Multi-drug resistant bacteria isolates from lymphatic filariasis patients in the Ahanta West District, Ghana

Abstract

Background: Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates.

Results: Of the sixty (60) participants, fifty-four (n = 54, 90%) were within 31-60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged (in months) seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli. and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively.

Conclusion: The findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.

Keywords: Acute dermatolymphangioadenitis; Antimicrobial resistance; Extended-spectrum beta-lactamase; Lymphatic filariasis; Methicillin-resistant Staphylococcus aureus; Multi-drug resistance; Secondary bacterial infection.

Fig. 1

Sensitivity profile of MRSA against different antibiotics Key: SXT Sulfamethoxazole-trimethoprim, FOX Cefoxitin, C Chloramphenicol, CIP Ciprofloxacin, CC Clindamycin, E Erythromycin, CN Gentamicin, TET Tetracycline, P Penicillin. The breaks (white line) in the graph indicate resistant isolates (where the bars are below the break) or sensitive isolates (bars extend beyond the break) to the respective antibiotics listed

Fig. 2

Sensitivity profile of E. coli against different antibiotics Key: SXT Sulfamethoxazole-trimethoprim, TET Tetracycline, AM Ampicillin, SAM Ampicillin-sulbactam, C Chloramphenicol, CRO Ceftriaxone, CXM Cefuroxime, CAZ Ceftazidime, CIP Ciprofloxacin, GM Gentamicin, MEM Meropenem. The breaks (white line) in the graph indicate resistant isolates (where the bars are below the break) or sensitive isolates (bars extend beyond the break) to the respective antibiotics listed

Fig. 3

Sensitivity profile of P. aeruginosa against different antibiotics Key: SXT Sulfamethoxazole-trimethoprim, AM Ampicillin, SAM Ampicillin-sulbactam, C Chloramphenicol, CRO Ceftriaxone, CXM Cefuroxime, CAZ Ceftazidime, CIP Ciprofloxacin, CN Gentamicin, MEM Meropenem, TET Tetracycline, AN Amikacin, AZT Aztreonam. The breaks (white line) in the graph indicate resistant isolates (where the bars are below the break) or sensitive isolates (bars extend beyond the break) to the respective antibiotics listed

Fig. 4

Presence of resistance genes in MDR