High prevalence of multidrug-resistant and ESBL-producing bacteria in a primary healthcare facility in Accra, Ghana: A cross-sectional study

Abstract

Antimicrobial resistance (AMR) is a global public health crisis, particularly in low- and middle-income countries where empirical antibiotic use is common. Data on bacterial resistance patterns in primary healthcare settings remain limited in Ghana, impeding effective treatment guidelines and infection control measures. This cross-sectional study, conducted at Shalina Health Centre in Accra, Ghana, between May and November 2024, examined bacterial infections among 156 systematically sampled patients. Clinical specimens underwent bacterial culture, identification via Gram staining and biochemical tests, and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion method. Extended-spectrum beta-lactamase (ESBL) production was assessed per Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis included prevalence estimation with 95% confidence intervals and subgroup comparisons using ANOVA and Chi-square tests. Bacterial infections were detected in 62.20% [97/156] of participants, with Escherichia coli [43.30%], Staphylococcus aureus [21.65%], and Klebsiella pneumoniae [19.59%] as the most prevalent pathogens. Gram-negative bacteria accounted for 75.26% of isolates. Females exhibited a significantly higher infection rate [69.64%] than males [43.18%] [p = 0.002]. Multidrug resistance (MDR) was widespread [97.94%], and 76.06% of Enterobacteriaceae isolates were ESBL producers. Resistance to fluoroquinolones, cephalosporins, and beta-lactams was particularly high among Gram-negative isolates. The study highlights the high burden of multidrug-resistant bacteria in primary healthcare settings, with significant resistance to key antibiotics. These findings emphasize the urgent need for enhanced antimicrobial stewardship, evidence-based prescribing practices, and strengthened infection prevention measures. Surveillance in non-tertiary healthcare facilities is crucial to mitigate AMR transmission and optimize treatment protocols in Ghana and similar settings.