{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:57:48Z","timestamp":1792789068205,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Fleming Fund","award":["FF49\/440"],"award-info":[{"award-number":["FF49\/440"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Antimicrobial resistance (AMR) in Gram-negative bacteria-causing bloodstream infections (BSIs), such as Klebsiella pneumoniae and non-typhoidal Salmonella (NTS), is a major public health concern. Nonetheless, AMR surveillance remains scarce in sub-Saharan Africa, where BSI treatment is largely empirical. The aim of the study was to determine the distribution and AMR patterns of BSI-causing NTS, K. pneumoniae, and other Gram-negative bacteria in Ghana. Methods: A cross-sectional study was conducted between April and December 2021 at eleven sentinel health facilities across Ghana as part of a pilot study on the feasibility and implementation of the human sector AMR surveillance harmonized protocol in sub-Saharan Africa. Gram-negative bacteria recovered from blood specimens of febrile patients were identified using MALDI-TOF and evaluated for antimicrobial resistance using the BD Phoenix M50 analyzer and Kirby-Bauer disc diffusion. The Department of Medical Microbiology at the University of Ghana served as the reference laboratory. Results: Out of 334 Gram-negative blood isolates, there were 18 (5.4%) NTS, 85 (25.5%) K. pneumoniae, 88 (26.4%) Escherichia coli, 40 (12.0%) Acinetobacter baumannii, 25 (7.5%) Pseudomonas aeruginosa, and 77 (23.1%) other Gram-negative bacteria. As a composite, the isolates displayed high resistance to the antibiotics tested\u2014amoxicillin (89.3%), tetracycline (76.1%), trimethoprim-sulfamethoxazole (71.5%), and chloramphenicol (59.7%). Resistance to third-generation cephalosporins [ceftriaxone (73.7%), cefotaxime (77.8%), and ceftazidime (56.3%)] and fluoroquinolones [ciprofloxacin (55.3%)] was also high; 88% of the isolates were multidrug resistant, and the rate of extended-spectrum beta-lactamase (ESBL) production was 44.6%. Antibiotic resistance in K. pneumoniae followed the pattern of all Gram-negative isolates. Antibiotic resistance was lower in NTS blood isolates, ranging between 16.7\u201338.9% resistance to the tested antibiotics. Resistance rates of 38.9%, 22.2%, and 27.8% were found for cefotaxime, ceftriaxone, and ceftazidime, respectively, and 27.8% and 23.8% for ciprofloxacin and azithromycin, respectively, which are used in the treatment of invasive NTS. The prevalence of multidrug resistance in NTS isolates was 38.9%. Conclusions: Multicenter AMR surveillance of Gram-negative blood isolates from febrile patients was well-received in Ghana, and the implementation of a harmonized protocol was feasible. High resistance and multidrug resistance to first- or second-choice antibiotics, including penicillins, third-generation cephalosporins, and fluoroquinolones, were found, implying that these antibiotics might have limited effectiveness in BSI treatment in the country. Continuation of AMR surveillance in Gram-negative blood isolates is essential for a better understanding of the extent of AMR in these pathogens and to guide clinical practice and policymaking.<\/jats:p>","DOI":"10.3390\/antibiotics12020255","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T04:58:25Z","timestamp":1675054705000},"page":"255","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Multicenter Surveillance of Antimicrobial Resistance among Gram-Negative Bacteria Isolated from Bloodstream Infections in Ghana"],"prefix":"10.3390","volume":"12","author":[{"given":"Eric S.","family":"Donkor","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1086-7559","authenticated-orcid":false,"given":"Khitam","family":"Muhsen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"},{"name":"Middle East Consortium on Infectious Disease Surveillance (MECIDS), Jerusalem 9149302, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry A. M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"School of Veterinary Medicine, University of Ghana, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0286-3638","authenticated-orcid":false,"given":"Fleischer C. N.","family":"Kotey","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas T. K. D.","family":"Dayie","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patience B.","family":"Tetteh-Quarcoo","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edem M. A.","family":"Tette","sequence":"additional","affiliation":[{"name":"Department of Community Health, University of Ghana Medical School, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2216-7237","authenticated-orcid":false,"given":"Mary-Magdalene","family":"Osei","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Egyir","sequence":"additional","affiliation":[{"name":"Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5012-9564","authenticated-orcid":false,"given":"Nicholas I.","family":"Nii-Trebi","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfred","family":"Owusu-Okyere","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Accra 00233, Ghana"},{"name":"National Public Health Reference Laboratory, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2172-8645","authenticated-orcid":false,"given":"Alex","family":"Owusu-Ofori","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana"},{"name":"Directorate of Laboratory Services, Komfo Anokye Teaching Hospital, Kumasi 10900, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1599-7224","authenticated-orcid":false,"given":"Yonatan","family":"Amir","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saritte","family":"Perlman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perdita Hilary","family":"Lopes","sequence":"additional","affiliation":[{"name":"Mott MacDonald, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adjo","family":"Mfodwo","sequence":"additional","affiliation":[{"name":"Mott MacDonald, Accra 00233, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola C.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Mott MacDonald, London N11 3JB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Gresham","sequence":"additional","affiliation":[{"name":"Ending Pandemics, San Francisco, CA 94102, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Smolinski","sequence":"additional","affiliation":[{"name":"Ending Pandemics, San Francisco, CA 94102, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2664-2303","authenticated-orcid":false,"given":"Dani","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel"},{"name":"Middle East Consortium on Infectious Disease Surveillance (MECIDS), Jerusalem 9149302, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/1469-0691.12144","article-title":"Incidence of bloodstream infection: A review of population-based studies","volume":"19","author":"Laupland","year":"2013","journal-title":"Clin. 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