Prevalence of multidrug-resistant uropathogens isolated from patients with urinary tract infections in a tertiary hospital in Ghana

Multidrug resistance (MDR) is of a major public health concern globally, with far-reaching consequences on affected populations. Urinary Tract Infections (UTI) remain one of the major infections for which antibiotics are prescribed in Ghana, and its overuse over time has raised concerns over the development of drug resistance in UTI patients. Understanding the antimicrobial resistance patterns of uropathogens is essential for informing appropriate UTI treatment and management strategies. We therefore investigated the antibiotic resistance patterns of uropathogens implicated in suspected cases of UTI in a tertiary hospital in Ghana between 2020 and 2021.

A prospective cross-sectional study was conducted at the Komfo Anokye Teaching Hospital in Ghana where 357 patients with suspected UTI had their urine samples cultured for bacteria. Sociodemographic data of participants were also collected. Isolates from positive UTI cultures were subjected to antimicrobial susceptibility testing (AST) according to CLSI guidelines (2020) using the Kirby-Bauer disk diffusion method. Data obtained was analysed using Microsoft Excel, STATA and GraphPad Prism.

We found the prevalence of uncomplicated UTI to be 26.6% (n/N = 95/357); with the identified uropathogens belonging to 10 different bacterial genera. Infections were found to be more frequent in females (67.4%, n/N = 64/95) than males. The study also found Escherichia coli (21.1%, n/N = 20/95) and Enterococcus spp. (20.0%, n/N = 19/95) as the most common organisms isolated. Antimicrobial resistance was observed in all 10 species isolated, with drug resistance highest against ampicillin (85.3%) and lowest against imipenem (19.0%) antibiotics. Multidrug resistance (MDR) was detected in 83.2% of bacteria. The study showed bacteria from 96.4% of UTI cases in males were multidrug resistant (p = 0.014) with similar higher proportions in individuals of middle-to-old age.

This study reveals high resistance of uropathogens against many commonly-used antibiotics for treating UTI in Ghana; with more than 80% being multi-drug resistant in this population. These findings are helpful in signalling the need for revised antibiotic prescription in the treatment and management of UTI. With the clinical pipeline running dry, this evidence-based study also calls for improved antimicrobial stewardship and infection prevention and control efforts in hospitals to mitigate the spread of MDR-bacteria.