Diarrheal disease remains a major global health problem particularly in children under 5 years and the emergence of
antibiotic-resistant strains of causative pathogens could slow control efforts, particularly in settings where treatment options are limited. This surveillance study conducted in Ghana aimed to determine the prevalence and antimicrobial susceptibility profile of
diarrhea-causing bacteria. This was a cross-sectional study carried out in five health facilities in the Ga West Municipality of Ghana between 2017 and 2021. Diarrheic stool samples from patients were collected and cultured on standard differential/selective media and isolates identified by standard biochemical tests, MALDI-TOF assay, and serological analysis. The antibiogram was determined using Kirby-Bauer disk diffusion and Microscan autoScan4 MIC panels which were used for extended-spectrum
beta-lactamase (ESBL) detection. Bacteria were isolated from 97.5% (772/792) of stool samples, and 167 of the isolates were diarrheagenic and met our inclusion criteria for antimicrobial resistance (AMR) analysis. These included Escherichia coli (49.1%, 82/167), Salmonella species (23.9%, 40/167), Vibrio species (16.8%, 28/167), and Shigella species (10.2%, 17/167). Among 24 Vibrio species, we observed resistances to
cefotaxime (21/24, 87.5%),
ceftriaxone (20/24, 83.3%), and
ciprofloxacin (6/24, 25%), including four multi-
drug resistant isolates. All 13 Vibrio parahaemolyticus isolates were resistant to
cefazolin. All 17 Shigella isolates were resistant to
tetracycline with resistance to
shigellosis drugs such as
norfloxacin and
ciprofloxacin. Salmonella isolates were highly susceptible to
norfloxacin (40/40, 100%) and
tetracycline (12/34, 35%). Two ESBL-producing E. coli were also identified with marked susceptibility to
gentamicin (66/72, 91.7%) and
amikacin (57/72, 79.2%) prescribed in the treatment of E. coli
infections. This study showed the different bacteria implicated in
diarrhea cases in Ghana and the need for differential diagnoses for better treatment outcomes. Escherichia coli, Shigella, Salmonella, and Vibrio have all been implicated in
diarrhea cases in Ghana. The highest prevalence was E. coli and Salmonella with Shigella the least prevalent. Resistance to commonly used drugs found in these isolates may render bacteria
infection treatment in the near future nearly impossible. Routine antimicrobial susceptibility testing, effective monitoring, and nationwide surveillance of AMR pathogens should be implemented to curb the increase of antimicrobial resistance in Ghana.