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High Carriage Rates of Multidrug-Resistant Gram-Negative Bacteria in Neonatal Intensive Care Units From Ghana
Appiah-Korang Labi1,2, Stephanie Bjerrum3, Christabel C Enweronu-Laryea4
1Department of Microbiology, Korle-Bu Teaching Hospital, Accra, Ghana.
Open Forum Infectious Diseases
|May 7, 2020
Summary
Multidrug-resistant Gram-negative bacteria (MDRGN) carriage is high in Ghanaian neonatal intensive care units (NICUs). This increases the risk of difficult-to-treat infections in newborns, highlighting an emerging problem in African NICUs.
Area of Science:
- Infectious Diseases
- Microbiology
- Neonatal Care
Background:
- Hospitalized neonates in neonatal intensive care units (NICUs) are at risk of invasive infections from multidrug-resistant Gram-negative bacteria (MDRGN).
- Data on MDRGN carriage in African NICUs are scarce, necessitating further investigation.
Purpose of the Study:
- To determine the prevalence of MDRGN carriage in neonates admitted to tertiary hospital NICUs in Ghana.
- To identify common MDRGN species and their antibiotic resistance profiles.
- To investigate factors associated with MDRGN carriage and the genetic relatedness of carriage and bloodstream isolates.
Main Methods:
- A cross-sectional study was conducted in two Ghanaian NICUs.
- Swabs from neonates and the environment were cultured for Gram-negative bacteria (GN), with antibiotic susceptibility testing performed.
- Whole-genome sequencing (WGS) was used to characterize carbapenemase-producing *Klebsiella pneumoniae* isolates.
Main Results:
- Pathogenic GN were found in 76.8% of neonates, with *Klebsiella* spp. and *Escherichia coli* being the most common.
- Carriage rates for MDRGN and third-generation cephalosporin-resistant organisms were 49.6% and 46.1%, respectively.
- Carbapenemase production was detected in 15.6% of *Klebsiella* spp., with carriage rates increasing significantly with length of stay and antibiotic use.
Conclusions:
- High carriage rates of MDRGN, including carbapenemase-producing Enterobacterales, represent a significant and emerging threat in African NICUs.
- Neonatal intensive care unit environments in Africa may be contributing to the spread of antimicrobial resistance.
- Early detection and infection control measures are crucial to mitigate the impact of MDRGN in vulnerable neonates.