Molecular characterization of multidrug-resistant (MDR) Escherichia coli in the Greater Accra Region, Ghana: a ‘One Health’ approach.

Background : ‘One health’, a concept that highlights the need to bring on board multiple players and actors together to addressing major health problems, have been proposed to be effective in data gathering to mitigate the menace of antimicrobial drug resistance (AMR). Data on MDR and extended-spectrum-beta-lactamase-producing Escherichia coli (ESBL- EC ) across humans, animals and the environment are limited in low-and-middle-income-countries (LMICs) including Ghana. Objective : This study used one health approach to determine the prevalence, antibiogram and AMR genes of ESBL- EC from diverse sources. Methodology : A cross-sectional study conducted in the Accra and Tema metropolis, Ghana. We randomly collected 1500 non-duplicated specimens from healthy human, cattle, pigs, lettuce, spring onions, pork, beef and soil samples. Escherichia coli ( E. coli ) was isolated and confirmed by MALDI-TOF MS. E. coli isolates were screened for their susceptibility against 13 antibiotic agents and ESBL-production. ESBL- EC isolates were whole-genome sequenced (WGS) and in silico analysis was used to determine AMR genes, sequence types (STs) and plasmid replicon types. Result : Overall, E. coli was recovered from 140 of 1500 (9.3%) specimens processed. About one-third of these E. coli isolates 50 (35.7%) were resistant to three or more antibiotics, and 30 (21.5%) were ESBL- EC . The proportion of ESBL- EC identified in healthy humans, cattle, pig, beef and soil were 14 (20.0%), 9 (22.5%), 3 (15.0%), 1 (50.0%) and 3 (37.5%), respectively. No E. coli was isolated from lettuce, spring onions and pork. Overall, the ESBL- EC exhibited high levels of resistance to ampicillin (100%), cefuroxime (100%), ciprofloxacin (53.6%), and to tetracycline (58.2%). However, all ESBL- EC isolates were sensitive to meropenem. The prevalent AMR genes detected were bla TEM-1B (32.0%; n=8), tet A (48.0%; n=12) and sul2 (32.0%; n=8). The dominant STs were ST10 (12%; n=3), ST 9312 (12%; n=3), ST 206 (12%; n=3) and ST 4151 (12%; n=3). IncFIB(Apoo1918) (40.0%; n=10) and IncFII(pCoo) (36.0%; n=9) plasmid replicons were commonly detected. Conclusion : Within the metropolis surveyed, we identified MDR ESBL- EC harbouring various AMR genes and plasmid replicons with diverse E. coli STs in healthy humans, animals and the environment. This study finding of bla CTX-M-15 in agricultural soil isolate is worrisome, emphasizing the need for a one-health approach in combating AMR.