Genotypic characterization of extended-spectrum ß-lactamase producing urinary isolates among pregnant women in Ho municipality, Ghana.

Objective: The case of antibiotic resistance has become a major global concern and Extended Spectrum ß-lactamase (ESBL) producing organisms have so far remained the biggest culprit. The consequences of urinary tract infection (UTI) and antibiotic resistance among pregnant women cannot be underestimated. We investigated UTI and ESBL production among urinary pathogens isolated from pregnant women. Method: We obtained non-repeat, clean catch midstream urine samples from 1345 pregnant women suspected of having UTI for bacterial identification at the Ho Teaching Hospital Laboratory between June 2013 and March 2015. The isolates were taken through relevant biochemical testing for identification and then subjected to antimicrobial agents for susceptibility testing using the disc diffusion method. We tested for ESBL production by the combined disc method and ESBL positive (+ESBL) phenotype isolates were genotyped for BlaTEM, BlaSHV, and BlaCTX-M using polymerase chain reaction (PCR). Data were analyzed using SPSS v24 and p-values < 0.05 were considered statistically significant. Results: Of the 1345 urine samples tested, 230 (17.1%, 95% CI: 15.1%-19.1%) yielded significant bacteriuria. The most common bacterium isolated was Staphylococcus aureus (29.6%) followed closely by Escherichia coli (28.7%) both of which were highest during the second trimester of gestation. We isolated 152 gram-negative isolates with 41.4% (63/230) being + ESBL. Of the 63 + ESBL, 45 (71.4%) possessed blaTEM, 42 (66.7%) had blaCTX-M and 2 (3.2%) possessed blaSHV genes; 38 possessed multiple ESBL genes comprising 2 with both SHV and TEM genes and 36 with both CTX-M and TEM genes. Conclusion: High prevalence of UTI and persistent transmission of ESBLs among pregnant women in the Ho Municipality is worrying and a course for public health concern. We recommend urine culture during pregnancy as a routine laboratory investigation to avoid birth-related complications.

Cryptosporidium Infection and Associated Risk Factors among Cattle in the Central Region of Ghana.

Cryptosporidium species infects a wide number of animals including livestock all over the world. The current study was done to determine the prevalence and risk factors of Cryptosporidium infection among cattle in the Central Region of Ghana. Two hundred and eighty-seven (287) faecal samples were randomly collected from animals on eight cattle farms in four districts across two agroecological zones. A commercial enzyme-linked immunosorbent assay kit (CoproELISA, Savyon® Diagnostics Ltd., Israel) for Cryptosporidium was used in the detection of Cryptosporidium antigens in faecal samples. Characteristics of the animals such as age, sex, and location, as well as consistency of faecal samples, were collected. Pearson's chi-square or Fisher's exact test was used to determine the association between explanatory variables and Cryptosporidium infection while a logistic regression model was also used to determine the risk of infection. The overall prevalence of Cryptosporidium infection was 23.7% (95% CI, 18.7-28.6). Prevalence was significantly higher (p = 0.049) among cattle aged 12-month old and above compared to those under 12 months of age. Among the four districts in the study area, Cape Coast metropolis recorded a significantly higher prevalence (60.5%; CI, 49.3-71.8), (p < 0.001) compared to the other three. Furthermore, a significant association was observed between the consistency of faecal samples and Cryptosporidium infection (p = 0.042). The prevalence of Cryptosporidium infection was also significantly higher among cattle from the coastal savanna zone (26.9%; 95% CI, 21.0-32.8) compared to those from the semideciduous forest area (p = 0.017). Cattle in the forest zone had a lower risk of being infected with the parasite compared to those from the coastal savanna zone (OR 0.408; 95% CI, 0.182-0.915). In conclusion, Cryptosporidium was prevalent among cattle in the Central Region of Ghana. A higher prevalence of Cryptosporidium infection occurred in older animals and among animals in the coastal agroecological zone. The area of location and age of animals were identified as risk factors for Cryptosporidium infection in the Central Region of Ghana.

Occurrence and distribution of extended-spectrum ß-lactamase in clinical Escherichia coli isolates at Ho Teaching Hospital in Ghana.

Objective: This study determined the occurrence and distribution of Extended Spectrum ß-Lactamase (ESBL) genotypes of E. coli isolates in Ho Teaching Hospital, Ghana. Design: A cross-sectional study. Setting: A single centre study was conducted at Ho Teaching Hospital of Ghana. Participants: Patients who visited Ho Teaching Hospital Laboratory with the request for culture and susceptibility testing. Main outcome measure: Escherichia coli were isolated, and Extended-Spectrum ß-Lactamase genes were detected. Results: Of the 135 isolates, 56(41.5%,95% CI: 33.1% - 50.3%) were ESBL producers. More males, 14(58.3%), produced ESBL than females, 42(37.8%). The ESBL prevalence was highest among the elderly who were 80 years and above 3(100.0%), with the least prevalence among patients within 50-59 years and 0-9 years age bracket, representing 4(25.0%) and 3(27.3%), respectively. The total prevalence of ESBL was marginally higher among out-patients (41.8% 95% CI: 31.9% - 52.2%) compared to in-patients [40.5% 95% CI: 24.8% - 57.9]. BlaTEM-1 was the predominant ESBL genotype obtained from 83.9% (47/56) of the confirmed ESBL producing isolates, with the least being TOHO-1 4(7.1%). The co-existence of 2 different ESBL genes occurred in 19(33.9%) of the isolates. The single and quadruple carriage were 16(28.6%) and 3(5.4%), respectively. The highest co-existence of the ESBL genotypes was recorded for blaTEM-1 and blaCTXM-1 15(26.8%), followed by blaTEM-1, blaCTXM-1 and blaSHV-73 [12(21.4%)]. Conclusion: The high prevalence of ESBL-producing E. coli isolates with multiple resistant gene carriage is a threat to healthcare in the study area. Funding: This research received no external funding.

Estimated Burden of Serious Fungal Infections in Ghana.

Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections. Incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia, and disseminated histoplasmosis cases in AIDS was estimated at 6275, 12,610 and 724, respectively. Oral and esophageal candidiasis collectively affect 27,100 Ghanaians and 42,653 adult asthmatics are estimated to have fungal asthma. We estimate a prevalence of 12,620 cases of chronic pulmonary aspergillosis (CPA and an incidence of 1254 cases of invasive aspergillosis (IA). Estimated cases of candidemia and candida peritonitis cases were 1446 and 217, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) and tinea capitis was 442,621 and 598,840, respectively. Mucormycosis and fungal keratitis each may affect 58 and 810 Ghanaians. These data highlight the urgent need for intensified awareness to improve diagnosis and management.