Abstract
Development of antimicrobial resistance has been assigned to excess and misuse of antimicrobial agents. Staphylococci are part of the normal flora but are also potential pathogens that have become essentially resistant to many known antibiotics. Resistances in coagulase negative staphylococci (CoNS) are suggested to evolve due to positive selective pressure following antibiotic treatment. This study investigated the presence of the nine most commonly used antimicrobial agents in human urine from outpatients in two hospitals in Ghana in relation to CoNS resistance. Urine and CoNS were sampled (n = 246 and n = 96 respectively) from patients in two hospitals in Ghana. CoNS were identified using Gram staining, coagulase test, and MALDI-TOF/MS, and the antimicrobial susceptibility to 12 commonly used antimicrobials was determined by disk diffusion. Moreover an analytical method was developed for the determination of the nine most commonly used antimicrobial agents in Ghana by using solid-phase extraction in combination with HPLC-MS/MS using electron spray ionization. The highest frequency of resistance to CoNS was observed for penicillin V (98%), trimethoprim (67%), and tetracycline (63%). S. haemolyticus was the most common isolate (75%), followed by S. epidermidis (13%) and S. hominis (6%). S. haemolyticus was also the species displaying the highest resistance prevalence (82%). 69% of the isolated CoNS were multiple drug resistant (≧4 antibiotics) and 45% of the CoNS were methicillin resistant. Antimicrobial agents were detected in 64% of the analysed urine samples (n = 121) where the most frequently detected antimicrobials were ciprofloxacin (30%), trimethoprim (27%), and metronidazole (17%). The major findings of this study was that the prevalence of detected antimicrobials in urine was more frequent than the use reported by the patients and the prevalence of resistant S. haemolyticus was more frequent than other resistant CoNS species when antimicrobial agents were detected in the urine.
Highlights
IntroductionDevelopment of antimicrobial resistance has been assigned to excess and misuse of antimicrobial agents which provide selective pressure favouring the appearance of resistant strains [2]
The development of effective antimicrobial agents has been accompanied by the emergence of drug resistant organisms, and has arisen as one of the most serious health care problems in the world, especially in low and middle income countries [1].Development of antimicrobial resistance has been assigned to excess and misuse of antimicrobial agents which provide selective pressure favouring the appearance of resistant strains [2]
S. haemolyticus showed a higher frequency of resistance to gentamicin and cefoxitin compared to S. epidermidis (Fisher’s exact test, p50.008 and p50.036, respectively), and a lower frequency of resistance to fusidic acid compared to the other staphylococcal species (p,0.036)
Summary
Development of antimicrobial resistance has been assigned to excess and misuse of antimicrobial agents which provide selective pressure favouring the appearance of resistant strains [2] In developing countries such as Ghana, increasing prevalence of resistance towards several antimicrobial groups has been reported in various bacterial pathogens [3,4,5]. More than 80% of Escherichia coli strains that were isolated from stools of healthy volunteers in Ghana exhibited resistance to ampicillin, tetracycline, chloramphenicol and co-trimoxazole [6] These studies do indicate a widespread prevalence of antimicrobial resistance in the most important bacterial pathogens in Ghana [6], and that resistance is a serious problem both for community-acquired as well as for nosocomial infections (hospital-acquired)
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