Prevalence of Salmonella and other gram negative bacterial infections among Fever and Diarrheal patients visiting Half-Assini Government Hospital

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JUNE, 2016
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Infections with Salmonella and other Gram negative bacteria are becoming more difficult to treat due to their resistance to commonly available antibiotics. Also, some district laboratories are not fully equipped to perform diagnostic tests to isolate and identify these pathogens. There have been reports of antimicrobial resistance as a result of production of Extended Spectrum Beta Lactamase (ESBL) in Accra and Kumasi but no such study has been done in Half-Assini. This study was therefore undertaken to determine the prevalence of Salmonella and other Gram negative organisms, their antimicrobial susceptibility pattern together with whether they were ESBL producers or not. Stool, blood and urine samples were collected non repetitively from patients with fever and diarrhoea and were cultured on their respective appropriate media. Growths that occurred were transferred onto Nutrient agar for biochemical and serological identification using the standard methods. Antimicrobial susceptibility of the isolates was done using disc diffusion Kirby Bauer method. The isolates were tested for ESBL production using double disc diffusion method. Pulsed-Field Gel Electrophoresis (PFGE) was done on Salmonella isolates. Prevalence of all the isolates was 10.9 %( 42/384) consisting of 5 Salmonella Choleraesuis (from stool samples), 4 Salmonella Typhi (3 from stool samples and 1 from blood sample) and 27 Escherichia coli (23 from urine samples and 4 from blood samples) and 6 Klebsiella pneumoniae (2 from blood samples and 4 from urine samples). All the bacterial isolates were susceptible to ceftriaxone, cefuroxime and cefotaxime. All the Salmonella isolates were also susceptible to ciprofloxacin and amoxicillin/clavulanic acid. There was high level of susceptibility of the other isolates to gentamycin (81.0%), ciprofloxacin (88.1%) and amoxicillin/clavulanic acid (73.8%). None of the 42 isolates was susceptible to ampicillin and tetracycline. None of the isolates produced ESBL. Pulsed-field gel electrophoresis showed that the 5 Salmonella Choleraesuis were similar in terms of DNA band size and separation while the 4 Salmonella Typhi also had the same genetic fingerprint.
A thesis submitted to the Department of Clinical Microbiology, in fulfillment of the requirement for the award of the degree of Master of Philosophy in Clinical Microbiology.