Browsing by Author "Dela, H."
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Item Antimicrobial resistance (AMR) and molecular characterization of Neisseria gonorrhoeae in Ghana, 2012-2015(Plos One, 2019-10-10) Addo, K.K.; Attram, N.; Agbodzi, B.; Dela, H.; Behene, E.; Nyarko, E.O.; Kyei, N.N.A.; Larbi, J.A.; Lawson, B.W.L.; Newman, M.J.; Duplessis, C.A.; Adams, N.; Unemo, M.; Letizia, A.G.Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance is essential for tracking the emergence and spread of AMR strains in local, national and international populations. This is crucial for developing or refining treatment guidelines. N. gonorrhoeae multiantigen sequence typing (NG-MAST) is beneficial for describing the molecular epidemiology of gonococci at national and international levels. Elucidation of AMR determinants to β-lactam drugs, is a means of monitoring the development of resistance. In Ghana, little is known about the current gonococcal AMR prevalence and no characterization of gonococcal isolates has been previously performed. In this study, gonococcal isolates (n = 44) collected from five health facilities in Ghana from 2012 to 2015, were examined using AMR testing, NG-MAST and sequencing of penA. High rates of resistance were identified to tetracycline (100%), benzylpenicillin (90.9%), and ciprofloxacin (81.8%). One isolate had a high cefixime MIC (0.75 μg/ml). Twenty-eight NG-MAST sequence types (STs) were identified, seventeen of which were novel. The isolate with the high cefixime MIC contained a mosaic penA-34 allele and belonged to NG-MAST ST1407, an internationally spreading multidrug-resistant clone that has accounted for most cefixime resistance in many countries. In conclusion, AMR testing, NG-MAST, and sequencing of the AMR determinant penA, revealed high rates of resistance to tetracycline, benzylpenicillin, and ciprofloxacin; as well as a highly diverse population of N. gonorrhoeae in Ghana. It is imperative to continue with enhanced AMR surveillance and to understand the molecular epidemiology of gonococcal strains circulating in Ghana and other African countries.Item Antimicrobial Resistance Of Foodborne Pathogens In Stool Of Diarrhoea Patients In Two Selected Health Facilities And Food From Vendors In Selected Communities In Ghana(University Of Ghana, 2021-12) Dela, H.Foodborne pathogens (FBPs) have been implicated as the cause of so many food poisonings and outbreaks worldwide. Food borne bacteria are the second most common FBP after viruses in causing public health threat due to the gradual emergence of antimicrobial resistance (AMR) in the food chain. Although contaminated food is frequently implicated as the cause of diarrhoeal-related hospitalization, especially during outbreak investigations in Ghana, integrated surveillance has not been conducted to ascertain this fact. This study engaged the various transdisciplinary sectors in human and environmental health to show the holistic approach in understanding the occurrence of AMR of foodborne bacteria in Ghana. Stool of patients attending Maamobi General hospital and Kaneshie polyclinic were collected, and questionnaire administered to patients to understand the risk factors involved in diarrhoea transmission. Ready-to-eat (RTE) food and water were collected from food vendors, palm swabs of food vendors as well as responses on possible risk factors leading to food and water contamination were investigated. Common pathogens isolated in stool were E. coli, E. cloacae, K. pneumoniae in food, while K. pneumoniae, Aeromonas spp. and E. cloacae were isolated from food, water and palm samples from the Maamobi and Kaneshie communities. Among the stool isolates, a total of 69.7% (85/122) Enterobacteriaceae was recovered in the study with an overall ESBL occurrence of 26.5%, predominantly among E. coli (13.2%; 10/76), Klebsiella pneumoniae (35.7%; 5/14) and Proteus mirabilis (57.1%; 4/7). Among the ESBL genes detected, blaTEM (n=14) was common, followed by blaCTX-M (n=13) and blaSHV (n=4). Thirty-four E. coli isolates from the stool samples possessed the heat labile (Lt) gene of Enterotoxigenic E. coli (ETEC) in the stool samples. All the Enterobacteriaceae isolates were resistant to the penicillins and aminoglycosides apart from E. coli which showed reduced susceptibility to both drug classes. The food items showed the common occurrence of E. cloacae (16.8%), Citrobacter spp (10.1%), E. faecalis (7.8%), Pseudomonas spp (6.7%) and K. pneumoniae (4.0%). Resistance genes and Diarrhoeagenic E. coli (DEC) showed among two C. freundii isolates possessing the blaTEM gene and one E. coli possessing the Lt gene of ETEC. Over 50% resistance to penicillins and Rifampicin among most of the Enterobacteriaceae (E. cloacae, Citrobacter spp, Aeromonas spp), and non- Enterobacteriaceae (E. faecalis) were observed among the isolates recovered. Common pathogens recovered in water and palm were K. pneumoniae, Aeromonas spp. and E. cloacae with one K. pneumoniae isolate from the palm of a food vendor possessing the blaTEM gene. Resistance to majority of the antibiotics among the Enterobacteriaceae as well as non-Enterobacteriaceae (E. faecalis and Pseudomonas spp) was observed. Mean Total Plate Counts (TPC) of 1.4 X 105 CFU/g) of unsatisfactory interpretation was observed in stew as well as mean Total Coliform Counts (TCC) of 2.2 X 105 CFU/g and 1.7 X 105 CFU/g occurring in stew and ‘waakye’ respectively. Over 50% of all water types examined for mesophilic bacteria by TPC and TCC were considered impure with all palm swabs showing a 100% purity. Environmental samples (food and water) showed the effect of non-adherence to proper hand hygiene on food and water contamination during street food vending and the need for targeted education and enforcement of food safety policies in the country. These findings confirm the existence of AMR FBPs posing a threat to food safety due to the difficult to treat infections in case of transmission. Similar resistance to beta-lactams, Tetracyclines, Azithromycin and Penicillinase antibiotics among the clinical and environmental isolates shows common FBP transmission patterns which warrants the need for more AMR integrated surveillance in the food chain prior to consumption.Item Antimicrobial use of patients with sexually transmitted infection symptoms prior to presentation at five health facilities in Southern Ghana(Antimicrobial Resistance & Infection Control, 2023) Attram, N.; Dela, H.; Behene, E.; et al.Background Unregulated and inappropriate antimicrobial use are major contributors to the evolution of antimicrobial resistance worldwide. It is important to monitor and collect data on the use of antibiotics at health facilities and in the general population in order to support antimicrobial stewardship programs. Methods As part of a gonorrhea surveillance study that was conducted from June 2012 to Jan 2018, we administered a questionnaire to elicit information on the types of antimicrobials used by individuals to treat symptoms of a gonorrhea infection prior to presenting at five health facilities in Southern Ghana. Results Almost one-third (383/1,349; 28%) of study participants admitted taking one or more antimicrobial types before hospital presentation, while 138/383 (36%) of those who took antimicrobials could not remember what they ingested. A greater percentage of individuals who reported prior antimicrobial use before presentation at a health facility tested positive for gonorrhea by NAAT (30%), in contrast to 24% for those without prior treatment (p=0.004). Penicillin and its derivatives, as well as ciprofloxacin and doxycycline, were the most used, while a few individuals reported taking drugs such as kanamycin and rifampin. Males were more likely than females to take an antimicrobial prior to attending a health center. Conclusion In order to curb excessive and inappropriate antimicrobial use, antibiotics used by patients before presenting at hospitals ought to be investigated by healthcare providers. It is recommended that health professionals receive continuing education on the consequences of unregulated antimicrobial use.Item Microbiological quality and antimicrobial resistance of Bacteria species recovered from ready-to-eat food, water samples, and palm swabs of food vendors in Accra, Ghana(International Journal of Food Microbiology, 2023) Dela, H.; Egyir, B.; Sulemana, H.; Tagoe, R.; Bentil, R.This study sought to investigate microbial quality and antimicrobial resistance of bacteria species from Ready-to Eat (RTE) food, water, and vendor palm swab samples. Between 2019 and 2020, RTE food, water and vendor palm swab samples were collected from food vending sites in Accra, Ghana. Samples were cultured and confirmed using the Matrix-assisted laser desorption ionizationtime of flight mass spectrometry (MALDI-TOF). Antimicrobial susceptibility testing (AST) was conducted using disk diffusion method. Beta-lactamase and Diarrheagenic Escherichia coli (DEC) genes were determined using Polymerase Chain Reaction (PCR). Total plate count (TPC) and Total coliform count (TCC) were performed on food and water samples. In total, 179 RTE food, 72 water and 10 vendor palm swab samples were collected. Enterobacter spp. (16.8 %), Citrobacter spp. (10.1 %), Enterococcus faecalis (7.8 %), Pseudomonas spp. (6.7 %) and Klebsiella pneumoniae (4.0 %) occurred in food. Isolates from water and palm were Klebsiella pneumoniae (20.8 %), Aeromonas spp. (16.7 %) and Enterobacter cloacae (11.1 %). Resistance to Amoxicillin-clavulanate, Tetracycline, Azithromycin, Sulfamethoxazole-trimethoprim, and Nitrofurantoin were common among Enterobacterales. High mean TPC and TCC showed in some RTE food and different water types used in vending depicting their unsafe condition for consumption and usage. The blaSHV and blaTEM genes were present in some Enterobacterales from food and water. The lt gene was identified in two food samples. AMR organisms associated with nosocomial infections in the samples investigated, calls for continuous surveillance in the food industry in Ghana. Also, the unsafe outcome of RTE food and water depicts the need for the enforcement of Ghana's food safety laws.Item Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana(BMC Infectious Diseases, 2019-04-26) Addo, K.K.; Dela, H.; Attram, N.; Behene, E.; Kumordjie, S.; Nyarko, E.O.; Kyei, N.N.A.; Carroll, J.N.A.; Kwakye, C.; Duplessis, C.A.; Adams, N.; Garges, E.; Letizia, A.G.Background: Understanding the underlying epidemiology that shapes Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT) infections can contribute to data driven policies directed towards curbing the proliferation of these pathogens in Ghana. Information on the symptoms and risk factors for STIs will help to identify high-risk individuals which will in turn inform STI syndromic management and tailor the use of public health resources. Methods: Participants were from 4 military clinics and 1 civilian STI clinic in Ghana and eligible if they had symptoms suggestive of STI. First void urine samples were collected and tested with Nucleic Acid Amplification Test (NAAT). A structured questionnaire was administered to all participants. Multivariate logistic regression identified factors associated with infection, separately for NG and for CT and for men and women. Results: A total of 950 patients, 58% of whom were females were enrolled, 28% had gonorrhea and 11% had chlamydia with more males testing positive than females. Reported symptoms that were more common among patients who tested positive for gonorrhea were painful urination and urethral discharge (all P values < 0.05). Additionally, multiple sexual partners and alcohol use were statistically associated with higher rates of gonorrhea in males while only the frequency of condom use was associated with gonorrhea for females. None of the symptoms or risk factors except marital status was associated with testing positive for chlamydia. Conclusion: Identifying these symptoms and risk factors help inform health care delivery systems for STIs in Ghana. Furthermore, men and women presenting with these symptoms and risk factors are a prime target for public health education campaigns, aimed at curbing the spread of gonorrhea and chlamydia infections.Item Whole genome analysis and antimicrobial resistance of Neisseria gonorrhoeae isolates from Ghana(Frontiers in Microbiology, 2023) Agbodzi, B.; Duodu, S.; Dela, H.; et al.Introduction: Gonorrhoea is a major public health concern. With the global emergence and spread of resistance to last-line antibiotic treatment options, gonorrhoea threatens to be untreatable in the future. Therefore, this study performed whole genome characterization of Neisseria gonorrhoeae collected in Ghana to identify lineages of circulating strains as well as their phenotypic and genotypic antimicrobial resistance (AMR) profiles. Methods: Whole genome sequencing (WGS) was performed on 56 isolates using both the Oxford Nanopore MinION and Illumina MiSeq sequencing platforms. The Comprehensive Antimicrobial Resistance Database (CARD) and PUBMLST. org/neisseria databases were used to catalogue chromosomal and plasmid genes implicated in AMR. The core genome multi-locus sequence typing (cgMLST) approach was used for comparative genomics analysis. Results and Discussion: In vitro resistance measured by the E-test method revealed 100%, 91.0% and 85.7% resistance to tetracycline, penicillin and ciprofloxacin, respectively. A total of 22 sequence types (STs) were identified by multilocus sequence typing (MLST), with ST-14422 (n = 10), ST-1927 (n = 8) and ST-11210 (n = 7) being the most prevalent. Six novel STs were also identified (ST-15634, 15636-15639 and 15641). All isolates harboured chromosomal AMR determinants that confer resistance to beta-lactam antimicrobials and tetracycline. A single cefixime-resistant strain, that belongs to N. gonorrhoeae multiantigen sequence type (NG-MAST) ST1407, a type associated with widespread cephalosporin resistance was identified. Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance (NG-STAR), identified 29 unique sequence types, with ST-464 (n = 8) and the novel ST-3366 (n = 8) being the most prevalent. Notably, 20 of the 29 STs were novel, indicative of the unique nature of molecular AMR determinants in the Ghanaian strains. Plasmids were highly prevalent: pTetM and pblaTEM were found in 96% and 92% of isolates, respectively. The TEM-135 allele, which is an amino acid change away from producing a stable extended-spectrum β-lactamase that could result in complete cephalosporin resistance, was identified in 28.5% of the isolates. Using WGS, we characterized N. gonorrhoeae strains from Ghana, giving a snapshot of the current state of gonococcal AMR in the country and highlighting the need for constant genomic surveillance.