Citation: Ahmed, H.; Zolfo, M.; Williams, A.; Ashubwe-Jalemba, J.; Tweya, H.; Adeapena, W.; Labi, A.-K.; Adomako, L.A.B.; Addico, G.N.D.; Banu, R.A.; et al. Antibiotic-Resistant Bacteria in Drinking Water from the Greater Accra Region, Ghana: A Cross-Sectional Study, December 2021–March 2022. Int. J. Environ. Res. Public Health 2022, 19, 12300. https:// doi.org/10.3390/ijerph191912300 Academic Editors: Bethany Hedt-Gauthier, Wendemagegn Enbiale Yeshanesh and Rose J. Kosgei Received: 11 August 2022 Accepted: 8 September 2022 Published: 28 September 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). International Journal of Environmental Research and Public Health Article Antibiotic-Resistant Bacteria in Drinking Water from the Greater Accra Region, Ghana: A Cross-Sectional Study, December 2021–March 2022 Hawa Ahmed 1, * , Maria Zolfo 2 , Anita Williams 3 , Jacklyne Ashubwe-Jalemba 4 , Hannock Tweya 5 , Wisdom Adeapena 6 , Appiah-Korang Labi 7 , Lady A. B. Adomako 1 , Gloria N. D. Addico 1 , Regina A. Banu 1 , Mark O. Akrong 1 , Gerard Quarcoo 1 , Selorm Borbor 1 and Mike Y. Osei-Atweneboana 1 1 Council for Scientific and Industrial Research-Water Research Institute (CSIR-WRI), Achimota, Accra P.O. Box AH 38, Ghana 2 Institute of Tropical Medicine, 2000 Antwerp, Belgium 3 MSF Luxembourg Operational Research (LuxOR) Unit, L-1617 Luxembourg, Luxembourg 4 Medwise Solutions, Nairobi P.O. Box 2356-00202 KNH, Kenya 5 Malawi International Training and Education Center for Health (Malawi-I-TECH), Lilongwe 3, Lilongwe P.O. Box 30369, Malawi 6 Kintampo Health Research Centre, Kintampo P.O. Box 200, Bono East, Ghana 7 WHO Country Office, 7 Ameda Street, Roman Ridge, Accra P.O. Box MB 142, Ghana * Correspondence: hawaahmed@csir.org.gh 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. Keywords: potable water; One Health; antimicrobial resistance (AMR); multidrug resistance; West Africa; Sustainable Development Goal (SDG) 6; SORT IT; operational research 1. Introduction Water is core to the survival of humans, animals and plants. Sustainable Development Goal (SDG) 6 calls to “achieve universal and equitable access to safe and affordable drinking water for all by the year 2030” [1]. Globally, 1.8 billion people still use drinking water sources contaminated with fecal matter, and this contamination is more prevalent in Africa [2]. Drinking water is often obtained from surface waters, reservoirs, boreholes or hand-dug wells [3]. In developing countries such as Ghana, inadequate or dysfunctional sewage systems, coupled with waste water treatment plant (WWTP) discharges, and runoff from agricultural lands and animal production systems, further contribute to the contamination of such water sources [4]. In total, 27% of the Ghanaian population have access to tap water, with 29% and 8% resorting to well water and other natural sources, Int. J. Environ. Res. Public Health 2022, 19, 12300. https://doi.org/10.3390/ijerph191912300 https://www.mdpi.com/journal/ijerph