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Massive emergence of multidrug-resistant Enterobacteriaceae in blood culture isolates of children in Ghana

Abstract number: O395

Huenger F., Agyekum A., Nkrumah B., Ekuban S., Sarpong N., Schwarz N.G., Schütt-Gerowitt H., May J., Adu-Sarkodie Y.

Objective: To evaluate the prevalence of antimicrobial resistance in Enterobacteriaceae isolated from blood cultures of children in rural Ghana.

Methods: Between October 2007 and June 2009 blood cultures were collected from children admitted to the Agogo Presbytarian Hospital located in the rural area of the Ashanti – Akim North District with a population of about 135,000. Peds Plus™ bottles and the BacTec™ 9050 system were used and detected strains were identified by Gram staining, selective subcultures, biochemical testing and specific agglutination tests. Minimum inhibitory concentration (MIC) of isolated Enterobacteriaceae and production of extended-spectrum-b-lactamases (ESBL) was determined by the Etest™ method.

Results: In this study isolated Enterobacteriaceae (n = 178) were non-typhoid Salmonella enterica (NTS) (113), Salmonella Typhi (39), Escherichia coli (15) Klebsiella sp. (9), Shigella boydii (1) and Enterobacter sp. (1).

NTS were highly resistant to ampicillin (80.5%), cotrimoxazole (82.3%), chloramphenicol (83.2%), and tetracycline (10.6%). No strain was resistant to ciprofloxacin, but one strain had reduced susceptibility to ceftriaxone. The majority of S. Typhi strains were also resistant to ampicillin (69.2%), cotrimoxazole (60.0%), chloramphenicol (66.7%), and tetracycline (60.0%), but all were completely susceptible to ciprofloxacin and ceftriaxone. All E. coli isolates were resistant to ampicillin and 20% produced ESBL. Resistance to cotrimoxacole (93.3%), tetracycline (86.7%), chloramphenicol (53.3%) and ciprofloxacin (26.7%) was frequently detected. All Klebsiella strains were resistant to ampicillin and tetracycline and 77.8% produced ESBL. Only one strain was susceptible to cotrimoxazole, 77.8% were resistant to chloramphenicol and one third to ciprofloxacin. The Enterobacter strain procuced ESBL and was only susceptible to ciprofloxacin. The Shigella boydii isolate was susceptible to ceftriaxone and ciprofloxacin.

Conclusion: The study indicates that the majority of Enterobacteriaceae causing bacteraemia in children in the study area are resistant to the majority of local available antibiotics. Moreover this massive emergence of multidrug-resistant Enterobacteriaceae and ESBL producing E. coli and Klebsiella strains in clinical isolates indicates a serious medical and economic burden for African healthcare systems. Surveillance programs and prevention strategies have to be established to face this challenge.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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