Investigating GLASS priority pathogens associated with urinary tract infection among patients at 37 Military Teaching Hospital

Abstract

Urinary tract infections (UTIs) are a common infection that is frequently encountered in settings such as hospitals and communities. It is the most frequent bacterial infection and the second most prevalent form of infection in humans. Currently, the rapidly increasing global spread of antibiotic resistance poses a serious challenge for caregivers. In 2015, the Global Antimicrobial Resistance Surveillance System (GLASS) program was introduced by the World Health Organization (WHO) with the aim of fostering global collaboration and establish standardized surveillance of antimicrobial resistance (AMR). GLASS priority pathogen causes a lot of infections that are very difficult to treat due to their ability of resisting multi-drugs. The use, misuse and overuse of antibiotic to manage UTIs have contributed to the surge of extended-spectrum beta- lactam (ESBL) and carbapenemase producing uropathogens. A cross-sectional study design was carried out to determine the prevalence of GLASS priority pathogens with the resistance genes they possess causing UTIs and determine the antibiogram from the third largest tertiary hospital in Ghana over the period of January 2023 – June 2023. Out of 500, mid-stream urine presented, 147 had significant growth with 63.2% (93/147) of the isolates recovered from CA-UTI and 38.1% (56/147) from HA-UTI. Four different GLASS priority pathogens were identified. The majority of isolates came from Enterobacteriaceae, with Escherichia coli being the most commonly identified uropathogen isolated 84(57.1%) followed by Klebsiella pneumoniae 53(36.1%), Acinetobacter baumanii 7(4.8%) and Staphylococcus aureus 3(2.0%). The antibiotics with the highest percentage of resistance include ampicillin, cefuroxime (72%) and ciprofloxacin (45%) while the least resistance includes amikacin (2%), imipenem (13%), meropenem (9%) and tigecycline (13%) which are all part of WHO watch and reserve category. Fifteen different sequence types (STs) were identified, including international clonal ones of E. coli such as ST131 and ST 410 and hypervirulent ones of K. pneumoniae such as ST464 and ST147. The isolates harbored β-lactamase resistance genes (variants of blaCTX-M (78.6%), blaSHV (35.7%), blaTEM (50.0%), as well as carbapenemase resistance genes (OXA-1 (64.3%) and OXA 232 (7.1%). The isolates carried virulence-associated genes including adhesins, toxins, anti-host defense factors, iron acquisition systems, and more. Overall, the plasmid group IncF (FII, FIA, and FIB) emerged the dominant 52.1%, followed by 27.4% Col group (Col156, Col(MG828), Col4401, ColKp3,and Col(BS512)). This research provides both the phenotypic and genotypic insight of GLASS priority pathogens causing urinary tract infections in Accra, Ghana, and also explores the presence of sequence types, antimicrobial resistance genes, virulence gene and plasmid in the genetic makeup of E. coli and K. pneumonia strains using the whole genome sequencing (WGS).