Laure Ngando^{1, 2,}, Leopold Mbous Nguimbus^{3, 4}, Frantz Guy Epoupa Ngalle⁵, Thérèse Nkoa¹, Albert Legrand Same Ekobo¹

Background: Urinary tract infections (UTIs), which are most often caused by Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae) and Candida species (Candida spp.), have until now been a health problem throughout the world, particularly in developing countries. Moreover, with the growing increase in antibiotic resistance in recent years, the treatment of these infections is becoming increasingly difficult. The aim of this study was to present the prevalence of E. coli, K. pneumoniae and Candida spp. in UTIs, investigate the association between the previous species responsible for these infections with age and sex, to present the patterns of antimicrobial resistance and the evolution of these resistances during the study period. Methods: This was a retrospective study that was conducted from January 04, 2010 to November 27, 2019 in Yaounde, capital of the Central region in the Centre Pasteur of Cameroon. Following collection of urine samples, the laboratory analyses included macroscopic examination, culture on cystine lactose electrolyte deficient (CLED) medium using the semi-quantitative technique, incubation in an oven at 37°C between 18 and 24 hours and antimicrobial sensitivity testing using the diffusion method and the Vitek 2-Compact device. Results: During the study period, 23,507 urine samples were analysed. The prevalence of infection caused by E. coli, K. pneumoniae and Candida spp. was 46.2%. The female sex was the most represented (25.1%) against 21% for the male sex. The mean age of participants with a clinical picture of a UTI was 35.5 years ± 29.2 SD with patients under 20 years of age being the most represented. The prevalence of infection caused by E. coli was 32.1% ; that of K. pneumoniae was 12.1% and the prevalence of Candida species was 1.9% with Candida albicans being more represented. In this study, a statistically significant association was found between the above germs with age group (p<0.001) and sex (p<0.001). Antimicrobial susceptibility testing showed that E. coli and K. pneumoniae were particularly resistant to antibiotics of the penicillin family, the cephalosporin family, the sulfamide family and the quinolone family. Candida species were highly sensitive to most of the antifungal agents tested. The profiles of the evolution of antibiotic sensitivity according to the study period showed that, from one family of drugs to another, resistance was generally greater than sensitivity, with lower rates in recent years (2017-2019). Conclusion: The treatment of UTIs caused by E. coli and K. pneumoniae remains a challenge due to the frequent use of highly resistant antibiotics. Continuous monitoring of multidrug resistance by the organisms concerned remains necessary in order to prevent situations of therapeutic failure and to find appropriate treatments for UTIs in our context.

Urinary tract infections, Escherichia coli, Klebsiella pneumoniae, Candida spp., antimicrobial resistance, continuous monitoring