Opintan, J. A.Newman, M. J.Addo, F. A.University of Ghana, College of Health Sciences, School of Biomedical and Allied Health Sciences, Department of Medical Microbiology2016-06-062017-10-132016-06-062017-10-132015-07http://197.255.68.203/handle/123456789/8342Thesis (MPhil.) - University of Ghana, 2015Background: Wound infections mostly caused by Pseudomonas are on the increase in hospitals in Ghana. Most of these infected wounds are very difficult to treat with available antibiotics. This failure of treatment has resulted in increased need for healthcare, undue financial burden on both hospitals and patients and finally death of many of these patients. This has become a source of worry for both patients and healthcare providers in Ghana. General Aim: The main aim of this study was to characterize antimicrobial resistant bacteria from infected wounds at the Korle-Bu Teaching Hospital (KBTH) and the Koforidua Regional Hospital (KRH) in Ghana. Methodology: Two hundred and twenty-two (222) consecutive, non-duplicated patients with infected wounds attending the KBTH and the KRH were swabbed. Bacteria were isolated, identified and characterized using standard microbiological methods. Antimicrobial susceptibility of the clinical isolates was determined according to the Clinical Laboratory Standard Institute guidelines (CLSI). Phenotypic and molecular techniques were used to detect carbapenem-resistant Pseudomonas strains and presence of metallo-beta-lactamase (MBL) genes, bla VIM-type, bla SPM-type and bla IMP-type. Vital clinical information of patients was obtained from folders at the time of sample collection and analyzed. Results: A total number of 194 bacteria were isolated from patients attending KBTH and KRH. The bacteria isolates included Pseudomonas spp. 92(47.4%), Proteus spp. 27(13.9%), Citrobacter spp. 20(10.3%), Escherichia coli 15(7.7%), Klebsiella spp. 15(7.7%), Staphylococcus aureus 14(7.2%), Enterobacter spp. 6(3.1%), Acinetobacter spp. 3(1.5%), methicillin-resistant Staphylococcus aureus1(0.5%) and Morganella morgani 1(0.5%). At KBTH, Pseudomonas spp. represented 67.0% of the 103 patients compared to 25.3% of the 91 patients from KRH. The antibiotic resistance pattern of Pseudomonas spp. showed high level of resistance to ciprofloxacin 24(26.1%) followed by gentamicin 20(21.3%), ceftazidime 18(19.6%), amikacin 15(16.3%), piperacillin/tazobactam 7(7.6%) and meropenem 1(1.1%). Phenotypically, one metallo-beta-lactamase (MBL) producing, carbapenem-resistant multidrug-resistant Pseudomonas aeruginosa (CR-MDRPA) was detected from KBTH. Up to 35.1% of 194 bacteria isolated met the criteria used to define multidrug resistance (MDR). An average of two years duration of non-healing wound was observed among patients with infected wounds attending KBTH and KRH. Increased systemic treatment with ciprofloxacin and metronidazole (Flagyl) were observed. There was no record of any patient treated with carbapenem at the time of sample collection. Conclusions: In the current study,high prevalence of multidrug resistance varied among isolates; Pseudomonas (13.0%), Proteus spp. (29.6%), Acinetobacter spp. (33.3%), Klebsiella spp. (40.0%), Enterobacter spp. (66.7%), Staphylococcus aureus (66.7%), Escherichia coli (73.3%) and Morganella morgani (100%). Very low levels of carbapenem-resistant Pseudomonas(1.1%) and methicillin-resistant Staphylococcus aureus(6.7%) were detectedin the infected wounds.xiii, 76p. : ill.enThesisUniversity of Ghana