Metallo-Beta-Lactamase-Producing Acinetobacter Spp. From Clinical Isolates at a Tertiary Care Hospital in Accra, Ghana.

Abstract

Background: One of the most pertinent issues in health-care institutions is the emergence and global spread of metallo-β-lactamase (MBL) producing bacteria of blaVIM-, blaIMP- and blaNDM types. Metallo-β-lactamase producing-Acinetobacter has become a public health concern due to therapeutic treatment challenges associated with nosocomial infections. In Ghana, limited information is available on clinical isolates of MBL-producing-Acinetobacter. Aim: The aim of the study was to determine the prevalence of MBL-producing-Acinetobacter spp. of routinely collected clinical isolates from the Korle-Bu Teaching Hospital, Accra. Methodology: A total of 87 clinical isolates of Acinetobacter were routinely collected from cultures of aspirates, urine, ear, eye and wound swabs between August 2014 to July 2015. Susceptibility pattern was done by Kirby-Bauer disk diffusion method. Meropenem-resistant Acinetobacter isolates were screened for enzymes using Modified Hodge test (MHT) and carbapenem-EDTA combined disc test (CDT). Additionally, multiplex PCR was used to determined MBL genes (blaVIM, blaIMP and blaNDM) in MBL screen positive Acinetobacter isolates. Results: The 87 Acinetobacter isolates showed high levels of antibiotic resistance to cefotaxime (90.8%), ceftadizime (75.9%), co-trimoxazole (70.1%), ciprofloxacin (64.4%), gentamicin (72.4%), levofloxacin (67.8%) and meropenem (59.8%). A total of 54 (62.1%) of Acinetobacter isolates were multidrug-resistant. Out of 52 (59.8%) meropenem-resistant Acinetobacter, 3 (5.8%) were carbapenemase producers by MHT whilst, 23 (44.2%) were MBL screen positive by CDT. There was no significant difference between the resistance pattern of amikacin, ceftazidime, co-trimoxazole, ciprofloxacin and meropenem amongst MBL screen positive and MBL screen negative isolates (p-value >0.05). A total of 7 of 87 (8.1%) MBL screen positive Acinetobcter isolates harboured blaNDM. Of these, 4 (57.1%) were from wound swabs, urine 2 (28.6%) and ear swab 1 (14.3%). However, no blaVIM or blaIMP was detected. Conclusion: PCR analysis for blaVIM, blaIMP and blaNDM showed that less than 9% of 87 Acinetobacter spp. harboured NDM encoding genes. MBL-producing-Acinetobacter isolates showed high levels of resistance to multiple antibiotics. The detection of blaNDM amongst MBL producing-Acinetobacter is a cause for concern, therefore, strict antibiotics usage and infection control measures should be instituted to prevent the spread of these resistance genes. University