Laure Ngando^{1, 2,}, Leopold Mbous Nguimbus^{3, 4}, Alice Ghislaine Ndoumba Afouba^{5, 6}, Thérèse Nkoa1, Albert Legrand Same Ekobo¹

Background: Infections of sterile body fluids are a global health problem, resulting in the deaths of an estimated 600,000 to 800,000 adults each year, according to World Health Organization estimates. The aim of this research was to present the microbiological, susceptibility and antimicrobial resistance profile of germs isolated from sterile body fluids during the study period. Methods: The study took place in the central region at the Centre Pasteur of Cameroon (CPC) from January 2010 to December 2019. Sterile body fluids (joint fluid, ascitic fluid, drain fluid, gastric fluid, hepatic fluid, cerebrospinal fluid, pericardial fluid, peritoneal fluid, pleural fluid and synovial fluid) were obtained by clinical specialists and samples were transferred to the CPC laboratory for analysis. India Ink and soluble antigen tests were carried out on cerebrospinal fluid (CSF) samples for Cryptococcus and Sabouraud chloramphenicol (Actidione-free) medium was used for culture. The search for other germs species was carried out on the appropriate culture media and incubations were carried out at 37°C under CO₂ between 18 and 24 hours. Other complementary tests, particularly biochemical tests, were carried out on the pure strains isolated. The Kirby-Bauer diffusion method was used to determine antimicrobial susceptibility, as well as the Vitek-2 Compact automated system. Results: From January 2010 to December 2019 a total of 2313 samples were analysed. The culture was positive for 1229 samples (53.1%). Men were more represented (55.0%) than women (41.1%). The average age of the infected participants was 33.4 ± 21.6 years with the <21 years group and the 41-60 years group being the most represented. Sample distributions by sex and age groups were significant (p<0.0001). The most represented bacterial and fungal species (>1%) were: Cryptococcus neoformans (13.8%) ; Streptococcus pneumoniae (6.8%) ; Staphylococcus aureus (4.8%); Escherichia coli (3.4%) ; Klebsiella pneumoniae (2.7%) ; Streptococcus sp. (2.1%) ; Haemophilus influenzae (1.5%) ; Staphylococcus sp. (1.4%) ; Streptococcus agalactiae (1.4%) and Pseudomonas aeruginosa (1.1%). The Pearson's Chi-squared test showed that a statistically significant association existed between the identified germs with sex (p<0.002) and age (p<0.0001). In addition, gender was a risk factor for CSF infection caused by Cryptococcus neoformans (OR: 2.07, 95% CI: 1.57-2.73, p<0.0001) with women having twice the risk of CSF infection compared to men. Antimicrobial susceptibility testing showed that resistance rates were higher for antibiotics in the penicillin, cephalosporin and sulfonamide families and that in terms of sensitivity, penicillins, cephalosporins, aminoglycosides, polypeptides, quinolones and oxazolidinones appeared to be effective against some of the bacterial species identified. As for fungi, Cryptococcus neoformans, Candida albicans and Candida sp. were sensitive to most of the antifungal agents tested. Conclusion: Infections of sterile body fluids are a health problem in both developed and developing countries. The alarming antimicrobial resistance results of the germs isolated in this research point to the need for increased surveillance investigations across the board to prevent neuromeningitis in our context.

sterile body fluids, risk factor, Cryptococcus neoformans, surveillance, neuromeningitis