapid spread of these dangerous organisms.