Helena Owusu

Operational research (OR) published in 2023 revealed low utilisation and suboptimal quality of blood culture services at a tertiary hospital in Ghana. To address these, several interventions were implemented, including sensitisation of physicians, training of laboratory staff, use of automated incubation systems, and improved availability of laboratory consumables. To assess the impact of these interventions, we conducted a follow-up study in a cross-section of inpatients (n = 1080) with suspected bloodstream infections (BSI) admitted in 2024. There were three key changes. First, there was a five-fold increase in requests for blood culture from 8% pre-OR to 40% post-OR. Culture requests were more frequent from child health department (63%) and intensive care units (53%) compared to surgery department (15%). Second, there was a reduction in delays: time from hospital admission to culture request was reduced from 2 days to 1 day, and the laboratory turn-around time was reduced from 7 days to 5 days. Third, there was a marginal improvement (p = 0.692) in the quality of blood cultures: diagnostic yield improved from 7% to 10%, and the contamination rate was reduced from 16% to 14%. Achieving universal culture utilisation among eligible patients and lowering contamination rates will require a detailed gap analysis and targeted interventions.

High levels of antimicrobial resistance (AMR) were found in healthy pigs in the Greater Accra region of Ghana in 2022; this led to awareness creation and education of pig farmers about how to improve antimicrobial practices and biosecurity. To assess changes in AMR after the intervention, we compared AMR, multi-drug resistance (MDR), and determined colistin resistance levels in healthy pigs in the region before (2022) and after (2024) the education of farmers. Rectal swabs (n = 140) from pigs in 14 farms were cultured for isolation of Enterobacterales (Escherichia coli and Enterobacter spp.) and subjected to antimicrobial susceptibility testing. A selective culture method was employed to isolate colistin-resistant Enterobacterales, which were further screened for the mcr-1 gene. AMR and MDR findings were compared with those from 140 pigs from the same farms in 2022. Enterobacterales were found in 137 (2022) and 138 (2024) rectal swabs, with Escherichia coli predominating. There was a marked increase in AMR prevalence for eight of the nine tested antibiotics in 2024. Notable increases in resistance were for tetracycline (58–82%), ampicillin (33–49%), and ciprofloxacin (3–33%). MDR prevalence was highest in Escherichia coli, increasing from 20% to 44%. Phenotypic colistin resistance was found in 44% of Escherichia coli isolates in 2024 (in 2022, using different methodology, phenotypic colistin resistance was 8%)—in 2024, the mcr-1 gene was found in 51% of these isolates. There were no relevant associations between farm and pig characteristics and prevalence of MDR and phenotypic colistin resistance. Although education is an important aspect of AMR control, the findings highlight that education alone cannot curb the rise of AMR. Further interventions including continuous surveillance, stronger regulatory policy on antimicrobial use, and behavioral interventions will be needed to mitigate the situation.

Compliance with standard treatment guidelines (STGs) for the empirical management of uncomplicated urinary tract infections (UTIs) ensures the rational use of antibiotics and mitigates antimicrobial resistance. Operational research (OR) at Korle Bu Polyclinic in Ghana (2022) showed suboptimal STG compliance (prescription of recommended antibiotics in the correct dose, route, frequency, and duration). Some of the recommendations from the OR, including training of medical residents, implementation of an antimicrobial stewardship team, and an audit–feedback system, were implemented. This before-and-after study compared the changes in empirical prescribing practices for patients diagnosed with uncomplicated UTIs before (October 2019–October 2021) and after (January 2023–December 2024) the OR. Of the 3717 and 3457 UTI patients in the before and after cohorts, 83% and 86% received empirical antibiotics, respectively. Among those who received empirical antibiotics, STG compliance increased from 60% to 66% (p-value < 0.001). However, STG compliance remained significantly lower among males (18%) compared to females (85%) in the after cohort, as 80% of males were prescribed antibiotics for a shorter period than the recommended 10–14 days. Moving forward, the training and audit–feedback system should emphasize longer antibiotic durations for males with UTI. Given its positive impact, the OR’s approach warrants replication for other disease conditions.

Increasing antimicrobial resistance (AMR) levels in Enterobacterales from pigs in Ghana prompted us to investigate farm feed, pig slurry, and farm water for Enterobacterales isolates, their antimicrobial resistance patterns, and antimicrobial residues. Between August and November 2024, we collected one sample each of feed, slurry, and water from 14 pig farms for microbiological analysis. Out of 42 samples, Enterobacterales (E. coli and Enterobacter spp.) were isolated from 30 (71.4%) samples, with the highest prevalence found in feed (85.7%), followed by slurry (78.6%) and water (50.0%). The prevalence of AMR to tetracyclines, trimethoprim-sulfamethoxazole, and ampicillin was high, with over 50% of isolates from slurry and water and 40% from feed exhibiting tetracycline resistance. Multi-drug resistance (MDR) was identified in nine (27.3%) isolates of Enterobacterales, with the highest prevalence found in feed (38.5%), then slurry (23.1%), and water (14.3%). Among 42 farm samples screened for colistin-resistant Enterobacterales, 10 (23.8%) exhibited phenotypic colistin resistance. No antimicrobial residues were detected. Risk factors associated with MDR included large farms with high pig turnover (p < 0.05) and the channelling of slurry into both covered and uncovered pits on the farm (p < 0.05). These high resistance levels underscore the urgent need for improved hygiene in feed, water, and slurry management, stricter antibiotic stewardship with veterinary oversight, and better enforcement of existing antibiotic use regulations on pig farms.

Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5–7 days in females and 10–14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10–14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.

The first comprehensive point prevalence survey at the Korle Bu Teaching Hospital (KBTH) was performed as part of the 2019 Global Point Prevalence Survey (Global-PPS) on antimicrobials. The aim was to establish a PPS baseline for the whole hospital and to identify required stewardship interventions. The PPS was conducted over three days in June 2019 using the GLOBAL-PPS standardized method for surveillance of antimicrobial utilization in hospitals to evaluate antimicrobial prescribing. In all, 988 patients were admitted to 69 wards. Overall antimicrobial prevalence was 53.3%. More community-acquired infections (CAI) were treated empirically compared to health-care associated infections (94.0% vs. 86.1% respectively, p = 0.002). Main indications for prescribing antimicrobials were pneumonia (18.4%), skin and soft tissue infections (11.4%) and sepsis (11.1%). Among antimicrobials, systemic antibiotics accounted for 83.5%, of which amoxicillin with beta-lactam inhibitor (17.5%), metronidazole (11.8%) and ceftriaxone (11.5%) dominated. Guideline compliance was 89.0%. Stop/review dates were completed in 33.4% and documented reason was recorded in 53.0% of all prescriptions. If the findings in this PPS can be addressed antimicrobial stewardship at the KBTH stands to improve significantly.