American Journal of Epidemiology and Infectious Disease
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American Journal of Epidemiology and Infectious Disease. 2020, 8(2), 63-77
DOI: 10.12691/ajeid-8-2-3
Open AccessArticle

Microbiological Profile, Sensitivity and Drug Resistance of Germs Responsible for Lower Respiratory Tract Infections in Yaounde, Cameroon

Laure Ngando1, 2, , Leopold Mbous Nguimbus3, 4, Claris Killa3, 4, Thérèse Nkoa1 and Dieudonné Adiogo5

1Department of Microbiology, Faculty of Medecine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon

2Laboratory of Bacteriology/Mycology, Centre Pasteur of Cameroon, Yaounde, Cameroon

3Department of Biochemistry, Faculty of Sciences, University of Yaounde I, Yaounde, Cameroon

4Catholic University of Central Africa, School of Health Science, Yaounde, Cameroon

5Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon

Pub. Date: August 31, 2020

Cite this paper:
Laure Ngando, Leopold Mbous Nguimbus, Claris Killa, Thérèse Nkoa and Dieudonné Adiogo. Microbiological Profile, Sensitivity and Drug Resistance of Germs Responsible for Lower Respiratory Tract Infections in Yaounde, Cameroon. American Journal of Epidemiology and Infectious Disease. 2020; 8(2):63-77. doi: 10.12691/ajeid-8-2-3

Abstract

Background: Lower respiratory tract infections (LRTIs) remains a serious public health problem in worldwide despite advances of medicine. The objectives of this study were to present the profile of germs responsible for LRTIs in Yaounde between 2010 to 2019, analyse the association between these germs with the gender and age groups of the study participants and present sensitivity and resistance profiles to the drugs used in this research during the same period. Methods: This retrospective and observational study was carried out from January 04, 2010 to December 24, 2019 in Yaounde, capital of the Center region, at Centre Pasteur of Cameroon. The laboratory analyses focused on the macroscopic study, the isolation and identification of bacterial and fungal species and the realization of an antimicrobial susceptibility testing by the method of diffusion. The automated method using the Vitek 2-compact automaton has also been used in the context of the search for profiles of sensitivity and resistance to antibiotics and antifungals. Results: A total of 1795 samples were analyzed during the study period with a prevalence of LRTIs of 47.8% (858 positive samples). Men were more represented with 449 (48.0%) samples compared to 377 (48.3%) samples for women. This difference in sample distribution by sex was significant (p = 0.01224). The age of the infected participants ranged from 7-90 years for a mean age of 51.2 years ± 15.4 SD. The age distribution in groups showed that LRTIs are common among adults aged 41-60 years with 372 (49.4%) samples. The difference in distribution was significant across age groups (p<0.0001). The bacterial and fungal species most represented in the study were: Pseudomonas aeruginosa (7.24%), Klebsiella pneumoniae (6.13%), Haemophilus influenzae (4.40%), Candida albicans (4.07%), Streptococcus pneumoniae (2.01%), Streptococcus sp. (1.78%), Serratia marcescens (1.56%), Acinetobacter baumannii (1.50%), Enterobacter cloacae (1.28%), Pseudomonas fluorescens (1.23%), Straphylococcus aureus (1.23%), Haemophilus sp. (1.00%), Pseudomonas sp. (0.95%), Candida sp. (0.95%), Escherichia coli (0.89%), Stenotrophomonas maltophilia (0.84%), Chryseomonas sp. (0.78%), Pseudomonas putida (0.78%), Streptococcus oralis (0.78%), Burkholderia cepacia (0.72%), Proteus mirabilis (0.67%), Chryseomonas luteola (0.61%), Haemophilus parainfluenzae (0.61%), Acinetobacter calcoace (0.50%), Trichosporon spp. (0.39%). A statistically significant associations of age groups (p<0.0001) and sex (p = 0.01224) with the identified germs were obtained in this study. Most of the germs were resistant to bacterial envelope inhibitors with higher resistance to ticarcillin (100% for Klebsiella pneumoniae and 75.4% for Pseudomonas aeruginosa). For inhibitors of protein synthesis, higher sensitivities were observed for the same germs (92.7% and 83.8% respectively to amikacin, 83.5% to chloramphenicol for Haemophilus influenzae). For folic acid synthesis inhibitors, the highest resistance was also found for Haemophilus influenzae (87.3%) and Klebsiella pneumoniae (71.8%) to cotrimoxazole. The isolated fungi were mostly susceptible to the antifungal agents tested. Conclusion: In the light of this work, it is necessary to extend the surveillance of antibiotic resistance strains throughout the country in order to define therapeutic strategies adapted to the local epidemiological data.

Keywords:
lower respiratory tract infections sensitivity resistance antimicrobial susceptibility testing Vitek 2-compact

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References:

[1]  Vijay S, Dalela G. Prevalence of LRTI in Patients Presenting with Productive Cough and Their Antibiotic Resistance Pattern. J Clin Diagn Res. 2016; 10(1): DC09-12.
 
[2]  Bajpai T, Shrivastava G, Bhatambare GS, Deshmukh AB, Chitnis V. Microbiological profile of lower respiratory tract infections in neurological intensive care unit of a tertiary care center from Central India. J Basic Clin Pharm. 2013; 4(3): 51-5.
 
[3]  Appelbaum PC, Gillespie SH, Burley CJ, Tillotson GS. Antimicrobial selection for community-acquired lower respiratory tract infections in the 21st century: a review of gemifloxacin. Int J Antimicrob Agents. 2004; 23(6): 533-46.
 
[4]  Domenech M, Sempere J, de Miguel S, Yuste J. Combination of Antibodies and Antibiotics as a Promising Strategy Against Multidrug-Resistant Pathogens of the Respiratory Tract. Front Immunol. 2018; 9: 2700.
 
[5]  Pakhale S, Mulpuru S, Verheij TJM, Kochen MM, Rohde GGU, Bjerre LM. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev. 2014; (10): CD002109.
 
[6]  Haddar CH, Joly J, Carricajo A, Verhoeven PO, Grattard F, Mory O, et al. Strategy using a new antigenic test for rapid diagnosis of Streptococcus pneumoniae infection in respiratory samples from children consulting at hospital. BMC Microbiol. 2020; 20(1): 79.
 
[7]  Alp E, Kalin G, Coskun R, Sungur M, Guven M, Doganay M. Economic burden of ventilator-associated pneumonia in a developing country. J Hosp Infect. 2012; 81(2): 128-30.
 
[8]  Pugh R, Grant C, Cooke RPD, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. 2015; (8): CD007577.
 
[9]  Tansarli GS, Mylonakis E. Systematic Review and Meta-analysis of the Efficacy of Short-Course Antibiotic Treatments for Community-Acquired Pneumonia in Adults. Antimicrob Agents Chemother. 2018; 62(9).
 
[10]  Halls A, Van’t Hoff C, Little P, Verheij T, Leydon GM. Qualitative interview study of parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care. BMJ Open. 2017; 7(9): e015701.
 
[11]  Goel N, Chaudhary U, Aggarwal R, Bala K. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the Intensive care unit. Indian J Crit Care Med. 2009; 13(3): 148-51.
 
[12]  Gai X-Y, Bo S-N, Shen N, Zhou Q-T, Yin A-Y, Lu W. Pharmacokinetic-pharmacodynamic analysis of ciprofloxacin in elderly Chinese patients with lower respiratory tract infections caused by Gram-negative bacteria. Chin Med J. 2019; 132(6): 638-46.
 
[13]  Godbole G, Gant V. Respiratory tract infections in the immunocompromised. Curr Opin Pulm Med. 2013; 19(3): 244-50.
 
[14]  Zeng Z-R, Tian G, Ding Y-H, Yang K, Liu J-B, Deng J. Surveillance study of the prevalence, species distribution, antifungal susceptibility, risk factors and mortality of invasive candidiasis in a tertiary teaching hospital in Southwest China. BMC Infect Dis. 2019; 19(1): 939.
 
[15]  Wardhana null, Datau EA. A patient with allergic bronchopulmonary mycosis caused by Aspergillus fumigatus and Candida albicans. Acta Med Indones. 2012; 44(4): 317-23.
 
[16]  Kandeel A, Palms DL, Afifi S, Kandeel Y, Etman A, Hicks LA, et al. An educational intervention to promote appropriate antibiotic use for acute respiratory infections in a district in Egypt- pilot study. BMC Public Health. 2019; 19(Suppl 3): 498.
 
[17]  Santerre Henriksen A, Smart JI, Hamed K. Susceptibility to ceftobiprole of respiratory-tract pathogens collected in the United Kingdom and Ireland during 2014-2015. Infect Drug Resist. 2018; 11: 1309-20.
 
[18]  Zhanel GG, DeCorby M, Adam H, Mulvey MR, McCracken M, Lagacé-Wiens P, et al. Prevalence of antimicrobial-resistant pathogens in Canadian hospitals: results of the Canadian Ward Surveillance Study (CANWARD 2008). Antimicrob Agents Chemother. 2010; 54(11): 4684-93.
 
[19]  Mamishi S, Mohammadian M, Pourakbari B, Hosseinpour Sadeghi R, Haghi Ashtiani MT, Abdosalehi MR, et al. Antibiotic Resistance And Genotyping Of Gram-Positive Bacteria Causing Hospital-Acquired Infection In Patients Referring To Children’s Medical Center. Infect Drug Resist. 2019; 12: 3719-26.
 
[20]  An S, Chen J, Wang Z, Wang X, Yan X, Li J, et al. Predominant characteristics of CTX-M-producing Klebsiella pneumoniae isolates from patients with lower respiratory tract infection in multiple medical centers in China. FEMS Microbiol Lett. 2012; 332(2): 137-45.
 
[21]  Gołaś M, Netsvyetayeva I, Sikora M, Piskorska K, Sulik-Tyszka B, Swoboda-Kopeć E. Trends in antifungal susceptibility of Candida species--one year observation. Pol J Microbiol. 2014; 63(2): 217-22.
 
[22]  Tchatchouang S, Bigna JJ, Nzouankeu A, Fonkoua M-C, Nansseu JR, Ndangang MS, et al. Prevalence of respiratory bacterial infections in people with lower respiratory tract infections in Africa: the BARIAFRICA systematic review and meta-analysis protocol. BMJ Open. 2018; 8(9): e023592.
 
[23]  Tchatchouang S, Nzouankeu A, Kenmoe S, Ngando L, Penlap V, Fonkoua M-C, et al. Bacterial Aetiologies of Lower Respiratory Tract Infections among Adults in Yaoundé, Cameroon. Biomed Res Int. 2019; 2019: 4834396.
 
[24]  Coico R. Gram staining. Curr Protoc Microbiol. 2005;Appendix 3:Appendix 3C.
 
[25]  Holmes B, Willcox WR, Lapage SP. Identification of Enterobacteriaceae by the API 20E system. J Clin Pathol. 1978; 31(1): 22-30.
 
[26]  Joyanes P, del Carmen Conejo M, Martínez-Martínez L, Perea EJ. Evaluation of the VITEK 2 System for the Identification and Susceptibility Testing of Three Species of Nonfermenting Gram-Negative Rods Frequently Isolated from Clinical Samples. J Clin Microbiol. 2001; 39(9): 3247-53.
 
[27]  Ligozzi M, Bernini C, Bonora MG, de Fatima M, Zuliani J, Fontana R. Evaluation of the VITEK 2 System for Identification and Antimicrobial Susceptibility Testing of Medically Relevant Gram-Positive Cocci. J Clin Microbiol. 2002; 40(5): 1681-6.
 
[28]  Nakasone I, Kinjo T, Yamane N, Kisanuki K, Shiohira CM. Laboratory-based evaluation of the colorimetric VITEK-2 Compact system for species identification and of the Advanced Expert System for detection of antimicrobial resistances: VITEK-2 Compact system identification and antimicrobial susceptibility testing. Diagn Microbiol Infect Dis. 2007; 58(2): 191-8.
 
[29]  Ramani R, Gromadzki S, Pincus DH, Salkin IF, Chaturvedi V. Efficacy of API 20C and ID 32C Systems for Identification of Common and Rare Clinical Yeast Isolates. J Clin Microbiol. 1998; 36(11): 3396-8.
 
[30]  Cuenca-Estrella M, Arendrup MC, Chryssanthou E, Dannaoui E, Lass-Florl C, Sandven P, et al. Multicentre determination of quality control strains and quality control ranges for antifungal susceptibility testing of yeasts and filamentous fungi using the methods of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antimicrobial Susceptibility Testing (AFST-EUCAST). Clin Microbiol Infect. 2007; 13(10): 1018-22.
 
[31]  Weinstein MP, Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 2019.
 
[32]  Détermination de la sensibilité aux antibiotiques. In: CASFM/EUCAST: Société Française de Microbiologie. 2019. p. 6-25.
 
[33]  R. Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria, 2019. https://www.R-project.org/.
 
[34]  Harrison E, Drake T, Ots R, finalfit: Quickly Create Elegant Regression Results Tables and Plots when Modelling, 2019. https://CRAN.R-project.org/package=finalfit.
 
[35]  Ahmed SM, Jakribettu RP, Meletath SK, B A, Vpa S. Lower Respiratory Tract Infections (LTRIs): An Insight into the Prevalence and the Antibiogram of the Gram Negative, Respiratory, Bacterial Agents. J Clin Diagn Res. 2013; 7(2): 253-6.
 
[36]  Samad A, Ahmed T, Rahim A, Khalil A, Ali I. Antimicrobial susceptibility patterns of clinical isolates of Pseudomonas aeruginosa isolated from patients of respiratory tract infections in a Tertiary Care Hospital, Peshawar. Pak J Med Sci. 2017; 33(3): 670-4.
 
[37]  Kengne M, Lebogo MBB, Nwobegahay JM, Ondigui BE. Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé, Cameroon. Pan Afr Med J. 2018; 31: 16.
 
[38]  Vishwanath S, Chawla K, Gopinathan A. Multidrug resistant Gram-negative bacilli in lower respiratory tract infections. Iran J Microbiol. 2013; 5(4): 323-7.
 
[39]  Liu Y-X, Cao Q-M, Ma B-C. Pathogens distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes and nosocomial pulmonary infection. BMC Infect Dis. 2019; 19(1): 603.
 
[40]  Sahu MK, Siddharth B, Choudhury A, Vishnubhatla S, Singh SP, Menon R, et al. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit. Ann Card Anaesth. 2016; 19(2): 281-7.
 
[41]  Xiao Q-Z, Su D-H, Jiang J-H, Zhong N-S. [Distribution and drug-resistance of 3 500 gram-negative bacteria in Guangzhou]. Di Yi Jun Yi Da Xue Xue Bao. 2005; 25(2): 132-8.
 
[42]  Dong L, Zhou X-C, Chen X-F, Yang J-H, Lin J, Zhang H-L, et al. [Detection of etiologic agents and antibiotic resistance in children with acute lower respiratory tract infection in Wenzhou City]. Zhongguo Dang Dai Er Ke Za Zhi. 2006; 8(5): 369-72.
 
[43]  Hua C-Z, Yu H-M, Chen Z-M, Li J-P, Shang S-Q. [Pathogenic bacteria of childhood lower respiratory tract infection]. Zhongguo Dang Dai Er Ke Za Zhi. 2006; 8(5): 365-8.
 
[44]  Gileles-Hillel A, Shoseyov D, Polacheck I, Korem M, Kerem E, Cohen-Cymberknoh M. Association of chronic Candida albicans respiratory infection with a more severe lung disease in patients with cystic fibrosis. Pediatr Pulmonol. 2015; 50(11): 1082-9.
 
[45]  Ginsburg AS, Tinkham L, Riley K, Kay NA, Klugman KP, Gill CJ. Antibiotic non-susceptibility among Streptococcus pneumoniae and Haemophilus influenzae isolates identified in African cohorts: a meta-analysis of three decades of published studies. Int J Antimicrob Agents. 2013;42(6): 482-91.
 
[46]  Feshchenko Y, Dzyublik A, Pertseva T, Bratus E, Dzyublik Y, Gladka G, et al. Results from the Survey of Antibiotic Resistance (SOAR) 2011-13 in Ukraine. J Antimicrob Chemother. 2016;71 Suppl 1:i63-69.
 
[47]  Van PH, Binh PT, Minh NHL, Morrissey I, Torumkuney D. Results from the Survey of Antibiotic Resistance (SOAR) 2009-11 in Vietnam. J Antimicrob Chemother. 2016;71 Suppl 1:i93-102.
 
[48]  Zafar A, Hasan R, Nizamuddin S, Mahmood N, Mukhtar S, Ali F, et al. Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002-15. J Antimicrob Chemother. 2016;71 Suppl 1: i103-109.
 
[49]  Torumkuney D, Mayanskiy N, Edelstein M, Sidorenko S, Kozhevin R, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Russia. J Antimicrob Chemother. 2018;73 suppl 5:v14-21.
 
[50]  Torumkuney D, Papaparaskevas J, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Greece. J Antimicrob Chemother. 2018;73 suppl 5: v36-42.
 
[51]  Abdullah FE, Ahuja KR, Kumar H. Prevalence and emerging resistance of Moraxella catarrhalis in lower respiratory tract infections in Karachi. J Pak Med Assoc. 2013; 63(11): 1342-4.
 
[52]  Zhao X, Wang L, Wei N, Zhang J, Ma W, Zhao H, et al. Epidemiological and clinical characteristics of healthcare-associated infection in elderly patients in a large Chinese tertiary hospital: a 3-year surveillance study. BMC Infect Dis. 2020; 20(1): 121.
 
[53]  Farooq L, Memon Z, Ismail MO, Sadiq S. Frequency and antibiogram of multi-drug resistant pseudomonas aeruginosa in a Tertiary Care Hospital of Pakistan. Pak J Med Sci. 2019; 35(6): 1622-6.
 
[54]  Rammaert B, Goyet S, Beauté J, Hem S, Te V, Try PL, et al. Klebsiella pneumoniae related community-acquired acute lower respiratory infections in Cambodia: clinical characteristics and treatment. BMC Infect Dis. 2012; 12: 3.