Laboratory-based nationwide surveillance of antimicrobial resistance in 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

Supplementary material

Figure S1 Weekly data report form.

Acknowledgments

The following biomedical scientists were involved in the microbiological analysis and data collation at the laboratory levels and are gratefully acknowledged: Hodogbe P and Adade NE, Korle-Bu Teaching Hospital, Accra; Ampah EO, Ridge Hospital, Accra; Arthur F and Derban I, University of Cape Coast Hospital, Cape Coast; Mensah E, Holy Family Hospital, Nkawkaw; Twasam J and Opoku CN, LEKMA Hospital; Mensah E and Amedzro I, Sekondi Public Health Reference Laboratory; Agede C, Volta Regional Hospital; Tetteh F, Tema General Hospital, Accra; Kwakye R and Ehiem RC, St Patrick’s Hospital, Offinso; Tetteh-Ocloo G, Koforidua Regional Hospital, Koforidua; Ayivase J, Holy Family Hospital, Berekum; Kuma GK, Sunyani Regional Hospital; Tetteh I, Komfo Anokye Teaching Hospital, Kumasi; Asiedu B, Upper East Regional Hospital; and Bobzah BP, Tamale Teaching Hospital, Tamale. The authors also thank the staff of the Medical Microbiology Department, University of Ghana Medical School (now School of Biomedical and Allied Health Sciences), for technical support. The authors appreciate the invaluable role played by Mr Amos Akanwena.

Funding

ReAct through the Ministry of Health/Ghana National Drug Programme (GNDP) and the Antibiotic Drug use Monitoring and Evaluation of Resistance (ADMER) project jointly provided funding for this surveillance; grant numbers are MoH/DM-UGMS/2014 and SSI 09-099, respectively. GNDP and ADMER are funded by ReAct and DANIDA.

Disclosure

The authors report no conflicts of interest in this work.