title: Genetic characterization of TEM-type ESBL-associated antibacterial resistance in Enterobacteriaceae in a tertiary hospital in Ghana.
abstract: BACKGROUND
  Antibiotic resistance due to the presence of extended-spectrum beta-lactamases (ESBLs) among Enterobacteriaceae is a worldwide problem. Data from Ghana regarding this resistance mechanism is limited. This study was designed to investigate the presence of TEM-type ESBL genes, their locations and their conjugabilities in clinical isolates of enterobacteria collected from the Korle-Bu Teaching Hospital in Ghana.
  
  
  METHODS
  Study isolates were characterized with respect to ESBL phenotype, TEM-type ESBL gene detection, location of the ESBL gene(s) and conjugability of the ESBL phenotype using nalidixic acid-resistant Escherichia coli K-12 as recipient. Phenotyping was by Kirby Bauer disk diffusion using cefpodoxime, ceftazidime, cefotaxime and their combinations with clavulanate. Gene detections were by PCR using blaTEM primers.
  
  
  RESULTS
  Overall, 37.96 % of 137 clinical isolates showed ESBL phenotype. The ESBLs occurred mostly in Klebsiella spp. (42.3 %) and then Escherichia coli (34.6 %). The TEM gene was detected in 48.1 % of ESBL-positive isolates and was determined to be plasmid-borne in 24 of 25 blaTEM detections. Overall, 62.7 % of TEM-producing isolates transferred the ESBL phenotype by conjugation.
  
  
  CONCLUSIONS
  The results highlight the presence of TEM-type ESBLs in the Korle-Bu Teaching Hospital and show considerable risk of environmental contamination through the urine of infected persons. An inhibition zone chart was generated which indicates the possible presence of complex beta-lactamase types. The data points to the fact that the ESBL-producing bacteria may disseminate this resistance mechanism via conjugation.
authors.affiliation: Department of Biochemistry, Cell and Molecular Biology, School of Biological Sciences, University of Ghana, Legon, Accra, Ghana. danomensah@gmail.com.|Department of Applied Chemistry and Biochemistry, University for Development Studies, Navrongo Campus, Navrongo, Ghana. danomensah@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Oduro-Mensah
authors.affiliation: Department of Microbiology, University of Ghana Medical School, Korle-Bu, Accra, Ghana.
authors.forename: Noah
authors.initials: N
authors.lastname: Obeng-Nkrumah
authors.affiliation: Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
authors.forename: Evelyn Yayra
authors.initials: EY
authors.lastname: Bonney
authors.affiliation: Adabraka Polyclinic, Ghana Health Service, Accra, Ghana.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Oduro-Mensah
authors.affiliation: Department of Microbiology, University of Ghana Medical School, Korle-Bu, Accra, Ghana.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Twum-Danso
authors.affiliation: Department of Biochemistry, Cell and Molecular Biology, School of Biological Sciences, University of Ghana, Legon, Accra, Ghana.
authors.forename: Yaa Difie
authors.initials: YD
authors.lastname: Osei
authors.affiliation: Department of Biochemistry, Cell and Molecular Biology, School of Biological Sciences, University of Ghana, Legon, Accra, Ghana.
authors.forename: Sammy Tawiah
authors.initials: ST
authors.lastname: Sackey
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D005869:Ghana; D006801:Humans; D008826:Microbial Sensitivity Tests; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases
keywords: Beta-lactamase; Conjugation; Inhibition zone chart; Reamplification