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Operational Research to Tackle Antimicrobial Resistance in Ghana

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (20 August 2022) | Viewed by 32403

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Dr. Bethany Hedt-Gauthier

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Guest Editor

1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
2. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
Interests: health systems; global surgery; surgical site infections; cesarean birth; digital health systems; operational research; statistics

Prof. Dr. Wendemagegn Enbiale Yeshanesh

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Guest Editor

Department of Dermatovenerology, College of Medicine and Health Sciences, Bahirdar University, Bahir Dar, Ethiopia
Interests: neglected tropical diseases; clinical trials and Antimicrobial resistance

Dr. Rose J. Kosgei

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Guest Editor

1. Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
2. Kenyatta National Hospital, Nairobi, Kenya
Interests: obstetrics; gynecology; Gyn-oncology; HIV/TB; data science

Special Issue Information

Dear Colleagues,

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobial medicines. This makes standard treatments ineffective and allows infections to persist, spread, and cause prolonged illness and death. In 2019, an estimated 1.27 million deaths were directly attributable to AMR and 4.95 million deaths were associated with AMR. The World Health Organization has declared AMR as one of the 10 global public health threats facing humanity.

During the 2015 World Health Assembly, countries committed to a Global Action Plan to tackle the main drivers of AMR such as misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene for both humans and animals; poor infection prevention and control measures in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.

This Special Issue highlights research from the Structured Operational Research and Training Initiative (SORT IT) project aimed at building sustainable operational research capacity to generate and utilize evidence to tackle the emergence, spread and health impact of AMR. SORT IT aims to make the AMR response in countries “data rich, information rich and action rich” More on SORT IT is available at: https://tdr.who.int/activities/sort-it-operational-research-and-training.

We welcome you to this Special Issue on tackling AMR in Ghana. The research studies within this issue cover the human, agricultural and environmental sectors and together constitute “local research for local solutions with local ownership” in Ghana.

Dr. Bethany Hedt-Gauthier
Prof. Dr. Wendemagegn Enbiale Yeshanesh
Dr. Rose J Kosgei
Guest Editors

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Keywords

health system resilience
SORT IT
SDGS
Universal Health Coverage
One Health

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Research

12 pages, 685 KiB

Open AccessArticle

High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017–2021

by Benjamin Asamoah, Appiah-Korang Labi, Himanshu A. Gupte, Hayk Davtyan, Georgette Marfo Peprah, Forster Adu-Gyan, Divya Nair, Karlos Muradyan, Nasreen S. Jessani and Paul Sekyere-Nyantakyi

Int. J. Environ. Res. Public Health 2022, 19(24), 16556; https://doi.org/10.3390/ijerph192416556 - 9 Dec 2022

Cited by 9 | Viewed by 2970

Abstract

Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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14 pages, 355 KiB

Open AccessArticle

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021

by Kwaku Anim Omenako, Anthony Enimil, Afia Frimpomaa Asare Marfo, Collins Timire, Palanivel Chinnakali, Ama Pokuaa Fenny, Kathiresan Jeyashree and Kwame Ohene Buabeng

Int. J. Environ. Res. Public Health 2022, 19(19), 12968; https://doi.org/10.3390/ijerph191912968 - 10 Oct 2022

Cited by 2 | Viewed by 2373

Abstract

Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January–December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

12 pages, 1948 KiB

Open AccessArticle

What Is in the Salad? Escherichia coli and Antibiotic Resistance in Lettuce Irrigated with Various Water Sources in Ghana

by Gerard Quarcoo, Lady A. Boamah Adomako, Arpine Abrahamyan, Samuel Armoo, Augustina A. Sylverken, Matthew Glover Addo, Sevak Alaverdyan, Nasreen S. Jessani, Anthony D. Harries, Hawa Ahmed, Regina A. Banu, Selorm Borbor, Mark O. Akrong, Nana A. Amonoo, Emmanuel M. O. Bekoe, Mike Y. Osei-Atweneboana and Rony Zachariah

Int. J. Environ. Res. Public Health 2022, 19(19), 12722; https://doi.org/10.3390/ijerph191912722 - 5 Oct 2022

Cited by 8 | Viewed by 2608

Abstract

Introduction: Safety of the environment in which vegetables are grown, marketed and consumed is paramount as most are eaten raw. Irrigation sources include open drains and streams, which are often contaminated with human and animal waste due to poor sanitation infrastructure. In irrigated vegetable farms using such sources in Ghana, we assessed Escherichia coli counts, antibiotic resistance patterns and resistant genes on irrigated lettuce. Methods: A cross-sectional study was conducted between January–May 2022, involving five major vegetable farms in Ghana. Results: Escherichia coli was found in all 25 composite lettuce samples analyzed. Counts expressed in CFU/g ranged from 186 to 3000, with the highest counts found in lettuce irrigated from open drains (1670) and tap water using hose pipes (3000). Among all bacterial isolates, resistance ranged between 49% and 70% for the Watch group of antibiotics, 59% for the Reserved group and 82% were multidrug-resistant. Of 125 isolates, 60 (48%) were extended-spectrum beta-lactamase-producing, of which five (8%) had the bla_TEM-resistant gene. Conclusions: Lettuce was contaminated with Escherichia coli with high levels of antibiotic resistance. We call on the Ghana Ministry of Food and Agriculture, Food and Drugs Authority and other stakeholders to support farmers to implement measures for improving vegetable safety. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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14 pages, 504 KiB

Open AccessArticle

Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021

by Helena Owusu, Pruthu Thekkur, Jacklyne Ashubwe-Jalemba, George Kwesi Hedidor, Oksana Corquaye, Asiwome Aggor, Allen Steele-Dadzie and Daniel Ankrah

Int. J. Environ. Res. Public Health 2022, 19(19), 12413; https://doi.org/10.3390/ijerph191912413 - 29 Sep 2022

Cited by 9 | Viewed by 3542

Abstract

Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5–7 days in females and 10–14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10–14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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13 pages, 1246 KiB

Open AccessArticle

Antibiotic-Resistant Bacteria in Drinking Water from the Greater Accra Region, Ghana: A Cross-Sectional Study, December 2021–March 2022

by Hawa Ahmed, Maria Zolfo, Anita Williams, Jacklyne Ashubwe-Jalemba, Hannock Tweya, Wisdom Adeapena, Appiah-Korang Labi, Lady A. B. Adomako, Gloria N. D. Addico, Regina A. Banu, Mark O. Akrong, Gerard Quarcoo, Selorm Borbor and Mike Y. Osei-Atweneboana

Int. J. Environ. Res. Public Health 2022, 19(19), 12300; https://doi.org/10.3390/ijerph191912300 - 28 Sep 2022

Cited by 8 | Viewed by 3625

Abstract

With safely managed water accessible to only 19% of the population in Ghana, the majority of its residents are at risk of drinking contaminated water. Furthermore, this water could be a potential vehicle for the transmission of antimicrobial-resistant bacteria. This study assessed the presence of bacteria and the antibiotic resistance profile of Escherichia coli and Pseudomonas aeruginosa in drinking-water sources using membrane filtration and Kirby–Bauer disc diffusion methods. A total of 524 water samples were analyzed for total coliforms, total heterotrophic bacteria, E. coli and P. aeruginosa. Samples included sachets, bottled water, tap water, borehole and well water. Most of the sachet and bottled water samples were within the limits of Ghana’s standards for safe drinking water for the parameters tested. Over 50% of tap and borehole water was also free of E. coli and P. aeruginosa. Overall, of 115 E. coli isolates from tap and ground water samples, most were resistant to cefuroxime (88.7%), trimethoprim–sulfamethoxazole (62.6%) and amoxicillin–clavulanate (52.2%). P. aeruginosa isolates were most resistant to aztreonam (48%). Multidrug resistance was predominantly seen among E. coli isolates (58%). Evidence from this study calls for routine antimicrobial resistance surveillance in drinking water across the country and additional treatment of water sources at household levels. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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11 pages, 1358 KiB

Open AccessArticle

Appropriateness of Antibiotic Prescribing for Acute Conjunctivitis: A Cross-Sectional Study at a Specialist Eye Hospital in Ghana, 2021

by Paa Kwesi Fynn Hope, Lutgarde Lynen, Baaba Mensah, Faustina Appiah, Edward Mberu Kamau, Jacklyne Ashubwe-Jalemba, Kwame Peprah Boaitey, Lady Asantewah Boamah Adomako, Sevak Alaverdyan, Benedicta L. Appiah-Thompson, Eva Kwarteng Amaning and Mathurin Youfegan Baanam

Int. J. Environ. Res. Public Health 2022, 19(18), 11723; https://doi.org/10.3390/ijerph191811723 - 17 Sep 2022

Cited by 4 | Viewed by 2416

Abstract

Most presentations of conjunctivitis are acute. Studies show that uncomplicated cases resolve within 14 days without medication. However, antibiotic prescription remains standard practice. With antimicrobial resistance becoming a public health concern, we undertook this study to assess antibiotic prescription patterns in managing acute conjunctivitis in an eye hospital in Ghana. We recorded 3708 conjunctivitis cases; 201 were entered as acute conjunctivitis in the electronic medical records (January to December 2021). Of these, 44% were males, 56% were females, 39% were under 5 years, 21% were children and adolescents (5–17 years) and 40% were adults (≥18 years). A total of 111 (55.2%) patients received antibiotics, of which 71.2% were appropriately prescribed. The use of antibiotics was more frequent in children under 17 years compared to adults (p < 0.0001). Of the prescribed antibiotics, 44% belonged to the AWaRe “Access” category (Gentamycin, Tetracycline ointment), while 56% received antibiotics in the “Watch” category (Ciprofloxacin, Tobramycin). Although most of the antibiotic prescribing were appropriate, the preponderance of use of the Watch category warrants stewardship to encompass topical antibiotics. The rational use of topical antibiotics in managing acute conjunctivitis will help prevent antimicrobial resistance, ensure effective health care delivery, and contain costs for patients and the health system. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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12 pages, 860 KiB

Open AccessArticle

Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times

by Francis Kwame Morgan Tetteh, Raymond Fatchu, Kingsley Ackah, Trudy Janice Philips, Hemant Deepak Shewade, Ama Pokuaa Fenny, Collins Timire, Jeffrey Karl Edwards and Emmanuel Abbeyquaye Parbie

Int. J. Environ. Res. Public Health 2022, 19(18), 11659; https://doi.org/10.3390/ijerph191811659 - 16 Sep 2022

Cited by 3 | Viewed by 2710

Abstract

In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017–2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent (n = 139) were bacteriologically confirmed, of whom 61% (n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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9 pages, 664 KiB

Open AccessArticle

Alarming Levels of Multidrug Resistance in Aerobic Gram-Negative Bacilli Isolated from the Nasopharynx of Healthy Under-Five Children in Accra, Ghana

by Mary-Magdalene Osei, Nicholas T. K. D. Dayie, Godfred S. K. Azaglo, Elizabeth Y. Tettey, Edmund T. Nartey, Ama P. Fenny, Marcel Manzi, Ajay M. V. Kumar, Appiah-Korang Labi, Japheth A. Opintan and Eric Sampane-Donkor

Int. J. Environ. Res. Public Health 2022, 19(17), 10927; https://doi.org/10.3390/ijerph191710927 - 1 Sep 2022

Cited by 8 | Viewed by 2529

Abstract

Nasopharyngeal carriage of aerobic Gram-negative bacilli (GNB) may precede the development of invasive respiratory infections. We assessed the prevalence of nasopharyngeal carriage of aerobic GNB and their antimicrobial resistance patterns among healthy under-five children attending seven selected day-care centres in the Accra metropolis of the Greater Accra region of Ghana from September to December 2016. This cross-sectional study analysed a total of 410 frozen nasopharyngeal samples for GNB and antimicrobial drug resistance. The GNB prevalence was 13.9% (95% CI: 10.8–17.6%). The most common GNB were Escherichia coli (26.3%), Klebsiella pneumoniae (24.6%), and Enterobacter cloacae (17.5%). Resistance was most frequent for cefuroxime (73.7%), ampicillin (64.9%), and amoxicillin/clavulanic acid (59.6%). The organisms were least resistant to gentamicin (7.0%), amikacin (8.8%), and meropenem (8.8%). Multidrug resistance (MDR, being resistant to ≥3 classes of antibiotics) was observed in 66.7% (95% CI: 53.3–77.8%). Extended-spectrum beta-lactamase (ESBL)-producing bacteria constituted 17.5% (95% CI: 9.5–29.9%), AmpC-producing bacteria constituted 42.1% (95% CI: 29.8–55.5%), and carbapenemase-producing bacteria constituted 10.5% (95% CI: 4.7–21.8%) of isolates. The high levels of MDR are of great concern. These findings are useful in informing the choice of antibiotics in empiric treatment of GNB infections and call for improved infection control in day-care centres to prevent further transmission. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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11 pages, 793 KiB

Open AccessArticle

Surveillance of WHO Priority Gram-Negative Pathogenic Bacteria in Effluents from Two Seafood Processing Facilities in Tema, Ghana, 2021 and 2022: A Descriptive Study

by Meldon Ansah-koi Agyarkwa, Godfred Saviour Kudjo Azaglo, Henry Kwabena Kokofu, Ebenezer Kwabena Appah-Sampong, Esi Nana Nerquaye-Tetteh, Emmanuel Appoh, Jewel Kudjawu, Ebenezer Worlanyo, Mariam Fuowie Batong, Amos Akumwena, Appiah-Korang Labi, Mary-Magdalene Osei, Srinath Satyanarayana, Robert Fraser Terry, Marcel Manzi and Japheth A. Opintan

Int. J. Environ. Res. Public Health 2022, 19(17), 10823; https://doi.org/10.3390/ijerph191710823 - 30 Aug 2022

Cited by 3 | Viewed by 1940

Abstract

Antimicrobial resistant (AMR) bacteria in effluents from seafood processing facilities can contribute to the spread of AMR in the natural environment. In this study conducted in Tema, Ghana, a total of 38 effluent samples from two seafood processing facilities were collected during 2021 and 2022, as part of a pilot surveillance project to ascertain the bacterial load, bacterial species and their resistance to 15 antibiotics belonging to the WHO AWaRe group of antibiotics. The bacterial load in the effluent samples ranged from 13–1800 most probable number (MPN)/100 mL. We identified the following bacterial species: E. coli in 31 (82%) samples, K. pneumoniae in 15 (39%) samples, Proteus spp. in 6 (16%) samples, P. aeruginosa in 2 (5%) samples and A. baumannii in 2 (5%) samples. The highest levels of antibiotic resistance (100%) were recorded for ampicillin and cefuroxime among Enterobacteriaceae. The WHO priority pathogens—E. coli (resistant to cefotaxime, ceftazidime and carbapenem) and K.pneumoniae (resistant to ceftriaxone)—were found in 5 (13%) effluent samples. These findings highlight the need for enhanced surveillance to identify the source of AMR and multi-drug resistant bacteria and an adoption of best practices to eliminate these bacteria in the ecosystem of the seafood processing facilities. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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14 pages, 610 KiB

Open AccessArticle

Antimicrobial, Multi-Drug and Colistin Resistance in Enterobacteriaceae in Healthy Pigs in the Greater Accra Region of Ghana, 2022: A Cross-Sectional Study

by Rita Ohene Larbi, Wisdom Adeapena, Matilda Ayim-Akonor, Ebenezer D. O. Ansa, Hannock Tweya, Robert Fraser Terry, Appiah-Korang Labi and Anthony D. Harries

Int. J. Environ. Res. Public Health 2022, 19(16), 10449; https://doi.org/10.3390/ijerph191610449 - 22 Aug 2022

Cited by 6 | Viewed by 2738

Abstract

There is little published information on antimicrobial resistance (AMR) in animals in Ghana. We determined the prevalence and factors associated with AMR, multi-drug resistance (MDR-resistance to ≥3 antimicrobial classes) and colistin resistance in Enterobacteriaceae in healthy pigs in Accra, Ghana. Rectal swabs obtained from the pigs on 20 farms from January to March 2022, were examined for Escherichia coli, Enterobacter spp. and Klebsiella pneumoniae. AMR was determined using standard microbiological techniques and the mcr-1 gene detected through molecular analysis. Enterobacteriaceae were isolated from 197 of 200 pigs: these comprised 195 E. coli isolates, 38 Enterobacter spp. and 3 K. pneumoniae, either singly or combined. Over 60% of E. coli were resistant to tetracycline, with 27% and 34% being resistant to amoxicillin/clavulanic acid and ampicillin, respectively; 23% of E. coli and 5% of Enterobacter spp. exhibited MDR phenotypes. Phenotypic colistin resistance was found in 8% of E. coli and Enterobacter spp., with the mcr-1 gene detected in half. Our study findings should be incorporated into on-going AMR, MDR and colistin resistance surveillance programs in Ghana. We further advocate for tailored-specific education for pig farmers on animal antimicrobial use and for strengthened regulatory policy on antimicrobial usage and monitoring in the animal production industry. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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12 pages, 861 KiB

Open AccessArticle

High Levels of Outpatient Antibiotic Prescription at a District Hospital in Ghana: Results of a Cross Sectional Study

by Obed Kwabena Offe Amponsah, Sharath Burugina Nagaraja, Nana Kwame Ayisi-Boateng, Divya Nair, Karlos Muradyan, Phanuel Seli Asense, Osei Kwaku Wusu-Ansah, Robert Fraser Terry, Mohammed Khogali and Kwame Ohene Buabeng

Int. J. Environ. Res. Public Health 2022, 19(16), 10286; https://doi.org/10.3390/ijerph191610286 - 18 Aug 2022

Cited by 9 | Viewed by 2628

Abstract

Background: Monitoring of antibiotic prescription practices in hospitals is essential to assess and facilitate appropriate use. This is relevant to halt the progression of antimicrobial resistance. Methods: Assessment of antibiotic prescribing patterns and completeness of antibiotic prescriptions among out-patients in 2021 was conducted at the University Hospital of Kwame Nkrumah University of Science and Technology in the Ashanti region of Ghana. We reviewed electronic medical records (EMR) of 49,660 patients who had 110,280 encounters in the year. Results: The patient encounters yielded 350,149 prescriptions. Every month, 33–36% of patient encounters resulted in antibiotic prescription, higher than the World Health Organization’s (WHO) recommended optimum of 27%. Almost half of the antibiotics prescribed belonged to WHO’s Watch group. Amoxicillin–clavulanic acid (50%), azithromycin (29%), ciprofloxacin (28%), metronidazole (21%), and cefuroxime (20%) were the most prescribed antibiotics. Antibiotic prescribing parameters (indication, name of drug, duration, dose, route, and frequency) were documented in almost all prescriptions. Conclusions: Extending antimicrobial stewardship to the out-patient settings by developing standard treatment guidelines, an out-patient specific drug formulary, and antibiograms can promote rational antibiotic use at the hospital. The EMR system of the hospital is a valuable tool for monitoring prescriptions that can be leveraged for future audits. Full article

(This article belongs to the Special Issue Operational Research to Tackle Antimicrobial Resistance in Ghana)

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