Spatiotemporal dynamics and antimicrobial resistance of bacterial pathogens recovered from various fomites at a paediatric care facility in Ghana

Hospital fomites are major reservoirs of nosocomial pathogens, facilitating healthcare-associated infections, particularly in critical units. However, longitudinal studies investigating the persistence of pathogens on hospital surfaces and their antimicrobial resistance (AMR) patterns remain limited. This study examined the spatiotemporal distribution and antimicrobial resistance of bacterial pathogens isolated from fomite surfaces at Princess Marie Louise Children's Hospital (PML), Accra, Ghana. A 12-week longitudinal study (September 4-November 26, 2023) was conducted across four departments: Emergency, Neonatal Intensive Care, Malnutrition, and Outpatient. High-touch surfaces (including bed rails, incubators, infusion stands, blood pressure cuffs, thermometers, stethoscopes, etc.) were sampled weekly using sterile saline-moistened swabs. Samples were promptly transported in STGG medium on ice to the bacteriology laboratory of the University of Ghana Medical School's Department of Medical Microbiology, for standard culture and antimicrobial susceptibility testing using the Kirby-Bauer method. A total of 1,120 bacterial isolates belonging to 33 genera were recovered from 600 swab samples. Among Gram-positive bacteria, Staphylococcus epidermidis (97 isolates, 34.3%), Staphylococcus haemolyticus (42 isolates, 14.8%), and Staphylococcus aureus (34 isolates, 12.0%) predominated. The most frequently isolated Gram-negative bacteria were Acinetobacter baumannii (91 isolates, 18.2%), Klebsiella pneumoniae (54 isolates, 10.8%), and Escherichia coli (38 isolates, 7.6%). Contamination levels varied by surface type. Thermometers (N = 25 isolates), thermometer trays (N = 24), weighing tables (N = 24), and IV setting trays (N = 22) exhibited the highest contamination frequencies. Among individual items, Babe's Cot A recorded the highest contamination (N = 30), while Omicron thermometer B had the lowest (N = 18) within the top-ranked fomites.AMR rates were moderate to high across several key pathogens, with resistance ranging from 0-93% in Staphylococcus aureus, 66.7-91.7% in Enterococcus faecium, 18.9-90% in Enterococcus faecium, 29.6-88.9% in Escherichia coli, and 40-82% in Klebsiella pneumoniae. Overall, the evaluated hospital fomites were heavily contaminated with a diverse array of bacterial pathogens exhibiting substantial antimicrobial resistance, underscoring the need to strengthen infection prevention and control measures in healthcare settings.