Extended-spectrum beta-lactamase-producing Enterobacterales in human health: Experience from the tricycle project, Ghana

Noah Obeng-Nkrumah, Appiah Korang-Labi, Paul Kwao, Beverly Egyir, Benjamin D. Nuertey, George Hedidor, Gifty Boateng, Kwaku Asah-Opoku, Thomas Dankwah, Esther Okine, Japheth A. Opintan

Research output: Contribution to journalArticlepeer-review

Abstract

Background Vulnerable groups, such as pregnant women, are at increased risk of potentially life-threatening infections with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) for both mother and newborn. However, data regarding ESBL-E carriage and associated risk factors in Ghanaian pregnant women remain scarce. Objective This study aimed to determine the prevalence of ESBL-E carriage and its associated risk factors among pregnant women attending the antenatal clinic at the Korle Bu Teaching Hospital. Methods A systematic sample of 700 pregnant women with gestational age ≥ 34 weeks attending the antenatal clinic at Korle Bu Teaching Hospital was included in the study. After administering a structured questionnaire to assess potential risk factors associated with ESBL-E carriage, patients were given a sterile stool container to submit at least 1 g of stool specimen. Recovered isolates from faecal specimens were identified using MALDI-TOF-MS technology. These isolates were then subjected to susceptibility testing and ESBL identification. A random subset of 24 ESBL-producing Escherichia coli isolates was whole-genome sequenced on the MiSeq Illumina platform. Risk factors associated with ESBL-E carriage were determined using multivariable logistic regression analysis. Results Among the 700 pregnant women, 42% (294) carried ESBL-E. The predominant ESBL-producing Enterobacterales were Escherichia coli (95%). Fifty percent (50%) of ESBL-E were multidrug resistant isolates (MDRs). Whole-genome sequencing of 24 ESBL-producing E. coli isolates revealed that blaCTX-M-15 (96%) was the most prevalent ESBL gene type. Notably, most isolates belonged to commensal phylogenetic groups (A, B1, and C; 88%). Having a primary level of education (aOR 1.45, 95% CI 1.05–1.96) and consuming legumes as the main source of protein (aOR 0.17, 0.40–0.83) were significantly associated with intestinal carriage of ESBL-E. Conclusion This study identified a high prevalence of ESBL-E and MDR-ESBL-E carriage among pregnant women. Our findings underscore the urgent need for public health interventions to control the spread of AMR.

Original languageEnglish
Article numbere0310058
JournalPLoS ONE
Volume19
Issue number11 November
DOIs
Publication statusPublished - Nov 2024

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