{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:47:59Z","timestamp":1791838079313,"version":"4.3.4"},"reference-count":40,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health Research, Department of Health &amp; Social Care of the United Kingdom"},{"name":"implementing partners"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials.<\/jats:p>","DOI":"10.3390\/ijerph192416556","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T06:14:00Z","timestamp":1670566440000},"page":"16556","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017\u20132021"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0915-2353","authenticated-orcid":false,"given":"Benjamin","family":"Asamoah","sequence":"first","affiliation":[{"name":"MDS-Lancet Laboratories, Accra P.O. Box AC 533, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Appiah-Korang","family":"Labi","sequence":"additional","affiliation":[{"name":"World Health Organization, Country Office, Accra P.O. Box MB 142, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6290-2419","authenticated-orcid":false,"given":"Himanshu A.","family":"Gupte","sequence":"additional","affiliation":[{"name":"Narotam Sekhsaria Foundation, Mumbai 4000 021, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9836-4261","authenticated-orcid":false,"given":"Hayk","family":"Davtyan","sequence":"additional","affiliation":[{"name":"Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgette Marfo","family":"Peprah","sequence":"additional","affiliation":[{"name":"MDS-Lancet Laboratories, Accra P.O. Box AC 533, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Forster","family":"Adu-Gyan","sequence":"additional","affiliation":[{"name":"MDS-Lancet Laboratories, Accra P.O. Box AC 533, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5497-2858","authenticated-orcid":false,"given":"Divya","family":"Nair","sequence":"additional","affiliation":[{"name":"International Union Against TB and Lung Disease (The Union), 75006 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7000-3977","authenticated-orcid":false,"given":"Karlos","family":"Muradyan","sequence":"additional","affiliation":[{"name":"Tuberculosis Research and Prevention Center, Yerevan 0014, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1160-3099","authenticated-orcid":false,"given":"Nasreen S.","family":"Jessani","sequence":"additional","affiliation":[{"name":"Centre for Evidence based Health Care, Department of Global Health, Stellenbosch University, Cape Town 800, South Africa"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Sekyere-Nyantakyi","sequence":"additional","affiliation":[{"name":"MDS-Lancet Laboratories, Accra P.O. Box AC 533, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,9]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2020). Antimicrobial resistance, Factsheet."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zalewska-pi, B. (2020). Phage Therapy as a Novel Strategy in the Treatment of Urinary Tract Infections Caused by E. coli. Antibiotics, 9.","DOI":"10.3390\/antibiotics9060304"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3678","DOI":"10.5897\/AJMR2014.7034","article-title":"Virulence factors and antibiotic resistance patterns of uropathogenic Escherichia coli","volume":"8","author":"Joshua","year":"2014","journal-title":"Afr. J. Microbiol. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1086\/318850","article-title":"Urinary Tract Infections: Disease Panorama and Challenges","volume":"183","author":"Stamm","year":"2001","journal-title":"J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: Epidemiology, mechanisms of infection and treatment options","volume":"13","author":"Walker","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_6","unstructured":"Bartoletti, R., and Johansen, T.E.B. (2017). Eau Guidelines on Urological Infections, Available online: https:\/\/www.researchgate.net\/publication\/284761422_Guidelines_on_urological_infections."},{"key":"ref_7","unstructured":"Plan, G.A., Resistance, A., Regulations, I.H., Atb, T., and Atb, N. (2019). A Technical Guide to Implementing the World Health Organization\u2019 s AWaRe Antibiotic Classification in MTaPS Program Countries, Available online: https:\/\/www.mtapsprogram.org\/wp-content\/uploads\/2021\/03\/USAID-MTaPS_Implementing-WHO-AWaRe-Classification.pdf."},{"key":"ref_8","first-page":"508","article-title":"Clinical review guidelines for management and care transitions in the emergency","volume":"48","author":"Kaye","year":"2015","journal-title":"J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.jsps.2018.02.023","article-title":"Risk factors for aquiring multidrug-resistant organisms in urinary tract infections: A systematic literature review","volume":"26","author":"Tenney","year":"2018","journal-title":"Saudi Pharm. J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Patients, O., and Donkor, E.S. (2018). Urinary Tract Infections among Bladder Outlet Obstruction Patients in Accra, Ghana: Aetiology, Antibiotic Resistance, and Risk Factors. Diseases, 6.","DOI":"10.3390\/diseases6030065"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"449","DOI":"10.12688\/f1000research.52652.1","article-title":"Prevalence of urinary tract infections and antibiogram of uropathogens isolated from children under five attending Bagamoyo District Hospital in Tanzania: A cross-sectional study [version 1; peer review: Awaiting peer review]","volume":"10","author":"Sangeda","year":"2021","journal-title":"F1000Res"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-018-3989-y","article-title":"Escherichia coli bacteriuria in pregnant women in Ghana: Antibiotic resistance patterns and virulence factors","volume":"11","author":"Forson","year":"2018","journal-title":"BMC Res. Notes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.ijid.2020.10.068","article-title":"Diagnosis and treatment of urinary tract infections in hospitalized adults in Ghana: The role of the clinical microbiology laboratory in improving antimicrobial stewardship","volume":"102","author":"Gambrah","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.2147\/IDR.S204880","article-title":"Community acquired urinary tract infections among adults in Accra, Ghana","volume":"12","author":"Horlortu","year":"2019","journal-title":"Infect. Drug Resist."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Yevutsey, S.K., Buabeng, K.O., Aikins, M., Anto, B.P., Biritwum, R.B., Frimodt-M\u00f8ller, N., and Gyansa-Lutterodt, M. (2017). Situational analysis of antibiotic use and resistance in Ghana: Policy and regulation. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4910-7"},{"key":"ref_16","unstructured":"(2022, August 20). Global Action Plan on Antimicrobial Resistance. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/193736\/9789241509763_eng.pdf?sequence=1."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101219","DOI":"10.1016\/j.jup.2021.101219","article-title":"A bird\u2019s eye view of Ghana\u2019s renewable energy sector environment: A Multi-Criteria Decision-Making approach","volume":"70","author":"Agyekum","year":"2021","journal-title":"Util. Policy"},{"key":"ref_18","unstructured":"Ministry of Health|Ghana official website [internet] (2021, August 20). Role and function. Available online: https:\/\/dhsprogram.com\/pubs\/pdf\/spa6\/02chapter02.pdf."},{"key":"ref_19","unstructured":"Ministry of Health-Ghana National Drugs Programme (GNDP) (2017). Standard Treatment Guidelines."},{"key":"ref_20","unstructured":"Prashanth, B.V.S. (2021, November 05). Urine Culture Contamination: A One-Year Retrospective Study at the Tertiary Care Hospital. 29 December 2014. Available online: https:\/\/go.gale.com\/ps\/i.do?id=GALE%7CA469639434&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=22784748&p=HRCA&sw=w&userGroupName=anon~70fd146c."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Altheide, S.T. (2021, November 05). Biochemical and Culture-Based Approaches to Identification in the Diagnostic Microbiology Laboratory. Available online: http:\/\/clsjournal.ascls.org\/content\/early\/2020\/01\/20\/ascls.119.001875.","DOI":"10.29074\/ascls.119.001875"},{"key":"ref_22","unstructured":"(2021, November 05). Antimicrobial Susceptibility Testing by the Kirby-Bauer Disc Diffusion Method. Available online: http:\/\/www.annclinlabsci.org\/content\/3\/2\/135.short."},{"key":"ref_23","unstructured":"CLSI, Dolinsky, A.L., Ohiro, R.K., Fan, W., Xiao, C., and Wu, F. (2019). National Committee for Clinical Laboratory Standards. 2000. Performance standard for antimicrobial susceptibility testing. Document M100\u2013S10. J. Int. Med. Res., 46, 18. Available online: http:\/\/www.epa.gov\/nerlcwww\/1604sp02.pdf%0Ahttp:\/\/www.emeraldinsight.com\/doi\/10.1108\/08876049410065598%0Ahttps:\/\/clsi.org\/media\/1469\/m100s27_sample.pdf%0Ahttp:\/\/shop.clsi.org\/site\/Sample_pdf\/M100S27_sample.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1093\/aje\/kwg074","article-title":"Estimating the relative risk in cohort studies and clinical trials of common outcomes","volume":"157","author":"McNutt","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.cca.2018.05.047","article-title":"Evaluation of the new Sysmex UF-5000 fl uorescence fl ow cytometry analyser for ruling out bacterial urinary tract infection and for prediction of Gram negative bacteria in urine cultures","volume":"484","author":"Grosso","year":"2018","journal-title":"Clin. Chim. Acta"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.urology.2019.10.018","article-title":"Multiplex PCR Based Urinary Tract Infection (UTI) Analysis Compared to Traditional Urine Culture in Identifying Significant Pathogens in Symptomatic Patients","volume":"136","author":"Wojno","year":"2019","journal-title":"Urology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e24619","DOI":"10.1002\/jcla.24619","article-title":"The prevalence of multiple drug resistance Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infections","volume":"36","author":"Jalil","year":"2022","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1055\/a-0576-0079","article-title":"Escherichia coli and Klebsiella pneumoniae Sensitivity\/Resistance Pattern Towards Antimicrobial Agents in Primary and Simple Urinary Tract Infection Patients Visiting University Hospital of Jamia Hamdard New Delhi","volume":"68","author":"Rizwan","year":"2018","journal-title":"Drug Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2597","DOI":"10.1007\/s00345-020-03464-w","article-title":"Adverse effects of chronic nitrofurantoin therapy in women with recurrent urinary tract infections in an outpatient setting","volume":"39","author":"Maredia","year":"2020","journal-title":"World J. Urol."},{"key":"ref_31","first-page":"337","article-title":"Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections","volume":"21","author":"Madani","year":"2012","journal-title":"Nat. Publ. Gr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"dlab003","DOI":"10.1093\/jacamr\/dlab003","article-title":"Antimicrobial resistance among uropathogens in the Asia-Pacific region: A systematic review","volume":"3","author":"Sugianli","year":"2021","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gekenidis, M., Kl\u00e4ui, A., Smalla, K., and Drissner, D. (2020). Transferable Extended-Spectrum \u03b2-Lactamase (ESBL) Plasmids in Enterobacteriaceae from Irrigation Water. Microorganisms, 8.","DOI":"10.3390\/microorganisms8070978"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"ofw281","DOI":"10.1093\/ofid\/ofw281","article-title":"The Increase in Hospitalizations for Urinary Tract Infections and the Associated Costs in the United States, 1998\u20132011","volume":"4","author":"Simmering","year":"2017","journal-title":"pen Forum Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.eclinm.2019.07.012","article-title":"Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care","volume":"14","author":"West","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_36","first-page":"64","article-title":"Henry Ford Health Scholarly Commons Re: Luke Harper, T. Blanc, M. Peycelon; et al. Circumcision and Risk of Febrile Urinary Tract Infection in Boys with Posterior Urethral Valves: Result of the CIRCUP Randomized Trial","volume":"81","author":"Health","year":"2021","journal-title":"Eur. Urol. Lett. Ed."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Klaus, R., and Lange-sperandio, B. (2022). Chronic Kidney Disease in Boys with Posterior Urethral Valves\u2013Pathogenesis, Prognosis and Management. Biomedicines, 10.","DOI":"10.3390\/biomedicines10081894"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Nicolle, L.E. (2014). Catheter Associated Urinary Tract Infections, Available online: https:\/\/aricjournal.biomedcentral.com\/articles\/10.1186\/2047-2994-3-23.","DOI":"10.1186\/2047-2994-3-23"},{"key":"ref_39","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sugianli, A.K., Ginting, F., Kusumawati, R.L., Parwati, I., De Jong, M.D., Van Leth, F., and Schultsz, C. (2020). Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0230489"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/24\/16556\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:37:11Z","timestamp":1760146631000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/24\/16556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,9]]},"references-count":40,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192416556"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192416556","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202211.0144.v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,9]]}}}