Antibiotic Resistance Profile of Non-Extended Spectrum Beta-Lactamase-producing Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Abstract

One of the major challenges facing health professionals is the prevalence of antibiotic resistance. Most Gram-negative bacteria produce beta-lactamases which are enzymes that in-activate ?-lactams. Recent publications suggested that extended spectrum beta-lactamase production in E. coli and K. pneumoniae is one of the main causes of antimicrobial resistance in penicillins, cephalosporins and some non-beta-lactam antibiotics in Accra. This present work sought to determine the resistance profile of antimicrobials to non-ESBL-producing isolates in Accra. The 400 K. pneumoniae and E. coli isolates were screened for non-ESBL-producing strains using the combined disk method. The minimum inhibition concentration for 17 antibiotics was determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  Among the 400 total bacterial isolates, 198 (49.5%) were non-ESBL producers. Co-resistances to ampicillin (66.7%), piperacillin (59.1%), tetracycline (77.8%) and trimethoprim/sulphamethoxazole (68.2%) have been collaborated in this work. The increasing rise in resistance to the beta-lactam/beta-lactamase inhibitor combination antibiotics such as amoxicillin/clavulanic acid (13.6%) and piperacillin/tazobactam (18.7%) is problematic since they have become the empirical drug of choice for treating most infections. The steady increase in resistance to gentamicin (17.2%) as well as the floroquinolones such as ciprofloxacin (39.4%) and norfloxacin (34.9%) is alarming. In the absence of ESBLs, cephalosporins generally have been effective in treating infections caused by enterobacteria. Nitrofurantoin remains reliable for managing non-life threatening urinary tract infections. Amikacin and imipenem continue to be effective third-line treatment options for Gram-negative bacteria infections.  As antibiotic resistance increases and the development of new antimicrobials declines, it is imperative that we use antimicrobials that are still effective rationally. Evidence based antibiotic prescriptions and usage as well as regular evaluation of antibiotic resistance will help to control the spread of antibiotic resistance in Accra, Ghana.

Keywords: Extended spectrum beta-lactamase, Resistance, Antibiotic