ReportGhanaian Hospitals Are Violated by Emerging Superbugs
Hospital Can Make Us Sicker
When we are sick, the hospital should be a safe haven where we can get medical attention and recover quickly. It was also intended to be clean environments that guaranteed the safety of its frequent users. Unfortunately, what should have made us stronger is now killing us, as the hospital is home to lethal bacterial pathogens. These bacteria take advantage of various hospital-related compromising situations to evolve and become more hazardous. Some of these bacterial agents are found on fomites (door handles, chairs, tables, faucets, and sinks) which harbor and spread bacteria. Others are dispersed into the air, where they become opportunistic and result in serious diseases. Most of these opportunistic bacteria can quickly adapt to environmental changes, as demonstrated by their ability to transition from planktonic to biofilms lifestyle for survival. Also, some have the potential to develop resistance mechanisms to common and last-resort antibiotics, enabling the development of “superbugs” that are incurably resistant to therapy.
Ghanaian Hospitals and Associated Challenges
Ghana’s population of more than 30 million is served by over 300 hospitals. The incidence of sepsis, and other immune-system disorders, as well as the population’s vulnerability to parasitic infections like malaria, are significant variables specific to Ghana. As a result, there are more patients admitted to hospitals, the intensive care unit (ICU) is crowded, hospital stays are lengthy, and antibiotics and other antimicrobial medications are used excessively. There is paucity of data on bacterial diversity and associated antimicrobial resistance (AMR) profiles in hospital settings. In Sub-Saharan Africa, especially in hospitals, AMR is becoming more and more of a problem. This situation necessitates an immediate research response. Additionally, the risk of AMR in Ghanaian hospitals is uncertain as bacteria mutate and novel strains emerge; the prevention of spread is difficult due to ignorance of the mechanisms that mediate resistance.
Findings and Interpretation
In 2017, we started an explorative study that was sponsored by a World Bank ACE grant and approved by the Ghana Health Service (GHS) to provide information on how safe Ghanaian hospitals are. The study was conducted at the West African Centre for Cell Biology of Infectious Pathogens, University of Ghana. The main goal was to catalog airborne and fomite-resident bacterial pathogens in Ghanaian hospitals’ ICU as well as establish their AMR profiles.
The study’s findings indicated that Ghanaian hospitals house bacteria that might cause infections. We discovered bacteria designated as Global Priority Pathogens (WHO) that require immediate attention, both Gram-negative and positive. All available antibiotics which were accessible and frequently used to treat bacterial and hospital-acquired infections in Ghana, were ineffective against these bacteria. Additionally, these bacteria exhibited significant levels of resistance to carbapenems and polymyxins (last-resort antibiotics). The results suggested that the discovered bacteria can result in infections that may be challenging to manage. Also, a majority of the detected resistant markers by genomic analysis were plasmid-mediated, which unfortunately might compound the challenges of AMR in Ghanaian hospitals. This appears as the first ICU-specific exploratory study to point to air and frequently used fomites as sources of resistant bacteria to commonly used and last-resort antibiotics.
Dr Isawumi Abiola is a Research Fellow at the West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, where he was awarded his doctorate degree in Molecular Cell Biology of Infectious Diseases
Conclusions
This study offers proof of the existence, prevalence, spread, and emergence of ‘superbugs’ that are extremely resistant in and from Ghanaian hospitals. All hospital patients may be exposed to health risks from air and fomite, according to the experimental pathogenicity and virulence profiles of the discovered bacteria. As potential causes of this outbreak and subsequent transmission, we point to the overuse of antibiotics in ICUs, incorrect cleaning of medically necessary examination instruments, and a general lack of basic hygiene within the hospitals. In addition, most hospitals’ unsanitary environments foster an environment where resistant bacteria might flourish. Inferentially, the study suggested that there may be a higher prevalence of bacterial pathogens that are resistant and that can result in illnesses that are acquired in hospitals.
Article by Dr Isawumi Abiola
West African Centre for Cell Biology of Infectious Pathogens
University of Ghana
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