Microbial profile and antimicrobial resistance patterns in clinical specimens from a secondary-level hospital in Accra, Ghana: a five-year retrospective study

BACKGROUND: Antimicrobial resistance (AMR) has emerged as a significant global health challenge, particularly in low- and middle-income countries where surveillance data remain limited. Understanding local microbial patterns and resistance trends is critical for guiding empirical therapy and implementing effective antimicrobial stewardship policies. This study aimed to characterize the microbial profile and antimicrobial resistance patterns of pathogens from clinical specimens at the Cocoa Clinic Laboratory, Ghana, from 2019 to 2023. METHODS: A retrospective analysis was conducted on 6,395 clinical specimens collected between January 2019 and December 2023 from a secondary-level hospital in Accra, Ghana. Samples, including midstream urine, high vaginal swabs (HVS), and blood, were processed for bacterial and fungal isolation using standard microbiological techniques. Descriptive and trend analyses were conducted on specimen types, pathogen prevalence, and resistance patterns. Antimicrobial susceptibility testing was performed, and data were analyzed using Microsoft Excel, SPSS version 27, and GraphPad Prism 8. RESULTS: A total of 6,395 clinical specimens were analyzed, of which 22.2% (95% CI: 19.6-24.9) yielded positive microbial growth. Urine samples constituted the majority of positive cultures (50.6%), followed by HVS (30.3%), with other specimen types accounting for 19.1%. Gram-negative organisms predominated (62.7%), with Escherichia coli emerging as the leading bacterial isolate across most years and specimen types. Notably, a shift in pathogen distribution was observed in 2023, when Candida species became the most frequently isolated organism, suggesting a possible change in pathogen distribution (p < 0.001). Females exhibited a higher culture positivity than males (61% vs. 39%, p < 0.0001), and adults aged 18-64 years accounted for the majority of isolates. Antimicrobial susceptibility testing revealed high effectiveness of amikacin, ciprofloxacin, and gentamicin (> 89% susceptibility), whereas cefuroxime, co-trimoxazole, and ampicillin/sulbactam showed high resistance rates (> 68%). CONCLUSION: Overall, temporal trends indicated an increase in infection rates from 2021 to 2023, contrasting with lower detection during the early COVID-19 period. This highlights an urgent need for continuous AMR surveillance, strict antibiotic stewardship, and the development of targeted infection control strategies. These findings provide valuable baseline data to inform clinicians, policymakers, and public health authorities in optimizing treatment guidelines and combating AMR in Ghana.