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Addae-Nuku DS, Kotey FCN, Dayie NTKD, Osei MM, Tette EMA, Debrah P, Donkor ES. Multidrug-Resistant Bacteria in Hospital Wastewater of the Korle Bu Teaching Hospital in Accra, Ghana. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221130613. [PMID: 36311334 PMCID: PMC9597020 DOI: 10.1177/11786302221130613] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/15/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is one of the top 10 public health threats. One approach to tackling the AMR menace could involve expanding the range of AMR surveillance domains to include hospital wastewater (HWW), a domain that has largely been overlooked by researchers. AIM To evaluate the occurrence of multidrug-resistant bacteria in hospital wastewater of the Korle Bu Teaching Hospital (KBTH). METHODOLOGY This was a longitudinal study involving 288 HWW samples consecutively collected across 12 weeks from the pool of wastewater emanating from 2 critical care units of KBTH-The Child Health Unit and the Maternity Unit-on Mondays and Thursdays, each week. The samples were cultured for bacteria, which were identified using the Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) technique and subjected to antimicrobial susceptibility testing via the Kirby-Bauer method. RESULTS In total, 294 bacteria of 23 different types, all being Gram-negative, were isolated from the 288 samples. The predominant ones were Escherichia coli (30.6%, n = 90), Klebsiella pneumoniae (11.2%, n = 33), Citrobacter freundii (10.9%, n = 32), Alcaligenes faecalis (5.8%, n = 17), and Pseudomonas mendocina (5.4%, n = 16). The prevalence of multidrug resistance among the isolates was 55.4% (n = 163). Moreover, the prevalence of extended-spectrum beta-lactamase (ESBL) producers was 15.6% (n = 46). E. coli accounted for the most ESBL-producing organisms (28.9%, n = 26). CONCLUSION The wastewater generated by the Maternity and Child Health Units of KBTH harbored a wide range of multidrug resistant bacteria, with a good proportion of these being ESBL producers, and the predominant one being E. coli. The study thus identifies the wastewater of KBTH as an important source of multidrug resistant organisms, and underscores the significance of appropriate treatment of wastewater of the hospital and other clinical, and related settings prior to its discharge.
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Affiliation(s)
- Daisy S Addae-Nuku
- Department of Medical Microbiology,
University of Ghana Medical School, Accra, Ghana
| | - Fleischer CN Kotey
- Department of Medical Microbiology,
University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie,
Accra, Ghana
| | - Nicholas TKD Dayie
- Department of Medical Microbiology,
University of Ghana Medical School, Accra, Ghana
| | - Mary-Magdalene Osei
- Department of Medical Microbiology,
University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie,
Accra, Ghana
| | - Edem MA Tette
- Department of Community Health,
University of Ghana Medical School, Accra, Ghana
| | - Philip Debrah
- Department of Pharmaceutics and
Microbiology, School of Pharmacy, College of Health Sciences, University of Ghana,
Legon, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology,
University of Ghana Medical School, Accra, Ghana
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Mutagonda RF, Bwire G, Sangeda RZ, Kilonzi M, Mlyuka H, Ndunguru J, Jonathan A, Makani J, Minja IK, Ruggajo P, Balandya E, Kamuhabwa AAR. Nasopharyngeal Carriage and Antibiogram of Pneumococcal and Other Bacterial Pathogens from Children with Sickle Cell Disease in Tanzania. Infect Drug Resist 2022; 15:4407-4418. [PMID: 35992757 PMCID: PMC9390788 DOI: 10.2147/idr.s367873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/03/2022] [Indexed: 01/30/2023] Open
Abstract
Background Bacterial infections contribute significantly to morbidity and mortality in sickle cell disease (SCD) patients, particularly children under five years of age. In Tanzania, prophylaxis against pneumococcal infection among children with SCD advocates the use of both oral penicillin V (PV) and pneumococcal vaccines (PNV). Therefore, this study aimed to investigate nasopharyngeal carriage and antibiogram of Streptococcal pneumoniae (S. pneumoniae) and Staphylococcus aureus (S. aureus) in children with SCD in Tanzania. Methods This cross-sectional study was undertaken at the two Sickle Pan-African Research Consortium (SPARCO) study sites in Dar es salaam, Tanzania. The study was conducted for six months and enrolled children with SCD between the ages of 6 to 59-months. A semi-structured questionnaire was used to collect patient data. Nasopharyngeal swabs were collected from all participants and cultured for Streptococcal pneumoniae and other bacterial isolates. Antimicrobial susceptibility tests of the isolates were done using the disc diffusion method. Results Out of 204 participants, the overall prevalence of bacterial carriage was 53.4%, with S. aureus (23.5%), coagulase-negative Staphylococci (CoNS) (23%) and S. pneumoniae (7.8%) being commonly isolated. In antibiotic susceptibility testing, S. aureus isolates were most resistant to penicillin (81.8%), whereas 81.3% of S. pneumoniae isolates were resistant to co-trimoxazole. The least antimicrobial resistance was observed for chloramphenicol for both S. aureus and S. pneumoniae isolates (6.3% versus 0%). The proportion of multi-drug resistance (MDR) was 66.7% for S. aureus isolates and 25% for S. pneumoniae isolates. Conclusion There are substantially high nasopharyngeal carriage pathogenic bacteria in children with SCD in Dar es Salaam, Tanzania. The presence of MDR strains to the commonly used antibiotics suggests the need to reconsider optimizing antimicrobial prophylaxis in children with SCD and advocacy on pneumococcal vaccines.
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Affiliation(s)
- Ritah F Mutagonda
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Correspondence: Ritah F Mutagonda, Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, P.O BOX 65013, Dar es salaam, Tanzania, Tel +255 713 816481, Email ;
| | - George Bwire
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Raphael Zozimus Sangeda
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Hamu Mlyuka
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Joyce Ndunguru
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Agnes Jonathan
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Irene Kida Minja
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Paschal Ruggajo
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Emmanuel Balandya
- Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania,Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Appolinary A R Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Dayie NTKD, Sekoh DNK, Tetteh-Quarcoo PB, Dayie AD, Osei MM, Kotey FCN, Donkor ES. Staphylococcus aureus Nasopharyngeal Carriage and Antimicrobial Resistance among Adults with Sickle Cell Disease at the Korle Bu Teaching Hospital in Accra, Ghana. Microbiol Insights 2022; 15:11786361221133959. [PMID: 36339725 PMCID: PMC9629541 DOI: 10.1177/11786361221133959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Sickle cell disease (SCD) patients are an important risk group for Staphylococcus aureus ( S. aureus) carriage and infections. Little is, however, known about the nasopharyngeal carriage epidemiology of the pathogen in this vulnerable population. Aim: The aim of this study was to evaluate S. aureus and methicillin-resistant S. aureus (MRSA) nasopharyngeal carriage prevalence, carriage determinants, and antimicrobial resistance among SCD adults in Ghana. Methodology: Nasopharyngeal swabs, obtained from 200 SCD adults recruited at the Korle Bu Teaching Hospital, were cultured for S. aureus, and these isolates were subjected to antimicrobial susceptibility testing via the Kirby-Bauer method. Results: The prevalence of S. aureus carriage was 41.5% (n = 83), and that of MRSA carriage was 1.0% (n = 2). Moreover, carriage of coagulase-negative Staphylococcus (CoNS) was the only determinant of S. aureus carriage identified (OR = 0.012, P < .0001). However, neither this variable nor the other features of the participants emerged as a determinant of MRSA carriage. The antimicrobial resistance rates decreased across penicillin (98.8%, n = 82), tetracycline (54.2%, n = 45), gentamicin (32.5%, n = 27), ciprofloxacin (21.7%, n = 18), erythromycin (18.1%, n = 15), clindamycin (10.8%, n = 9), amoxicillin-clavulanic acid (10.8%, n = 9), teicoplanin (1.2%, n = 1), and linezolid (0.0%, n = 0), and the multidrug resistance rate was 45.8% (n = 38). Conclusion: The nasopharyngeal carriage prevalence of S. aureus in the current study was high, while that of MRSA was low. The isolates were highly resistant to several of the antibiotics tested, but not teicoplanin and linezolid, making these antibiotics suitable for treatment of S. aureus infections among the SCD population.
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Affiliation(s)
- Nicholas TKD Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Deborah NK Sekoh
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | | | - Alberta D Dayie
- Department of Chemistry, University of Cape Coast, Cape Coast, Ghana
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | - Fleischer CN Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
- FleRhoLife Research Consult, Teshie, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
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Anafo RB, Atiase Y, Dayie NTKD, Kotey FCN, Tetteh-Quarcoo PB, Duodu S, Osei MM, Alzahrani KJ, Donkor ES. Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana. Pathogens 2021; 10:pathogens10080937. [PMID: 34451401 PMCID: PMC8398970 DOI: 10.3390/pathogens10080937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022] Open
Abstract
Aim: This study investigated the spectrum of bacteria infecting the ulcers of individuals with diabetes at the Korle Bu Teaching Hospital in Accra, Ghana, focusing on Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA), with respect to their prevalence, factors predisposing to their infection of the ulcers, and antimicrobial resistance patterns. Methodology: This cross-sectional study was conducted at The Ulcer Clinic, Department of Surgery, Korle Bu Teaching Hospital, involving 100 diabetic foot ulcer patients. The ulcer of each study participant was swabbed and cultured bacteriologically, following standard procedures. Antimicrobial susceptibility testing was done for all S. aureus isolated, using the Kirby-Bauer method. Results: In total, 96% of the participants had their ulcers infected—32.3% (n = 31) of these had their ulcers infected with one bacterium, 47.9% (n = 46) with two bacteria, 18.8% (n = 18) with three bacteria, and 1.0% (n = 1) with four bacteria. The prevalence of S. aureus and MRSA were 19% and 6%, respectively. The distribution of the other bacteria was as follows: coagulase-negative Staphylococci (CoNS) (54%), Escherichia coli (24%), Pseudomonas spp. (19%), Citrobacter koseri and Morganella morgana (12% each), Klebsiella oxytoca (11%), Proteus vulgaris (8%), Enterococcus spp. (6%), Klebsiella pneumoniae (5%), Proteus mirabilis and Enterobacter spp. (4%), Klebsiella spp. (2%), and Streptococcus spp. (1%). The resistance rates of S. aureus decreased across penicillin (100%, n = 19), tetracycline (47.4%, n = 9), cotrimoxazole (42.1%, n = 8), cefoxitin (31.6%, n = 6), erythromycin and clindamycin (26.3% each, n = 5), norfloxacin and gentamicin (15.8% each, n = 3), rifampicin (10.5%, n = 2), linezolid (5.3%, n = 1), and fusidic acid (0.0%, n = 0). The proportion of multidrug resistance was 47.4% (n = 9). Except for foot ulcer infection with coagulase-negative Staphylococci, which was protective of S. aureus infection of the ulcers (OR = 0.029, p = 0.001, 95% CI = 0.004–0.231), no predictor of S. aureus, MRSA, or polymicrobial ulcer infection was identified. Conclusions: The prevalence of S. aureus and MRSA infection of the diabetic foot ulcers were high, but lower than those of the predominant infector, coagulase-negative Staphylococci and the next highest infecting agent, E. coli. Diabetic foot ulcers’ infection with coagulase-negative Staphylococci protected against their infection with S. aureus. The prevalence of multidrug resistance was high, highlighting the need to further intensify antimicrobial stewardship programmes.
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Affiliation(s)
- Ramzy B. Anafo
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (R.B.A.); (N.T.K.D.D.); (F.C.N.K.); (P.B.T.-Q.); (M.-M.O.)
| | - Yacoba Atiase
- Department of Medicine, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana;
| | - Nicholas T. K. D. Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (R.B.A.); (N.T.K.D.D.); (F.C.N.K.); (P.B.T.-Q.); (M.-M.O.)
| | - Fleischer C. N. Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (R.B.A.); (N.T.K.D.D.); (F.C.N.K.); (P.B.T.-Q.); (M.-M.O.)
- FleRhoLife Research Consult, Accra P.O. Box TS 853, Ghana
| | - Patience B. Tetteh-Quarcoo
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (R.B.A.); (N.T.K.D.D.); (F.C.N.K.); (P.B.T.-Q.); (M.-M.O.)
| | - Samuel Duodu
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra P.O. Box LG 54, Ghana;
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra P.O. Box LG 54, Ghana
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (R.B.A.); (N.T.K.D.D.); (F.C.N.K.); (P.B.T.-Q.); (M.-M.O.)
- FleRhoLife Research Consult, Accra P.O. Box TS 853, Ghana
| | - Khalid J. Alzahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif P.O. Box 11099, Saudi Arabia;
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra P.O. Box KB 4236, Ghana; (R.B.A.); (N.T.K.D.D.); (F.C.N.K.); (P.B.T.-Q.); (M.-M.O.)
- Correspondence: or
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