coli and fluoroquinolone consumption at population levels [30, 31]. Our own data suggest that even if resistance was present at low levels prior to the introduction of the quinolones, an upsurge in resistance may reflect a selective advantage that came with quinolone introduction. This is particularly likely for Ghana were artemisinin combination therapies have recently been introduced to replace chloroquine. Furthermore, because almost all quinolone resistant- E. coli were multiply resistant, selective pressure from other, even more commonly applied, antimicrobials will help see more to maintain the quinolone-resistant

clonal groups we identified in this study. Conclusion Fluoroquinolones, largely ciprofloxacin, were introduced very recently to Ghana with high expectations. This study demonstrates that resistance to these drugs is already common and occurs through multiple mechanisms, suggesting that heavy use of these valuable drugs may rapidly obliterate their usefulness. In addition to

the impact that the emergence and dissemination of quinolone resistant bacteria may have on the use of fluoroquinolone antibacterials, we found that QREC were almost invariably Cobimetinib price resistant to multiple antimicrobials. This is worrisome because it means that, if the commensal flora is reflective of resistance profiles in pathogens, there may be few low-cost alternatives for managing infections due to Gram-negative enteric organisms. Additionally, horizontally-acquired resistance to the quinolones, and presumably other agents may be present on mobile elements that could be transmitted to pathogens. Recent calls for antimicrobial development have spotlighted hospital pathogens and Gram-positive

community-acquired pathogens such as Staphylococci [32]. Our data suggest that there is Fossariinae also a pressing need for orally Pritelivir cell line administrable drugs with activity against Gram-negative organisms, which can be used to manage community enteric infections in Ghana and other parts of Africa. Additionally, known strategies for containing antimicrobial resistance need to be more rigorously applied [33–35]. Methods Strains This study was approved by the Institutional Review Board of the University of Ghana Medical School. E. coli isolates were recovered from stool specimens collected from consenting, apparently healthy individuals who presented for medical check-ups at the Korle-Bu Teaching Hospital and the Microbiology Department of the University of Ghana Medical School. Colonies with a typical E. coli morphology on MacConkey agar were subjected to biochemical testing, and where this was inconclusive, by 16 S amplification and sequencing [36]. Colonies from the same specimen with identical biochemical and susceptibility profiles were treated as identical strains.