Volume 89, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Infections with bacteria producing extended-spectrum beta-lactamases (ESBLs) are increasing across Africa. This study reports on ESBL-producing as significant causes of infections and antibiotic resistance at Korle-Bu Teaching Hospital in Accra, Ghana. Of 300 isolates examined, 49.3% produced ESBLs. The prevalence of ESBLs was significantly high among isolates from neonates (28 of 43, 65.1%; relative risk = 1.62, 95% confidence interval = 1.33–2.13, = 0.002) and adult patients > 65 years of age (36 of 51, 70.5%; relative risk = 1.89, 95% confidence interval = 1.41–2.40, = 0.001). A marked increase in minimum inhibitory concentrations of ESBL-positive species was noticed compared with those for the other strains. Using these concentrations, we found that 26 (17%) ESBL producers were resistant to two or more antibiotics (aminoglycosides, fluoroquinolones, sulfonamide, and carbapenems) whereas 5 (3.2%) non–ESBL producers were multidrug resistant. Regular ESBL detection and evaluation of antibiotic resistance may help reduce the spread of ESBLs and antibiotic resistance in Ghana.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Wilke MS, Lovering AL, Strynadka NCJ, , 2005. β-lactam antibiotic resistance: a current structural perspective. Curr Opin Microbiol 8: 525533.[Crossref] [Google Scholar]
  2. Jacoby GA, Munoz-Price LS, , 2005. The new β-lactamases. N Engl J Med 352: 380391.[Crossref] [Google Scholar]
  3. Thomson K, , 2013. Detection of gram-negative β-lactamase producing pathogens in the clinical lab. Curr Pharm Des 19: 250256.[Crossref] [Google Scholar]
  4. Liebana E, Carattoli A, Coque TM, Hasman H, Magiorakos AP, Mevius D, Peixe L, Poirel L, Schuepbach-Regula G, Torneke K, Torren-Edo J, Torres C, Threlfall J, , 2013. The public health risks of enterobacterial isolates producing extended-spectrum β-lactamases (ESBL) or AmpC β-lactamases in food and food-producing animals: an EU perspective of epidemiology, analytical methods, risk factors and control options. Clin Infect Dis 56: 10301037.[Crossref] [Google Scholar]
  5. Cantón R, Bryan J, , 2012. Global antimicrobial resistance: from surveillance to stewardship. Part 1: surveillance and risk factors for resistance. Expert Rev Anti Infect Ther 10: 12691271.[Crossref] [Google Scholar]
  6. Yi-Hui W, Po-Lin C, Yuan-Pin H, Wen-Chien K, , 2012. Risk factors and clinical impact of levofloxacin or cefazolin nonsusceptibility or ESBL production among uropathogens in adults with community-onset urinary tract infections. J Microbiol Immunol Infect 2012 Oct 11. pii:S1684-1182(12)00206-X, doi:1.1016/j.jmii2012.09.001 [Epub ahead of print]. [Google Scholar]
  7. Essack SY, Hall LM, Pillay DG, McFadyen ML, Livermore DM, , 2001. Complexity and diversity of Klebsiella pneumoniae strains with extended-spectrum β-lactamases isolated in 1994 and 1996 at a teaching hospital in Durban, South Africa. Antimicrob Agents Chemother 45: 8895.[Crossref] [Google Scholar]
  8. Bell JM, Turnidge JD, Gales AC, Pfaller MA, Jones RN, , 2002. Prevalence of extended-spectrum β-lactamase (ESBL)-producing clinical isolates in the Asia-Pacific region and South Africa: regional results from SENTRY Antimicrobial Surveillance Program (1998 to 99). Diagn Microbiol Infect Dis 42: 193198.[Crossref] [Google Scholar]
  9. Tau NP, Smith AM, Sooka A, Keddy KH, , 2012. Molecular characterization of extended-spectrum β-lactamase-producing Shigella isolates from humans in South Africa, 2003–2009. J Med Microbiol 61: 162164.[Crossref] [Google Scholar]
  10. Bouchillon SK, Johnso BM, Hoban DJ, , 2004. Determining incidence of extended-spectrum β-lactamase-producing Enterobacteriaceae, vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus in 38 centres from 17 countries: the PEARLS study 2001 to 2002. Int J Antimicrob Agents 24: 119124.[Crossref] [Google Scholar]
  11. Khalaf NG, Eletreby MM, Hanson ND, , 2009. Characterization of CTX-M ESBLs in Enterobacter cloacae, Escherichia coli and Klebsiella pneumoniae clinical isolates from Cairo, Egypt. BMC Infect Dis 9: 8489.[Crossref] [Google Scholar]
  12. Ben-Hamouda T, Foulon T, Ben-Mahrez K, , 2004. Involvement of SHV-12 and SHV-2a encoding plasmids in outbreaks of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a Tunisian neonatal ward. Microb Drug Resist 10: 132138.[Crossref] [Google Scholar]
  13. Aitmhand R, Soukri A, Moustaoui N, Amarouch H, Eimdaghri N, Sirot D, Benbachir M, , 2002. Plasmid-mediated TEM-3 extended-spectrum β-lactamase-production in Salmonella typhimurium in Casablanca. J Antimicrob Chemother 49: 169172.[Crossref] [Google Scholar]
  14. Blomberg B, Jureen R, Manji KP, Tamim BS, Mwakagile DS, Urassa WK, Fataki M, Msangi V, Tellevik MG, Maselle SY, Langeland N, , 2005. High rate of fatal cases of pediatric septicemia caused by gram-negative bacteria with extended-spectrum β-lactamases in Dar es Salaam, Tanzania. J Clin Microbiol 43: 745749.[Crossref] [Google Scholar]
  15. Aibinu I, Odugbemi T, Koenig W, Ghebremedhin B, , 2012. Sequence type ST131 and ST10 complex (ST617) predominant among CTX-M-15-producing Escherichia coli isolates from Nigeria. Clin Microbiol Infect 18: E49E51.[Crossref] [Google Scholar]
  16. Cowan ST, Steel KJ, Barrow GI, Feltham RK, , 2004. Characteristics of gram negative bacteria. , eds. Cowans and Steels Manual for Identification of Medical Bacteria. Third edition. London: Cambridge University Press, 94150. [Google Scholar]
  17. Clinical and Laboratory Standards Institute (CLSI), 2007. Performance standards for antimicrobial susceptibility testing, 17th informational supplement. M100-S17. Wayne, PA: The Institute.
  18. Clinical and Laboratory Standards Institute (CLSI), 2006. Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically, 7th edition. Approved standard. M7-A7. Wayne, PA: The Institute.
  19. Hoban D, Lascols C, Nicolle LE, Badal R, Bouchillon S, Hackel M, Hawser S, , 2012. Antimicrobial susceptibility of Enterobacteriaceae, including molecular characterization of extended-spectrum beta-lactamase-producing species, in urinary tract isolates from hospitalized patients in North America and Europe: results from the SMART study. Diagn Microbiol Infect Dis 74: 6264.[Crossref] [Google Scholar]
  20. European Centre for Disease Prevention and Control (ECDC), 2011. Antimicrobial resistance surveillance in Europe 2010. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). [Google Scholar]
  21. Newman MJ, Frimpong E, Asamoah-Adu A, Sampane-Donkor E, Opintan JA, , 2011. Resistance to antimicrobial drugs in Ghana. Infect Drug Resist 4: 215220. [Google Scholar]
  22. Codjoe FS, Newman MJ, Enweronu-Laryea C, , 2009. Neonatal infections: is extended-spectrum β-lactamase-producing gram-negative bacilli part of the problem? Ghana J. of Allied Health Sciences 3: 1529. [Google Scholar]

Data & Media loading...

  • Received : 18 Oct 2012
  • Accepted : 14 Apr 2013
  • Published online : 06 Nov 2013

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error