Multidrug-Resistant Gram-Negative Bacterial Infections in a Tertiary-Care Hospital in Northern Ghana: A Three-Year Retrospective Analysis

Abstract

Background: A variety of clinically important pathogens have developed multidrug resistance(MDR), which threatens global public health. This study aimed to determine the incidence,patterns, and trends of MDR of gram-negative bacterial isolates in clinical specimens in theTamale Teaching Hospital, Ghana. Methods: This retrospective study analyzed gram-negative bacterial isolates andantimicrobial susceptibility test (AST) results of patients who visited the Tamale TeachingHospital laboratory between 2017 and 2019. Results: A total of 2,779 gram-negative bacterial isolates and their phenotypic AST resultswere analyzed. From these, 1,297 gram-negative bacteria (46.7%) were isolated from urinesamples, while the rest were isolated from sputum (20.9%), wound (14.3%), and swabs(11.7%) samples, etc. Escherichia coli (23.8%) was the most common gram-negative pathogenfound predominantly in the urine samples (33.2%). All gram-negative bacteria isolatedbetween 2017 and 2019 showed high MDR. Klebsiella pneumoniae gradually increased itsMDR from 84.0% in 2017, 89.5% in 2018, to 95.1% in 2019. On the other hand, the MDR ratesin Pseudomonas aeruginosa were approximately 65.8%, varying from 59.5% in 2017 to78.7% in 2019. Among tested antimicrobials, amikacin was the most effective. Resistance toamikacin in Enterobacter spp., E. coli, and K. pneumoniae in vitro were 16.2%, 11.8%, and17.7%, respectively. Conclusion: The study has shown that the high levels of MDR in gram-negative bacteriaisolated may be associated with the infections recorded at the Tamale Teaching Hospital. The major gram-negative pathogens isolated have resistance to penicillins, cephalosporins,and fluoroquinolones. Aminoglycosides can offer high antibiotic activity to overcome gramnegativebacterial resistance. Further studies will be needed to decide policy direction oninfection prevention and control, and antimicrobial stewardship programs