Skip to main content
Top
Published in:

Open Access 01-12-2017 | Research

Prevalence of antimicrobial resistant pathogens from blood cultures: results from a laboratory based nationwide surveillance in Ghana

Authors: Japheth Awuletey Opintan, Mercy Jemima Newman

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

Login to get access

Abstract

Background

Blood stream infections (BSI) are critical medical conditions with high morbidity and mortality. There is paucity of information on BSI from surveillance studies in Ghana.

Aim

This study sought to demonstrate how useful BSI data can be gleaned from population-based surveillance, especially from resource-limited settings.

Methods

Data from a nationwide surveillance of antimicrobial drug resistance (AMR) in Ghana were extracted and analyzed. Secondly, we revived archived Staphylococcus aureus isolates from blood cultures that were cefoxitin resistant (CRSA), and screened these for protein A (spa) and mec A genes.

Results

Overall blood culture positivity was 11.2% (714/6351). All together, participating laboratories submitted 100 multidrug resistant blood culture isolates (Gram-negative = 49 and Gram-positive = 51). Prevalence of some Gram-negative isolates was as follows; Escherichia coli (20.4%), Pseudomonas aeruginosa (16.3%), Enterobacter spp. (14.3%), Salmonella serotype Typhi (8.2%) and Non-typhoidal Salmonella [NTS] (8.2%). Gram-positive pathogens included Staphylococcus aureus (66.7%), coagulase negative S. aureus [CoNS] (17.6%) and Streptococcus pneumoniae (11.8%). No methicillin resistance was confirmed in our CRSA isolates. Most blood stream associated infections were from inpatients (75%) and cultured bacteria were resistant to common and cheaper antimicrobials.

Conclusion

E. coli and S. aureus are common pathogens associated with BSI in Ghana and they are resistant to several antimicrobials. Active and continuous AMR surveillance can serve multiple purposes, including data generation for BSI.
Literature
1.
go back to reference Fabbro-Peray P, Sotto A, Defez C, Cazaban M, Molinari L, Pinède M, et al. Mortality attributable to nosocomial infection: a cohort of patients with and without nosocomial infection in a French university hospital. Infect Control Hosp Epidemiol. 2007;28:265–72.CrossRefPubMed Fabbro-Peray P, Sotto A, Defez C, Cazaban M, Molinari L, Pinède M, et al. Mortality attributable to nosocomial infection: a cohort of patients with and without nosocomial infection in a French university hospital. Infect Control Hosp Epidemiol. 2007;28:265–72.CrossRefPubMed
2.
go back to reference Munson EL, Diekema DJ, Beekmann SE, Chapin KC, Doern GV. Detection and treatment of bloodstream infection: laboratory reporting and antimicrobial management. J Clin Microbiol. 2003;41:495–7.CrossRefPubMedPubMedCentral Munson EL, Diekema DJ, Beekmann SE, Chapin KC, Doern GV. Detection and treatment of bloodstream infection: laboratory reporting and antimicrobial management. J Clin Microbiol. 2003;41:495–7.CrossRefPubMedPubMedCentral
3.
go back to reference Wilson J, Elgohari S, Livermore DM, Cookson B, Johnson A, Lamagni T, et al. Trends among pathogens reported as causing bacteraemia in England, 2004-2008. Clin Microbiol Infect. 2011;17:451–8.CrossRefPubMed Wilson J, Elgohari S, Livermore DM, Cookson B, Johnson A, Lamagni T, et al. Trends among pathogens reported as causing bacteraemia in England, 2004-2008. Clin Microbiol Infect. 2011;17:451–8.CrossRefPubMed
4.
go back to reference Adam HJ, DeCorby M, Rennie R, Karlowsky JA, Hoban DJ, Zhanel GG, et al. Prevalence of antimicrobial resistant pathogens from blood cultures from Canadian hospitals: results of the CANWARD 2007-2009 study. Diagn Microbiol Infect Dis. 2011;69:307–13.CrossRefPubMed Adam HJ, DeCorby M, Rennie R, Karlowsky JA, Hoban DJ, Zhanel GG, et al. Prevalence of antimicrobial resistant pathogens from blood cultures from Canadian hospitals: results of the CANWARD 2007-2009 study. Diagn Microbiol Infect Dis. 2011;69:307–13.CrossRefPubMed
5.
go back to reference Hamer DH, Darmstadt GL, Carlin JB, Zaidi AK, Yeboah-Antwi K, Saha SK, et al. Etiology of bacteremia in young infants in six countries. Pediatr Infect Dis J. 2015;34:e1–8.CrossRefPubMed Hamer DH, Darmstadt GL, Carlin JB, Zaidi AK, Yeboah-Antwi K, Saha SK, et al. Etiology of bacteremia in young infants in six countries. Pediatr Infect Dis J. 2015;34:e1–8.CrossRefPubMed
6.
go back to reference Krakash KP, Vinod A, Geethanjali PP. Bloodstream bacterial pathogens and their antibiotic resistance pattern in Dhahira Region, Oman. Oman Med J. 2011;26:240–79. Krakash KP, Vinod A, Geethanjali PP. Bloodstream bacterial pathogens and their antibiotic resistance pattern in Dhahira Region, Oman. Oman Med J. 2011;26:240–79.
7.
go back to reference Nielsen MV, Sarpong N, Krumkamp R, Dekker D, Loag W, Amemasor S, et al. Incidence and characteristics of bacteremia among children in rural Ghana. PLoS One. 2012;7:e44063.CrossRefPubMedPubMedCentral Nielsen MV, Sarpong N, Krumkamp R, Dekker D, Loag W, Amemasor S, et al. Incidence and characteristics of bacteremia among children in rural Ghana. PLoS One. 2012;7:e44063.CrossRefPubMedPubMedCentral
8.
go back to reference Obeng-Nkrumah N, Labi AK, Addison NO, Labi JE, Awuah-Mensah G. Trends in paediatric and adult bloodstream infections at a Ghanaian referral hospital: a retrospective study. Ann Clin Microbiol Antimicrob. 2016;15:49.CrossRefPubMedPubMedCentral Obeng-Nkrumah N, Labi AK, Addison NO, Labi JE, Awuah-Mensah G. Trends in paediatric and adult bloodstream infections at a Ghanaian referral hospital: a retrospective study. Ann Clin Microbiol Antimicrob. 2016;15:49.CrossRefPubMedPubMedCentral
9.
go back to reference Opintan JA, Newman MJ, Arhin RE, Donkor ES, Gyansa-Lutterodt M, Mills-Pappoe W. Laboratory-based nationwide surveillance of antimicrobial resistance in Ghana. Infect Drug Resist. 2015;8:379–89.CrossRefPubMedPubMedCentral Opintan JA, Newman MJ, Arhin RE, Donkor ES, Gyansa-Lutterodt M, Mills-Pappoe W. Laboratory-based nationwide surveillance of antimicrobial resistance in Ghana. Infect Drug Resist. 2015;8:379–89.CrossRefPubMedPubMedCentral
10.
go back to reference CLSI. Clinical Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: twenty-second informational supplement;[. provides updated tables for. M02-A11 and M07 …. (2012). CLSI. Clinical Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: twenty-second informational supplement;[. provides updated tables for. M02-A11 and M07 …. (2012).
11.
go back to reference Egyir B, Guardabassi L, Sørum M, Nielsen SS, Kolekang A, Frimpong E, et al. Molecular epidemiology and antimicrobial susceptibility of clinical Staphylococcus aureus from healthcare institutions in Ghana. PLoS One. 2014;9:e89716.CrossRefPubMedPubMedCentral Egyir B, Guardabassi L, Sørum M, Nielsen SS, Kolekang A, Frimpong E, et al. Molecular epidemiology and antimicrobial susceptibility of clinical Staphylococcus aureus from healthcare institutions in Ghana. PLoS One. 2014;9:e89716.CrossRefPubMedPubMedCentral
12.
go back to reference Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Seasonal variation in Escherichia coli bloodstream infection: a population-based study. Clin Microbiol Infect. 2009;15:947–50.CrossRefPubMedPubMedCentral Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Seasonal variation in Escherichia coli bloodstream infection: a population-based study. Clin Microbiol Infect. 2009;15:947–50.CrossRefPubMedPubMedCentral
13.
go back to reference Albrecht SJ, Fishman NO, Kitchen J, Nachamkin I, Bilker WB, Hoegg C, et al. Reemergence of gram-negative health care-associated bloodstream infections. Arch Intern Med. 2006;166:1289–94.CrossRefPubMed Albrecht SJ, Fishman NO, Kitchen J, Nachamkin I, Bilker WB, Hoegg C, et al. Reemergence of gram-negative health care-associated bloodstream infections. Arch Intern Med. 2006;166:1289–94.CrossRefPubMed
14.
go back to reference Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002). Diagn Microbiol Infect Dis. 2004;50:59–69.CrossRefPubMed Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002). Diagn Microbiol Infect Dis. 2004;50:59–69.CrossRefPubMed
15.
go back to reference Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19:501–9.CrossRefPubMed Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19:501–9.CrossRefPubMed
16.
go back to reference Gross U, Amuzu SK, de Ciman R, Kassimova I, Gross L, Rabsch W, et al. Bacteremia and antimicrobial drug resistance over time, Ghana. Emerg Infect Dis. 2011;17:1879–82.CrossRefPubMedPubMedCentral Gross U, Amuzu SK, de Ciman R, Kassimova I, Gross L, Rabsch W, et al. Bacteremia and antimicrobial drug resistance over time, Ghana. Emerg Infect Dis. 2011;17:1879–82.CrossRefPubMedPubMedCentral
17.
go back to reference Laupland KB, Church DL. Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev. 2014;27:647–64.CrossRefPubMedPubMedCentral Laupland KB, Church DL. Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev. 2014;27:647–64.CrossRefPubMedPubMedCentral
18.
go back to reference Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections. Ann Intern Med. 2004;140:26–32.CrossRefPubMed Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections. Ann Intern Med. 2004;140:26–32.CrossRefPubMed
19.
go back to reference Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother. 2005;49:760–6.CrossRefPubMedPubMedCentral Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother. 2005;49:760–6.CrossRefPubMedPubMedCentral
20.
go back to reference Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Predictive scoring model of mortality in Gram-negative bloodstream infection. Clin Microbiol Infect. 2013;19:948–54.CrossRefPubMed Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Predictive scoring model of mortality in Gram-negative bloodstream infection. Clin Microbiol Infect. 2013;19:948–54.CrossRefPubMed
21.
go back to reference Acquah SE, Quaye L, Sagoe K, Ziem JB, Bromberger PI, Amponsem AA. Susceptibility of bacterial etiological agents to commonly-used antimicrobial agents in children with sepsis at the Tamale Teaching Hospital. BMC Infect Dis. 2013;13:89.CrossRefPubMedPubMedCentral Acquah SE, Quaye L, Sagoe K, Ziem JB, Bromberger PI, Amponsem AA. Susceptibility of bacterial etiological agents to commonly-used antimicrobial agents in children with sepsis at the Tamale Teaching Hospital. BMC Infect Dis. 2013;13:89.CrossRefPubMedPubMedCentral
22.
go back to reference Labi AK, Obeng-Nkrumah N, Bjerrum S, Enweronu-Laryea C, Newman MJ. Neonatal bloodstream infections in a Ghanaian Tertiary Hospital: are the current antibiotic recommendations adequate. BMC Infect Dis. 2016;16:598.CrossRefPubMedPubMedCentral Labi AK, Obeng-Nkrumah N, Bjerrum S, Enweronu-Laryea C, Newman MJ. Neonatal bloodstream infections in a Ghanaian Tertiary Hospital: are the current antibiotic recommendations adequate. BMC Infect Dis. 2016;16:598.CrossRefPubMedPubMedCentral
23.
go back to reference Alizadeh AM, Kabiri Movahed R, Mohammadnia M. Comparative evaluation of conventional and BACTEC methods for detection of bacterial infection. Tanaffos. 2016;15:112–6.PubMedPubMedCentral Alizadeh AM, Kabiri Movahed R, Mohammadnia M. Comparative evaluation of conventional and BACTEC methods for detection of bacterial infection. Tanaffos. 2016;15:112–6.PubMedPubMedCentral
24.
go back to reference Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008-2014. Int J Infect Dis. 2016;50:75–82.CrossRefPubMedPubMedCentral Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008-2014. Int J Infect Dis. 2016;50:75–82.CrossRefPubMedPubMedCentral
25.
go back to reference Reddy EA, Shaw AV, Crump JA. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:417–32.CrossRefPubMedPubMedCentral Reddy EA, Shaw AV, Crump JA. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:417–32.CrossRefPubMedPubMedCentral
26.
go back to reference Luzzaro F, Ortisi G, Larosa M, Drago M, Brigante G, Gesu G. Prevalence and epidemiology of microbial pathogens causing bloodstream infections: results of the OASIS multicenter study. Diagn Microbiol Infect Dis. 2011;69:363–9.CrossRefPubMed Luzzaro F, Ortisi G, Larosa M, Drago M, Brigante G, Gesu G. Prevalence and epidemiology of microbial pathogens causing bloodstream infections: results of the OASIS multicenter study. Diagn Microbiol Infect Dis. 2011;69:363–9.CrossRefPubMed
27.
go back to reference Negussie A, Mulugeta G, Bedru A, All I, Shimeles D, et al. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Blood Culture Isolates among Septicemia Suspected Children in Selected Hospitals Addis Ababa, Ethiopia. Int J Biol Med Res. 2015;6:4709–17.PubMedPubMedCentral Negussie A, Mulugeta G, Bedru A, All I, Shimeles D, et al. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Blood Culture Isolates among Septicemia Suspected Children in Selected Hospitals Addis Ababa, Ethiopia. Int J Biol Med Res. 2015;6:4709–17.PubMedPubMedCentral
28.
go back to reference Muñoz P, Cruz AF, Rodríguez-Créixems M, Bouza E. Gram-negative bloodstream infections. Int J Antimicrob Agents. 2008;32(Suppl 1):S10–4.CrossRefPubMed Muñoz P, Cruz AF, Rodríguez-Créixems M, Bouza E. Gram-negative bloodstream infections. Int J Antimicrob Agents. 2008;32(Suppl 1):S10–4.CrossRefPubMed
29.
go back to reference Pearson A, Chronias A, Murray M. Voluntary and mandatory surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother. 2009;64(Suppl 1):i11–7.CrossRefPubMed Pearson A, Chronias A, Murray M. Voluntary and mandatory surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother. 2009;64(Suppl 1):i11–7.CrossRefPubMed
30.
go back to reference Obeng-Nkrumah N, Twum-Danso K, Krogfelt KA, Newman MJ. High levels of extended-spectrum beta-lactamases in a major teaching hospital in Ghana: the need for regular monitoring and evaluation of antibiotic resistance. Am J Trop Med Hyg. 2013;89:960–4.CrossRefPubMedPubMedCentral Obeng-Nkrumah N, Twum-Danso K, Krogfelt KA, Newman MJ. High levels of extended-spectrum beta-lactamases in a major teaching hospital in Ghana: the need for regular monitoring and evaluation of antibiotic resistance. Am J Trop Med Hyg. 2013;89:960–4.CrossRefPubMedPubMedCentral
31.
go back to reference Myat TO, Hannaway RF, Zin KN, Htike WW, Win KK, et al. ESBL- and carbapenemase-producing enterobacteriaceae in patients with bacteremia, Yangon, Myanmar, 2014. Emerg Infect Dis. 2017;23:857–9.CrossRefPubMedPubMedCentral Myat TO, Hannaway RF, Zin KN, Htike WW, Win KK, et al. ESBL- and carbapenemase-producing enterobacteriaceae in patients with bacteremia, Yangon, Myanmar, 2014. Emerg Infect Dis. 2017;23:857–9.CrossRefPubMedPubMedCentral
32.
go back to reference Chomvarin C, Siripornmongcolchai T, Chaicumpar K, Limpaiboon T, Wongkham C, et al. Evaluation of polymerase chain reaction, conventional and MRSA screen latex agglutination methods for detection of methicillin-resistant, −borderline and -susceptible Staphylococcus aureus. Southeast Asian J Trop Med Public Health. 2004;35:879–85.PubMed Chomvarin C, Siripornmongcolchai T, Chaicumpar K, Limpaiboon T, Wongkham C, et al. Evaluation of polymerase chain reaction, conventional and MRSA screen latex agglutination methods for detection of methicillin-resistant, −borderline and -susceptible Staphylococcus aureus. Southeast Asian J Trop Med Public Health. 2004;35:879–85.PubMed
Metadata
Title
Prevalence of antimicrobial resistant pathogens from blood cultures: results from a laboratory based nationwide surveillance in Ghana
Authors
Japheth Awuletey Opintan
Mercy Jemima Newman
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0221-0

Keynote webinar | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Watch it live: Wednesday 29th January, 18:00-19:30 CET
 

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more