High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017-2021

Abstract

Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials.

Keywords: Access, Watch and Reserve (AWaRE) classification; Ghana; MDS Lancet Laboratories; antimicrobial resistance (AMR); multi-drug resistance (MDR); urinary tract infection; uropathogens.

Figure 1

Annual trends in the number of isolates for the top five GNBs and gram positives from urine samples of patients with urinary tract infections at MDS Lancet laboratories, Ghana, from 2017 to 2021. Number for each year is the total of each isolate for the particular year; Other GNB: all gram-negative bacilli isolated in the laboratory apart from E.coli, Klebsiella spp., Proteus spp., Pseudomonas spp. and Acinetobacter spp.; GPC: Gram-positive cocci.

Figure 2

Annual trends in the proportions of resistance to selected antimicrobials among E. coli isolated from urine samples of patients with urinary tract infections at MDS Lancet Laboratories, Ghana, from 2017 to 2021. ¹ Proportion for each year calculated with the number of samples in which E. coli was isolated in the year as the denominator (2017 = 1256, 2018 = 1877, 2019 = 3078, 2020 = 3469, 2021 = 5015); AUG: Amoxicillin/clavulanic acid; CXM: Cefuroxime; CIP: Ciprofloxacin; FOS: Fosfomycin; NIT: Nitrofurantoin; ESBL: Extended-spectrum beta-lactamase.