High level of colonization with third-generation cephalosporin-resistant Enterobacterales in African community settings, Ghana

Noah Obeng-Nkrumah; Dennis Schrøder Hansen; Georgina Awuah-Mensah; Nana Kweiba Blankson; Niels Frimodt-Møller; Mercy Jemima Newman; Japheth Awuletey Opintan; Karen Angeliki Krogfelt

doi:10.1016/j.diagmicrobio.2023.115918

High level of colonization with third-generation cephalosporin-resistant Enterobacterales in African community settings, Ghana

Diagn Microbiol Infect Dis. 2023 May;106(1):115918. doi: 10.1016/j.diagmicrobio.2023.115918. Epub 2023 Feb 10.

Authors

Noah Obeng-Nkrumah¹, Dennis Schrøder Hansen², Georgina Awuah-Mensah³, Nana Kweiba Blankson⁴, Niels Frimodt-Møller⁵, Mercy Jemima Newman⁶, Japheth Awuletey Opintan⁶, Karen Angeliki Krogfelt⁷

Affiliations

¹ Department of Medical Laboratory Sciences, University of Ghana School of Biomedical and Allied Health Sciences, University of Ghana, Legon, Accra, Ghana. Electronic address: nobeng-nkrumah@ug.edu.gh.
² Department of Clinical Microbiology, Herlev and Gentofte University Hospital, Denmark.
³ School of Life Sciences Medical School, Queen's Medical Centre, University of Nottingham, Nottingham England.
⁴ Department of Microbiological diagnostics, Statens Serum Institut, Copenhagen Denmark.
⁵ Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
⁶ Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Legon, Accra, Ghana.
⁷ Department of Science and Environment, Pandemix Center Roskilde University, Roskilde, Denmark. Electronic address: karenak@ruc.dk.

PMID: 37058979
DOI: 10.1016/j.diagmicrobio.2023.115918

Abstract

A cross-sectional survey was conducted in eight Ghanaian communities to investigate the extent of intestinal colonization with 3^rd-generation cephalosporin-resistant Enterobacterales. The study collected faecal samples and corresponding lifestyle data from 736 healthy residents to assess the occurrence of cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae, with a focus on genotypes of plasmid-mediated ESBLs, AmpCs, and carbapenemases. The results showed that 371 participants (50.4%) carried 3^rd-generation cephalosporin-resistant E. coli (n=362) and K. pneumoniae (n=9). Most of these were ESBL-producing E. coli (n=352, 94.9%), carrying CTX-M genes (96.0%, n=338/352), mostly for CTX-M-15 (98.9%, n=334/338). Nine participants (1.2%) carried AmpC-producing E. coli that harboured bla_DHA-1 or blaCMY-2 genes, and two participants (0.3%) each carried a carbapenem-resistant E. coli that harboured both bla_NDM-1 and bla_CMY-2. Quinolone-resistant O25b: ST131 E. coli were recovered from six participants (0.8%) and were all CTX-M-15 ESBL-producers. Having a household toilet facility was significantly associated with a reduced risk of intestinal colonization (adjusted odds ratio, 0.71; 95% CI, 0.48-0.99; P-value=0.0095) in multivariate analysis. These findings raise serious public health concerns, and effective control of the spread of antibiotic-resistant bacteria is possible by providing better sanitary conditions for communities.

Keywords: AmpCs; Carbapenemases; ESBLs; Fecal carriage; Ghana; Risk factors.

Publication types

Review

MeSH terms

Cephalosporins / pharmacology
Cross-Sectional Studies
Escherichia coli Infections* / microbiology
Escherichia coli* / genetics
Ghana / epidemiology
Humans
Klebsiella pneumoniae / genetics
beta-Lactamases / genetics

Substances

beta-Lactamases
Cephalosporins