Prevalence and Trends of Multidrug-Resistant Gram-Negative Bacteria in the Tamale Metropolis, Ghana (2020-2023)

다국어 초록 (Multilingual Abstract)

Background: Multidrug-resistant gram-negative bacteria (MDR) represent a serious risk to public health, especially in environments with limited resources. MDR pathogen-induced infections raise morbidity, death, and medical expenses. Comprehensive data on the prevalence and trends of MDR Gram-negative bacteria are lacking in Ghana's Northern Region, which includes the Tamale Metropolis. By calculating the prevalence, analyzing antibiotic resistance patterns, and evaluating the trends of MDR Gram-negative bacteria in the Tamale Metropolis between 2020 and 2023, this study seeks to close this gap.
Methodology: The Tamale Public Health Reference Laboratory's microbiological data was used in a retrospective longitudinal study design. Data on bacterial isolates from clinical specimens (blood, urine, sputum, and wound swabs) were extracted between January 2020 and December 2023. Gram-negative bacteria, such as Acinetobacter spp, Klebsiella spp, Pseudomonas aeruginosa, and Escherichia coli, were found. The Clinical and Laboratory Standards Institute (CLSI) recommendations for conducting antimicrobial susceptibility tests were followed. Descriptive statistics and chi-square tests were used in the statistical study to find the variables linked to MDR.
Results: Gram-negative bacterial infections were identified in 1570 (33.7%) of the 4,859 clinical samples examined. Among Gram-negative isolates, the overall incidence of MDR was 40.8%; the highest resistance rates were found for ciprofloxacin (46%) and cephalosporins (51%). The most frequently isolated organisms were Escherichia coli and Klebsiella spp, which accounted for 20.4% and 28.9% of cases, respectively. Individuals 60 years of age and older had the highest prevalence of MDR.
Conclusion: This study shows that multidrug-resistant Gram-negative bacteria are highly prevalent in the Tamale Metropolis, and their resistance to widely used antibiotics has significantly increased. The results highlight the critical need for improved antimicrobial stewardship, focused infection control measures, and ongoing monitoring of regional resistance trends. To reduce the spread of MDR infections and enhance clinical results, it is imperative to strengthen laboratory capacity and enforce stringent antibiotic use restrictions.

목차 (Table of Contents)

• LIST OF FIGURES ························································································································ iv LIST OF TABLES ··························································································································· v LIST OF ABBREVIATIONS ········································································································· vi ABSTRACT IN ENGLISH ·········································································································· viii
• I. INTRODUCTION ························································································································ 1
• 1.1. Research background ············································································································ 1 1.2.Problemstatement ················································································································3 1.3. Significance of the study ······································································································· 4 1.4. Research question. ················································································································ 5 1.5. Objectives ····························································································································· 5
• 1.5.1. General Objective ······································································································ 5
• 1.5.2. Specific Objectives ···································································································· 5 1.6. Hypothesis ···························································································································· 5 1.7. Operational definition ··········································································································· 5
• II. LITERATURE REVIEW ············································································································ 7
• 2.1. Multidrug-resistant gram-negative bacterial epidemiology ················································ 7
• 2.2. Gram-negativebacteria········································································································8
• 2.3. Multidrug-Resistance in gram-negative bacteria ······························································· 9
• 2.3.1. Acinetobacter baumannii ························································································· 10 2.3.2. Enterobacteriaceae ··································································································· 11 2.3.3. Pseudomonas aeruginosa ························································································ 11
• 2.4. RiskFactorsforResistance·······························································································12
• 2.5. EmpiricTreatmentGuidelines···························································································13 2.5.1. Pneumonia Associated with Ventilators and Hospital-Acquired Pneumonia ·········· 14 2.5.2. Blood Stream Infections ·························································································· 15 2.5.3. Intra-Abdominal Infections ····················································································· 18 2.5.4. Urinary Tract Infections ··························································································· 19
• 2.6. TherapeuticApproachestoGram-NegativeInfections·····················································21
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• 2.6.1. The Resurgence of Old Antibiotics ········································································· 21
• 2.6.2. New Antibiotics ······································································································· 24 2.7. Thethreatofantimicrobialresistanceindevelopingcountries·········································30 2.7.1. Causes of antimicrobial resistance ··········································································· 31
• III. METHODOLOGY ··················································································································· 37
• 3.1. Study design. ······················································································································· 37 3.2. Study population. ················································································································ 37 3.2.1. Population and setting ······························································································ 37 3.3. Sampling Procedure. ··········································································································· 38
• 3.3.1. Sampling frame ········································································································ 38
• 3.3.2. Sampling technique ································································································· 38
• 3.3.3. Inclusion Criteria ····································································································· 39
• 3.3.4. Exclusion Criteria ···································································································· 39
• 3.3.1. Sample Size Estimation ··························································································· 40
• 3.3.2. Antibiotic susceptibility testing, identification, and isolation of bacteria are pre-study realizations. ······························································································ 40
• 3.4. Variables ······························································································································ 40 3.5. Statistical Analysis ············································································································ 42 3.6. Ethical Consideration ·········································································································· 42
• IV. RESULTS ································································································································· 44
• 4.1. Descriptivecharacteristicsofthestudypopulation···························································44 4.1.1. Demographic characteristics ···················································································· 44 4.1.2.Laboratorymarkers ·································································································45
• 4.2. Period Prevalence of MDR amongst Gram-negative confirmed cases ······························· 47 4.3. Trend of MDR cases across demographic characteristics of patients ································· 48 4.4. Trends of Antimicrobial Resistance pattern for antimicrobial categories ·························· 54
• V. DISCUSSION ···························································································································· 58
• 5.1. Prevalence of Multidrug-Resistant Gram-Negative Bacteria ············································ 58 5.2. Antibiotic Resistance Patterns ··························································································· 59 5.3.TrendsinMultidrug-Resistance ·························································································60 5.4. Public Health Implications of Multidrug-Resistance in Tamale Metropolis ······················ 61 5.5. Implications for Antimicrobial Stewardship and Infection Control ··································· 62
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• VI.CONCLUSION ·······················································································································63
• 6.1. Recommendations ··············································································································· 64 6.2. Limitations of the Study ······································································································ 65
• REFERENCES ······························································································································· 66