Gram-Negative Urinary Colonization and Antimicrobial Resistance in Ghana: Susceptibility Patterns and the Knowledge-Behaviour Gap

Background and Objective Antimicrobial resistance among uropathogens increasingly threatens the effectiveness of empirical antibiotic treatment for urinary tract infections, particularly where culture and sensitivity testing is infrequently performed before prescribing. Recruitment was irrespective of urinary symptoms, and a positive specimen was defined by significant bacteriuria (≥105 CFU/mL) rather than clinical presentation; isolates therefore represent urinary tract colonisation rather than confirmed urinary tract infection. This study determined the antimicrobial susceptibility and multiple antibiotic resistance (MAR) indices of Gram-negative bacteria isolated from the urine of 58 university students at Dr. Hilla Limann Technical University (DHLTU), Ghana, recruited irrespective of urinary symptoms, and assessed students' AMR awareness and antibiotic-use behaviours. Materials and Methods A cross-sectional study (June-July 2024) involving 58 university students, recruited irrespective of urinary symptoms, used systematic random sampling, Kirby-Bauer disk diffusion (CLSI, 2023), MAR index calculation, and a structured questionnaire; data were analysed using descriptive and inferential statistics. Results Fifty-eight Gram-negative bacterial isolates were recovered from urine samples, predominantly Pseudomonas spp. and Serratia marcescens. Resistance was highest to ampicillin (96%), co-trimoxazole (96%), nitrofurantoin (96%), and tetracycline (96%); amikacin and the fluoroquinolones remained effective (76-93% susceptible). Median MAR indices exceeded the 0.2 high-risk threshold for most organism groups (range: ~0.25-0.93). All students were AMR-aware, yet 35% reported hoarding antibiotics, 22% reported sharing antibiotics, and 8% reported obtaining antibiotics without a prescription, with no significant association between risky behaviour and MAR index (Mann-Whitney U test, p > 0.05). Conclusion High resistance to first-line agents and a clear knowledge-behaviour gap indicate that routine urine culture and susceptibility testing should be promoted to guide empirical therapy, alongside antimicrobial stewardship and behaviour-focused interventions to reduce inappropriate antibiotic use among university students.