Geographical Distribution of β-Lactam Resistance among Klebsiella spp. from Selected Health Facilities in Ghana.

Elvis Quansah,Isaac Dadzie,Dorcas Obiri-Yeboah,Obed Cudjoe,Prince Amoah Barnie,Desmond Omane Acheampong,Richael Odarkor Mills,Ebenezer Asmah

doi:10.3390/tropicalmed4030117

Elvis Quansah, Isaac Dadzie + Show 6 more

Open Access

https://doi.org/10.3390/tropicalmed4030117

Copy DOI

Abstract

β-Lactam-resistant Klebsiella isolates continue to cause multidrug resistance infections worldwide. This study aimed to describe the geographical distribution of extended spectrum β-lactamase (ESBL), AmpC β-lactamase (AmpC), and carbapenemase production among 139 Klebsiella isolates recovered from patients at major referral health facilities in Ghana. The phenotypic methods of combined disc diffusion test, modified three-dimensional test, modified Hodge test (MHT), and combined disc test were performed for each isolate to detect ESBL, AmpC, carbapenemase, and metallo-β-lactamase (MBL) producers, respectively. Except for MBL, all other β-lactam resistance mechanisms were highest in the healthcare facilities situated in the northern belt of Ghana. Significant regional difference of ESBL producers was observed between the northern and middle belts as well as the northern and southern belts. Genotypic detection with polymerase chain reaction (PCR) revealed the presence of bla TEM 36/139 (25.9%), bla SHV 40/139 (28.8%), bla CTX-M 37/139 (26.6%), bla OXA-48 3/139 (2.16%), and bla NDM 1/139 (0.72%) genotypes. In conclusion, there were variations in β-lactam resistance among Klebsiella spp. from health facilities situated in the northern, middle, and southern belts of Ghana. The study provides preliminary evidence that emphasizes the need to direct more attention to antimicrobial resistance control, especially in the northern belt of Ghana. Findings from this study may be critical for creating and fine-tuning effective antimicrobial resistance control strategies and for informing accurate antibiotic prescription by practitioners.

Highlights

This study aimed to describe the geographical distribution of ESBL, AmpC, and carbapenemase-producing Klebsiella isolates from major referral health centers situated in the northern, middle, and southern belts of Ghana using phenotypic and genotypic techniques
This study described the distribution of ESBL, AmpC, carbapenemase, and MBL resistance mechanisms by geographical location of the health facilities in Ghana
The present study documented the highest prevalence of ESBL, AmpC, and carbapenemase production in Klebsiella isolates from health facilities situated within the northern belt

Summary

Introduction

Among the human infections caused by the genus Klebsiella, Klebsiella pneumoniae remain the most clinically relevant species, accounting for over 70% of these infections [1]. Recent evidence indicates increasing relevance of Klebsiella oxytoca in nosocomial infections [2]. Until the 1990s, K. pneumoniae typically produced a single or rarely two plasmid-encoded β-lactamases. K. pneumonia is recognized as “a pool of potent β-lactamases” [8] and an indicator species for plasmid-encoding β-lactamases [8]. These β-lactamases constitute the chief resistance mechanisms that mediate the inactivation of β-lactam antibiotics by hydrolyzing the amide bond of the β-lactam ring [9,10]. Metallo-β-lactamase (MBL) are the most transmissible and are troublesome owing to their recent global dissemination and enhanced ability to hydrolyze a wide range of β-lactams [11]

Objectives

Methods

Results

Discussion

Conclusion