Leveraging donor support to develop a national antimicrobial resistance policy and action plan: Ghana’s success story

Background: To mitigate the increasing trend of antimicrobial drug resistance (AMR), the Global Action Plan (GAP) on AMR was adopted at the 68th World Health Assembly in May 2015. Subsequently, member countries were encouraged to mirror the five key strategic objectives of GAP to develop their respective National Action Plans (NAPs) by 2017. Country-specific data on AMR is, however, critical for a comprehensive NAP that will inform policy and also anchor all the objectives of GAP. Systematic reviews have been suggested by some authors to generate relevant data to inform NAP development. Objectives: This article highlights Ghana’s success story in the development of its AMR policy documents and how it could further be implemented through donor support. Methods: Literature and desk review of the activities of Ghana’s National Platform on Antimicrobial Resistance leading to the development of the NAP and AMR policy was done. Results: Ghana launched its NAP together with the accompanying policy document in April 2018. Country-specific data, which guided these documents, were obtained by leveraging donor support activities through the National Platform on Antimicrobial Resistance. Conclusion: Ghana’s success story on the development of AMR policy documents is pivoted on a strong political will and the leveraging of donor support for specific activities

Quinolone resistance in Escherichia coli from Accra, Ghana

We documented for the first time the molecular basis for quinolone resistance in Ghana and the presence of horizontally disseminated genes conferring resistance to these drugs. --author-supplied descriptio

Quinolone resistance in Escherichia coli from Accra, Ghana

<p>Abstract</p> <p>Background</p> <p>Antimicrobial resistance is under-documented and commensal <it>Escherichia coli </it>can be used as indicator organisms to study the resistance in the community. We sought to determine the prevalence of resistance to broad-spectrum antimicrobials with particular focus on the quinolones, which have recently been introduced in parts of Africa, including Ghana.</p> <p>Results</p> <p>Forty (13.7%) of 293 <it>E. coli </it>isolates evaluated were nalidixic acid-resistant. Thirteen (52%) of 2006 and 2007 isolates and 10 (66.7%) of 2008 isolates were also resistant to ciprofloxacin. All but one of the quinolone-resistant isolates were resistant to three or more other antimicrobial classes. Sequencing the quinolone-resistance determining regions of <it>gyrA </it>and <it>parC</it>, which encode quinolone targets, revealed that 28 quinolone-resistant <it>E. coli </it>harboured a substitution at position 83 of the <it>gyrA </it>gene product and 20 of these isolates had other <it>gyrA </it>and/or <it>parC </it>substitutions. Horizontally-acquired quinolone-resistance genes <it>qnrB1</it>, <it>qnrB2</it>, <it>qnrS1 </it>or <it>qepA </it>were detected in 12 of the isolates. In spite of considerable overall diversity among <it>E. coli </it>from Ghana, as evaluated by multilocus sequence typing, 15 quinolone-resistant <it>E. coli </it>belonged to sequence type complex 10. Five of these isolates carried <it>qnrS1 </it>alleles.</p> <p>Conclusions</p> <p>Quinolone-resistant <it>E. coli </it>are commonly present in the faecal flora of Accra residents. The isolates have evolved resistance through multiple mechanisms and belong to very few lineages, suggesting clonal expansion. Containment strategies to limit the spread of quinolone-resistant <it>E. coli </it>need to be deployed to conserve quinolone effectiveness and promote alternatives to their use.</p

Prevalence and characterization of Salmonella among humans in Ghana

BACKGROUND: Non-typhoidal Salmonella (NTS) is a public health problem worldwide and particularly in Africa with high disease burden. This study characterized Salmonella isolates from humans in Ghana to determine serovar distribution, phage types, and antimicrobial resistance. Further, the clonal relatedness among isolates was determined. METHODS: One hundred and thirty-seven Salmonella isolates (111 clinical and 26 public toilet) were characterized using standard serotyping, phage typing, and antimicrobial susceptibility testing methods. The molecular epidemiology of common serovars (Salmonella Typhimurium and Salmonella Enteritidis) was established by pulsed field gel electrophoresis (PFGE). RESULTS: Twenty-two serovars were identified with S. Enteritidis, S. Typhimurium, and Salmonella Derby as the most dominant. One hundred and twelve isolates showed resistance to more than one antimicrobial. Fifty-eight (n = 58/112; 54.5%) strains were multi-resistant with low resistance to cephalosporins ceftazidime (8.0%), cefotaxime (4.5%), and cefoxitin (2.7%) with synergy to clavulanic acid indicating possible ESBLs. Isolates showed high resistance to trimethoprim (66.1%), tetracycline (61.6%), ampicillin (57.1%), sulfamethoxazole (46.4%), chloramphenicol (33.9%), and ciprofloxacin (25.0%). The most common resistance pattern of multi-resistant serovars was to ampicillin, chloramphenicol, sulphonamide, and trimethoprim. S. Enteritidis (18/43) strains reacted with typing phages but did not conform to any phage type with PT14B and PT4 as predominant definitive phage types. Six S. Typhimurium strains reacted but did not conform to any recognized phage type while seven were non-typable. The predominant definitive phage types were DT1 and DT22. PFGE patterns of human S. Enteritidis were closely related to patterns of poultry isolates obtained in a previous study in Ghana. CONCLUSIONS: Cephalosporin resistance is uncommon among Salmonella from humans in Ghana. Poultry may be an important source of human salmonellosis. There is an urgent need for the implementation of routine surveillance of antimicrobial use and bacterial resistance among humans in Ghana

Regional Dissemination of a Trimethoprim-Resistance Gene Cassette via a Successful Transposable Element

Antimicrobial resistance is a growing international problem. We observed a 50% increase in the prevalence of trimethoprim resistance among fecal Escherichia coli from healthy Nigerian students between 1998 and 2005, a trend to increase that continued in 2009.A PCR-based screen revealed that 131 (43.1%) of isolates obtained in Nigeria in 2005 and 2009 carried integron-borne dfrA cassettes. In the case of 67 (51.1%) of these isolates, the cassette was a class 1-integron-borne dfrA7 gene, which has been reported at high prevalence from E. coli isolates from other parts of Africa. Complete sequencing of a 27 Kb dfrA7-bearing plasmid from one isolate located the dfrA7 gene within a Tn21-type transposon. The transposon also contained an IS26-derived bla/sul/str element, encoding resistance to β-lactams, sulphonamides and streptomycin, and mercury resistance genes. Although the plasmid backbone was only found in 12 (5.8%) of trimethoprim-resistant isolates, dfrA7 and other transposon-borne genes were detected in 14 (16.3%) and 32 (26.3%) of trimethoprim resistant isolates collected in Nigeria in 2005 and 2009, respectively. Additionally, 37 (19.3%) of trimethoprim-resistant E. coli isolates collected between 2006 and 2008 from Ghana were positive for the dfrA7 and a transposon marker, but only 4 (2.1%) harbored the plasmid backbone.Our data point to transposition as a principal mechanism for disseminating dfrA7 among E. coli from Nigeria and Ghana. On-going intensive use of the affordable broad-spectrum antibacterials is likely to promote selective success of a highly prevalent transposable element in West Africa

Surveillance of bacterial pathogens of diarrhoea in two selected sub metros within the Accra metropolis

Background: In recent years, many localities within the Greater Accra Region (GAR) have witnessed several episodes of cholera outbreaks, with some deaths.Compared to previous epidemics, which usually followed heavy rains, recent outbreaks show no seasonality.Objectives: To investigate infective bacterial diseases in selected sub metros within the GAR.Methods: We used existing disease surveillance systems in Ghana, and investigated all reported cases of diarrhoea that met our case-definition. A three-daytraining workshop was done prior to the start of study, to sensitize prescribers at the Korle-Bu Polyclinic and Maamobi General hospital. A case-based investigationform was completed per patient, and two rectal swabs were taken for culture at the National Public Health and Reference Laboratory. Serotyping and antibiogramprofiles of identified bacteria were determined. Potential risk factors were also assessed using a questionnaire.Results: Between January and June 2012, a total of 361 diarrhoeal cases with 5 deaths were recorded. Out of a total of 218 rectal swabs cultured, 71 (32.6%) Vibrio cholerae O1 Ogawa serotypes, and 1 (0.5%) Salmonella (O group B) were laboratory confirmed. No Shigella was isolated. The Vibrio cholerae isolates were susceptible to ciprofloxacin and tetracycline. Greater than 80% of patients reported having drank sachet water 24 h prior to diarrhoea onset, and many (144/361) young adults (20-29 years) reported with diarrhoea.Conclusion: Enhanced surveillance of diarrhoeal diseases (enteric pathogens) within cholera endemic regions, will serve as an early warning signal, and reduce fatalities associated with infective diarrhoea.Keywords: Diarrhoeal disease surveillance, enteric pathogens, Vibrio cholerae, Salmonell