Antimicrobial Resistance in Klebsiella pneumoniae Isolates from Clinical and Environmental Sources in Ho, Ghana

Abstract Background Antimicrobial resistance (AMR) in Klebsiella pneumoniae poses a significant global health threat, particularly in low and middle-income countries where surveillance and control measures are often limited. This study aimed to conduct a phenotypic and molecular analysis of AMR in K. pneumoniae isolates from clinical and environmental sources in Ho, Ghana, to determine the prevalence of resistance genes and characterize its diversity. A total of 200 clinical isolates were collected from the Ho Teaching Hospital, and 62 environmental isolates were obtained from soil and water sources across various communities in Ho. Antibiotic susceptibility testing (AST) and PCR-based molecular analysis were performed to characterize resistance profiles and detect key resistance genes, including CTX-M , AAC(6')-Ib , qnrA , KPC , and NDM-1 . Results The results revealed high resistance rates among clinical isolates, particularly to amoxicillin-clavulanate (85%) and ciprofloxacin (64.5%), while imipenem showed the lowest resistance (5%). PCR analysis identified a high prevalence of resistance genes, with AAC(6')-Ib (96.5%), qnrA (90%), and CTX-M (86.5%) being the most common. Carbapenem resistance genes, KPC and NDM-1 , were detected in 30% and 43.54% of clinical isolates, respectively. Environmental isolates exhibited high resistance to gentamicin (69.4%) and imipenem (56.5%), with AAC(6')-Ib (90.3%) and NDM-1 (46.8%) being the most prevalent resistance genes. Significant correlations were observed between the presence of resistance genes and phenotypic resistance, particularly for CTX-M and amoxicillin-clavulanate resistance. Conclusions The study highlights the widespread presence of multidrug-resistant K. pneumoniae in both clinical and environmental settings in Ho, Ghana, with clinical isolates showing higher resistance gene prevalence for beta-lactams and fluoroquinolones. The detection of carbapenem resistance genes in environmental isolates underscores the role of environmental reservoirs in the spread of AMR. These findings emphasize the urgent need for enhanced surveillance, infection control measures, and antimicrobial stewardship programs to mitigate the spread of resistant K. pneumoniae strains. The study provides critical insights into the local epidemiology of AMR and informs strategies for combating this growing public health threat.