Network of Interaction among Enterobacter Species and Klebsiella Pneumonia Clinical Isolates and the Antibiotic Resistance Pattern at Cape Coast

Kwame Kumi Asare1, *, Jennifer Mbata2, Samuel Amoah3, Peter Bilatam Mayeem4, Felicity Bentsi-Enchill2, Yeboah Kwaku Opoku2
1 Department of Biomedical Science, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
2 Department of Biology Education, Faculty of Science Education, University of Education, Winneba, Ghana
3 Laboratory Unit, University of Cape Coast Hospital, Cape Coast, Ghana
4 Offinso College of Education, Ashanti Region, Ghana

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© 2023 Asare et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Biomedical Science, School of Allied Health Sciences, College of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana; Tel: 0247685454; E-mail:



Urgent surveillance is required to provide the needed information for the containment of multidrug-resistant (MDR) Enterobacteriaceae. The objective was to examine the antibiotic-resistant patterns among the clinically isolated Enterobacter species and Klebsiella pneumonia from the outpatient department of the University of Cape Coast from 2014 to 2020.


The cultured isolates were Gram-stained for morphological and biochemical tests. Antibiotic susceptibility tests for the K. pneumonia and Enterobacter spp were done using the modified Kirby-Bauer diffusion technique. A double-disk synergy antibiotic test using cefotaxime, amoxicillin/clavulanic acid and ceftazidime antibiotic test was used to identify extended-spectrum beta-lactase (ESBL) and MDR among the isolates. The network of interactions between bacteria isolates and resistant types and the pattern of interaction of K. pneumonia (in the resistant-10 group) and Enterobacter spp (resistant-12) and the various antibiotics tested was performed using Cytoscape version 3.8.2 software. The data are presented in percentage and statistical significance between MDR and extensively drug-resistant (XDR) compared with Chi-square test.


K. pneumonia formed a clustering network with other bacteria isolates around resistant type 10 (resistant-10) and Enterobacter spp around resistant type 12 (resistant-12). The interactions (edges) of bacteria isolates and resistant types (nodes) were unique for Staphylococcus saprophyticus with Proteus mirabilis which exhibited two patterns of interactions (resistant-10 and resistant-12), connecting the two resistant types among the bacteria isolates. The interactive network patterns of Enterobacter spp and the various antibiotics were different from the interaction patterns for K. pneumonia. The K. pneumonia isolates were highly resistant to cefuroxime 2/3 (66.67%) and ampicillin 2/3 (66.67%) in the year 2020. Enterobacter spp on the other hand were highly resistant to tetracycline 16/20 (80.00%) in 2014 and ceftriaxone 5/9 (55.56%), levofloxacin 5/9 (55.56%), ceftazidime 5/9 (55.56%) and gentamycin 5/9 (55.56%) in 2020. Chi-square analysis showed a highly significant difference of χ2 = 11.87, p=0.0006 and χ2 = 7.789, p=0.0053 between MDR and XDR Enterobacter spp isolates in 2014 and 2020, respectively.


Early detection, constant monitoring and control practices and policies that prevent the misuse or overuse of these antibiotics are required to slow down the rapid development of resistance to Enterobacter spp and K. pneumonia in Cape Coast.

Keywords: Enterobacteriaceae, Enterobacter species, Klebsiella pneumonia, Multiple drug resistance, Extended drug resistance, Extended-spectrum β-lactamases, Carbapenem-resistant Enterobacteriaceae.