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

• Published in: PloS one 2024-11, Vol.19 (11), p.e0310058
• Main Authors: Obeng-Nkrumah, Noah, Korang-Labi, Appiah, Kwao, Paul, Egyir, Beverly, Nuertey, Benjamin D, Hedidor, George, Boateng, Gifty, Asah-Opoku, Kwaku, Dankwah, Thomas, Okine, Esther, Opintan, Japheth A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analysis; Anti-Bacterial Agents - pharmacology; Antibiotics; At risk populations; Beta lactamases; beta-Lactamases - genetics; beta-Lactamases - metabolism; Biology and Life Sciences; Biotechnology industry; Care and treatment; Clinics; Co-trimoxazole; Data collection; Diagnosis; DNA sequencing; Drug resistance; E coli; Education; Enterobacterales; Enterobacteriaceae - enzymology; Enterobacteriaceae - genetics; Enterobacteriaceae - isolation & purification; Enterobacteriaceae infections; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Escherichia coli; Escherichia coli - genetics; Escherichia coli - isolation & purification; Feces; Feces - microbiology; Female; Gene sequencing; Genomes; Genomic analysis; Genomics; Gestational age; Ghana - epidemiology; Gynecology; Health aspects; Health promotion; Hospitals; Humans; Infection; Legumes; Medical research; Medicine and Health Sciences; Medicine, Experimental; Microbial Sensitivity Tests; Multidrug resistance; Nucleotide sequencing; Obstetrics; Phylogenetics; Phylogeny; Pregnancy; Pregnant women; Prevalence; Protein sources; Public health; Questionnaires; Regression analysis; Research and Analysis Methods; Risk Factors; Tazobactam; Teaching hospitals; Tetracycline; Tetracyclines; Toilet facilities; Urinary tract diseases; Urinary tract infections; Urogenital system; Whole genome sequencing; Womens health; Young Adult; β Lactamase
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0310058

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. 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. 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. 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. 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.