Carbapenemase Production and Detection of Colistin-Resistant Genes in Clinical Isolates of Escherichia Coli from the Ho Teaching Hospital, Ghana.

Background: Effective and successful treatment of infectious diseases is a significant gain in clinical settings. However, resistance to antibiotics, especially the last-resort medicines, including carbapenems and colistin is on the rise. Aim: The aim of this study was to detect carbapenemase production and colistin-resistant genes in clinical isolates of Escherichia coli. Method. The study was a cross-sectional study carried out from July 2018 to June 2019. One hundred and thirty-five nonrepetitive E. coli isolates obtained from various clinical samples were screened for carbapenemase production using meropenem (10 µg) and imipenem (10 µg) disks. Screened-positive isolates were further subjected to a confirmatory test using modified carbapenem inhibition method (mCIM). Deoxyribonucleic acid (DNA) was extracted from all the isolates to detect colistin-resistant genes by polymerase chain reaction. Data were analyzed using GraphPad Prism version 8.00 for Windows and IBM SPSS version 26 (IMB Corp. New York, USA). Results: Of the 135 isolates, 2 were screened positive for carbapenemase production but tested negative to mCIM. With the colistin-resistant genes, only mcr-1 and mcr-2_700bp were detected in 3 of the E. coli isolates, representing 2.2%. The mcr-1 was detected in a high vaginal swab sample of a female aged between 65 and 84 years. Mcr-2_700bp was also detected in urine and blood samples of the patients. Conclusion: The study investigated the presence of carbapenemase and colistin-resistant genes in E. coli organisms. The absence of carbapenemase in the isolates and the detection of colistin-genes call for strict infection prevention and control practices to prevent their introduction and spread to other bacterial species, respectively.

Burden of Fluoroquinolone Resistance in Clinical Isolates of Escherichia coli at the Ho Teaching Hospital, Ghana.

BACKGROUND: The growing burden of antibiotic resistance is a threat to the management of infections. Infections by Escherichia coli are routinely treated with fluoroquinolone antimicrobial agents. Due to their frequent use, there has been increasing resistance to these drugs. We set out to determine the burden of fluoroquinolone resistance among clinical E. coli isolates at the Ho Teaching Hospital, Ghana. METHODS: This was a cross-sectional study conducted from July 2018 to June 2019. One hundred and thirty-five E. coli isolates were cultured from various clinical samples. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method with discs of nalidixic acid (NAL), ciprofloxacin (CIP), norfloxacin (NOR) and levofloxacin (LEV). Deoxyribonucleic acid (DNA) was extracted from the resistant isolates for the detection of fluoroquinolone resistant genes by polymerase chain reaction. RESULTS: Ninety of the 135 isolates (66.7%) were resistant to at least one of the four fluoroquinolone drugs investigated. Resistance to NAL, CIP, NOR, and LEV was 51.0%, 51.1%, 38.8% and 35.7% respectively. Out of the fluoroquinolone resistant isolates, 69 carried one or more fluoroquinolone resistant genes. The predominant resistant genes were aac(6')-Ib-cr (48.9%) and qnrD (25.6%). Seven of the isolates carried both qnrS and aac(6')-Ib-cr genes. Two isolates carried 5 different fluoroquinolone resistant genes. CONCLUSION: High prevalence of resistance to 4 fluoroquinolone drugs was recorded with associated resistant genes. This is a threat to current efforts to control the spread of antibiotic resistance and calls for concerted efforts to curb the spread of these resistant organisms.

A Comparative Study of the Epidemiology of Treponemal Infection in the Volta and Oti Regions of Ghana: A Five-Year Multisite Parallel Population-Based Analysis vis-à-vis the Sentinel Survey.

Treponemal infections can be blood-borne with great public health consequences. This study is aimed at comparatively describing the five-year (2013-2017) regional epidemiology of treponemal infection using pregnant women in the sentinel survey and apparently healthy blood donors as a proxy for the general population at four sentinel sites in the Volta and Oti Regions of Ghana. We analyzed retrospective data from 17,744 prospective blood donors aged 18 to 58 years and 7,817 pregnant women in a sentinel survey with ages from 15 to 49 years at Hohoe, Ho, Tongu, and Krachi West sentinel sites in the Volta and Oti Regions. Laboratory data extracted include variables such as age, gender, date of blood donation, and Treponema pallidum chromatographic immunoassay results from the blood banks of the four study sites. The five-year treponemal infection rate among the pregnant women in the sentinel survey and prospective blood donors was 0.79% and 2.38%, respectively. Site-specific infection rate for population-based/sentinel survey was 4.6%/1.1%, 2.0%/0.5%, 1.3%/1.1, and 1.2%/0.3% for Hohoe, Ho, Krachi West, and Tongu, respectively. Significant gender disparity in Treponemal infection rate exists with a male preponderance. The regional infection rate in the sentinel survey is lower compared to the general population. Therefore, the use of pregnant women as a proxy for population estimates could underestimate the burden in the study jurisdiction.

Factors Influencing Adherence to Tuberculosis Treatment in the Ketu North District of the Volta Region, Ghana.

Annually, ten million cases of tuberculosis (TB) and about 1.8 million mortalities are recorded. Adherence to TB treatment not only reduces death outcomes but prevents prolonged sickness, transmission to others, and the development of multidrug-resistant TB. This study is aimed at determining the rate of treatment adherence, knowledge of TB infection, and the possible factors influencing adherence to TB treatment in the Ketu North District in the Volta Region of Ghana. A cross-sectional study design was employed. A semistructured questionnaire was used to obtain data from respondents. Adherence to TB treatment and knowledge level about TB infection were assessed. A Chi-square test analysis was used to determine the variables that were associated with treatment adherence. Logistic regression analysis was used to determine potential factors that contribute to treatment adherence. A total of 125 TB registrants were enrolled in the study. The majority (102 (81.6%)) adhered to the TB treatment regimen. However, the level of knowledge about night sweat being a symptom of TB infection was relatively low (78 (62.4%)). Logistic regression analysis revealed that the male gender was about three times more likely (OR = 2.978, 95%CI = 1.173-7.561; p = 0.022) to be associated with adherence to TB treatment. However, food availability (OR = 2.208, 95% CI (0.848-5.753); p = 0.10) and household size (OR = 0.538, 95% CI (0.195-1.483); p = 0.23) were not significantly associated with treatment adherence. In this study, adherence to TB treatment and the knowledge level of TB infection were high. However, the knowledge level of night sweat being a symptom of TB infection was relatively low. Being a male was significantly associated with treatment adherence. An intensified health education on the symptoms of TB infection is therefore recommended.

Inter-rater Variability in Malaria Microscopy at the LEKMA Hospital, Ghana.

BACKGROUND: Malaria remains a major cause of morbidity and mortality worldwide and particularly in sub-Saharan Africa where it is endemic. As such, it is important that a proper diagnosis is made before treatment is initiated. Malaria parasite count plays a key role in the diagnosis and management of malaria. Variations in ratings by laboratory personnel can impact negatively on the treatment regimen for malaria-infected patients. The study is thus aimed at evaluating and comparing the proficiency and parasitaemia counts by two different categories of laboratory staff at the LEKMA Hospital, Ghana. MATERIALS AND METHODS: A total of 200 confirmed malaria-positive samples were used in the study. Six thick and thin films were prepared from each sample and uniquely labelled. Two of the six slides were given to two WHO-accredited malaria microscopists to examine and report their respective parasite count/µl (parasite count/WBC × 8000). These were used as the reference for the two categories of laboratory staffs: rater A being diploma holders (Technical Officers referred to as untrained rater) and rater B being degree holders (Medical Laboratory Scientist referred to as trained rater) at the LEKMA Hospital. RESULTS: In comparison to the expected outcome, the parasite count by the rater group A (190 (151-239)]) and the rater group B (177 (140-224)) demonstrated significant positive correlation (r = 0.995, p < 0.0001 vs. r = 0.995, p < 0.0001, respectively) with the expected outcome in the cases of heavy parasitaemia. A statistically significant difference (p < 0.05) between counts by the different raters in low parasitemia was observed in this study. A persistent nosedive inter-rater agreement from k = 0.82 to k = 0.40 with increasing density cutoff was observed in this study. CONCLUSION: The study observed that the degree of inter-rater agreement of parasite density count by various categories of laboratory personnel is almost perfect. However, the parasite count between raters varied significantly with very low levels of parasitemia but better correlated with heavy parasitemia.

Predicting type 2 diabetes mellitus among fishermen in Cape Coast: a comparison between the FINDRISC score and the metabolic syndrome.

BACKGROUND: Studies over the past decades have observed a sharp rise in the prevalence and incidence of type 2 diabetes mellitus (T2DM). A highly sensitive and specific predictive tool for risky populations is essential. This study assessed two significant diabetes mellitus predictive tools for effectiveness and accuracy among people living in fishing communities in Cape Coast, Ghana. METHOD: In April 2019, we recruited one hundred and thirty-five (135) fishermen from three fishing communities in Cape Coast in the Central Region of Ghana. Each participant underwent a standard metabolic procedure including clinical examination as well as taking of anthropometric variables such as weight, height, waist and hip circumference were also measured. The FINDRISC questionnaire was used to gather data from the respective participants. Serum glucose and lipids were estimated with enzymatic techniques, and metabolic syndrome (MetS) screened with the international diabetes federation (IDF) criteria. RESULTS: Of the 135 participants, 71 (52.6%) were women. The average age of study participants was 52 ± 16 years with females averagely older (56.6 ± 15.0) than the males (47.3 ± 15.0). This study recorded 31.1% and 8.9% prediabetic and diabetic fishermen respectively. Frequency of both prediabetes and diabetes was significantly predominant among females (71.4% vs 83.3%) than males (26.2% vs 25.0%) (p < 0.001) respectively. Prevalence of MetS according to the IDF criteria was 18.5%, significantly higher among females (92.0%) than recorded among the males (18.5%). The discriminatory accuracy of FINDRISC [aROC = 0.76 (95% CI 0.68 to 0.83); sensitivity = 58.3% and specificity = 86.9%; p = 0.003; optimal cut-off point = 13.50] and the MetS [aROC = 0.74 (95% CI 0.66 to 0.81); sensitivity = 75.0% and specificity = 71.5%; p = 0.002] despite demonstrating a significantly good capacity to detect T2DM were statistically comparable [aROC = 0.018 (95% CI -0.152 to 0.189); p = 0.834] in our study. CONCLUSION: Our findings indicate that both FINDRISC (with a suitable cut-off value of 13.5) and MetS screening tools possess a good predictive capacity for the detection of T2DM. Additionally, FINDRISC can be employed to detect MetS in a high-risk population.

The Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Patterns: A Nine-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana.

BACKGROUND: Bloodstream infections are among the top causes of morbidity and mortality in people of all ages, especially in immunocompromised patients in sub-Saharan Africa. This study aimed at describing the epidemiology of bloodstream infections and antimicrobial susceptibility pattern over a nine-year period at St. Dominic Hospital, Akwatia, in the Eastern Region of Ghana. METHOD: This study retrospectively analysed data from 4,489 patients who were referred to the Laboratory Department for blood culture and sensitivity testing from January 2009 to December 2017. Sociodemographic data included age, gender, and patients' department. Blood culture results were retrieved from archival records in the laboratory. The authorities of St. Dominic Hospital granted approval for the study. RESULTS: The incidence of bloodstream infection over the 9 years was 51.4 positive cultures per 100,000 hospital attendance. Staphylococcus aureus was the leading causative agent of bacteraemia for the first two scalar years (2009-2011 (38.9%) and 2012-2014 (42.2%)) while coagulase-negative staphylococcus (CoNS) (50.5%) was predominant for the last scalar year (2015-2017), followed by Staphylococcus aureus (169/587 (28.8%)). The highest incidence of bloodstream infections was recorded in the wet seasons (months of May (8.9 per 10,000 persons) and October (10.1 per 10,000 persons)). The bacterial isolates demonstrated high resistance to tetracyclines (390/531 (73.4%)), penicillins (1282/1669 (76.8%)), and sulphonamides (450/499 (90.2%)). CONCLUSION: Bloodstream infection and antimicrobial resistance are high in patients seeking healthcare in Akwatia. This therefore calls for concerted efforts aimed at reducing the incidence in the study area.