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Laboratory-based nationwide surveillance of antimicrobial resistance in Ghana

Authors Opintan J, Newman MJ, Arhin RE, Donkor ES, Gyansa-Lutterodt M, Mills-Pappoe W

Received 17 May 2015

Accepted for publication 13 August 2015

Published 18 November 2015 Volume 2015:8 Pages 379—389

DOI https://doi.org/10.2147/IDR.S88725

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Rekha Dhanwani

Peer reviewer comments 5

Editor who approved publication: Professor Suresh Antony

Japheth A Opintan,1 Mercy J Newman,1 Reuben E Arhin,1 Eric S Donkor,1 Martha Gyansa-Lutterodt,2 William Mills-Pappoe3

1Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, 2Pharmaceutical Services, Ministry of Health, Ghana Health Services, 3Clinical Laboratory Unit, Institutional Care Division, Ghana Health Service, Accra, Ghana

Abstract: Global efforts are underway to combat antimicrobial resistance (AMR). A key target in this intervention is surveillance for local and national action. Data on AMR in Ghana are limited, and monitoring of AMR is nonexistent. We sought to generate baseline data on AMR, and to assess the readiness of Ghana in laboratory-based surveillance. Biomedical scientists in laboratories across Ghana with capacity to perform bacteriological culture were selected and trained. In-house standard operating protocols were used to perform microbiological investigations on clinical specimens. Additional microbiological tests and data analyses were performed at a centralized laboratory. Surveillance data were stored and analyzed using WHONET program files. A total of 24 laboratories participated in the training, and 1,598 data sets were included in the final analysis. A majority of the bacterial species were isolated from outpatients (963 isolates; 60.3%). Urine (617 isolates; 38.6%) was the most common clinical specimen cultured, compared to blood (100 isolates; 6.3%). Ten of 18 laboratories performed blood culture. Bacteria isolated included Escherichia coli (27.5%), Pseudomonas spp. (14.0%), Staphylococcus aureus (11.5%), Streptococcus spp. (2.3%), and Salmonella enterica serovar Typhi (0.6%). Most of the isolates were multidrug-resistant, and over 80% of them were extended-spectrum beta-lactamases-producing. Minimum inhibitory concentration levels at 50% and at 90% for ciprofloxacin, ceftriaxone, and amikacin on selected multidrug-resistant bacteria species ranged between 2 µg/mL and >256 µg/mL. A range of clinical bacterial isolates were resistant to important commonly used antimicrobials in the country, necessitating an effective surveillance to continuously monitor AMR in Ghana. With local and international support, Ghana can participate in global AMR surveillance.

Keywords: antimicrobial resistance, ESBL-producing, quinolone, multiple drug resistance

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