Drug Resistance and Susceptibility Profile of Bacterial and Fungal Isolates from Stool Samples in Yaounde, Cameroon

Laure Ngando^{1, 2,} , Leopold Mbous Nguimbus^{3, 4}, Alain Bruno Ndjapou Chedjou⁵ and Therese Nkoa¹

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 Animal Biology, Faculty of Sciences, University of Yaounde I, Yaounde, Cameroon

Cite this paper:
Laure Ngando, Leopold Mbous Nguimbus, Alain Bruno Ndjapou Chedjou and Therese Nkoa. Drug Resistance and Susceptibility Profile of Bacterial and Fungal Isolates from Stool Samples in Yaounde, Cameroon. American Journal of Infectious Diseases and Microbiology. 2020; 8(3):99-112. doi: 10.12691/ajidm-8-3-3

Abstract

Background: Intestinal pathologies of bacterial or fungal origin constitute a public health problem all over the world and particularly in developing countries. The diseases associated with these infections, including diarrhea, significantly affect children and continue to be the cause of morbidity and mortality observed in developed countries and even more so in the third world. Objective: The objectives of this study were to present the profile of the germs involved in intestinal infections in Yaounde between 2010 and 2020, to analyze the association between these germs with the sex and age groups of the study subjects and to present the profiles of sensitivity and drug resistance of species isolated from stool samples during the same period. Methods: This retrospective study was carried out from January 04, 2010 to January 07, 2020 in Yaounde at the Centre Pasteur of Cameroon. After collection of stool samples, laboratory analyzes focused on macroscopic study, isolation and identification of bacterial and fungal species and then performing an antimicrobial susceptibility test by the diffusion method. The automated method using the Vitek 2-compact automaton was also used in order to highlight drug susceptibility and resistance profiles. Results: 40,339 stool samples were analyzed during the study period with a prevalence of intestinal infections of 8.1% (3284 samples positive for the presence of a bacterial or fungal species). The male sex was the most represented with 1697 samples (4.2%) against 1484 (3.7%) samples for the female sex. This difference in sex distribution was statistically significant (p<0.001). The age of participants positive for infection ranged from 0-100 years with a mean age of 26.9 years ± 21.3 SD. The most contaminated age group was made up of patients aged less than 20 years, ie 1620 (9.3%) samples for an average age of 8.8 years ± 3.8 SD. The difference in the distribution of the samples by age group was significant (p<0.0001). The bacterial species most represented in the stool samples were: Shigella flexneri (1.16%), Vibrio cholerae (1.14%), Salmonella sp. (0.74%), Escherichia coli (0.62%), Campylobacter sp. (0.15%), Shigella sonnei (0.13%), Shigella sp. (0.11%), Shigella boydii (0.11%), Salmonella enteritidis (0.09%), Salmonella typhimurium (0.09%), Campylobacter jejuni (0.08%), Shigella dysenteriae A2 (0.04%), Salmonella typhi (0.03%), Campylobacter coli (0.03%), Campylobacter lari (0.03%), Salmonella hadar (0.03%) and Shigella dysenteriae A1 (0.03%). Regarding fungi, Candida albicans (2.63%) was the most represented followed by other strains of Candida (Candida sp. with a prevalence of 0.85%). Significant associations of age groups (p<0.0001) and sex (p<0.001) with the organisms isolated were obtained in this study. About 40 antibiotics and 8 antifungals were used. The greatest resistance was observed for drugs which inhibit the synthesis of bacterial envelopes, nucleic acids, folic acid and proteins. The most resistant species were: Shigella flexneri (81.0% resistance to ticarcillin); Campylobacter coli (91.7% resistance to cefatrizine); Campylobacter lari and Vibrio cholerae (100% and 92.4% resistance to nalidixic acid); Shigella dysenteriae A2 and Shigella sonnei (100% and 96.1% resistance to cotrimoxazole); Vibrio cholerae (82.1% resistance to Colistin). For fungi, Candida albicans was the most represented and showed a high sensitivity for most of the antifungal agents used. Conclusion: In the light of the results of this study, it is essential to extend the surveillance of the resistance of strains to antibiotics in other regions of Cameroon to define the therapeutic strategies adapted to the epidemiological data in our context.

Keywords:
intestinal pathologies antimicrobial susceptibility test Vitek 2-compact surveillance Cameroon

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References:

[1]	Beyene G, Tasew H. Prevalence of intestinal parasite, Shigella and Salmonella species among diarrheal children in Jimma health center, Jimma southwest Ethiopia: a cross sectional study. Ann Clin Microbiol Antimicrob. 2014; 13: 10.
[2]	Mulatu G, Beyene G, Zeynudin A. Prevalence of Shigella, Salmonella and Campylobacter species and their susceptibility patters among under five children with diarrhea in Hawassa town, south Ethiopia. Ethiop J Health Sci. 2014; 24(2): 101-8.
[3]	Ateudjieu J, Bita’a LB, Guenou E, Chebe AN, Chukuwchindun BA, Goura AP, et al. [Profile and antibiotic susceptibility pattern of bacterial pathogens associated with diarrheas in patients presenting at the Kousseri Regional Hospital Anne, Far North, Cameroon]. Pan Afr Med J. 2018; 29: 170.
[4]	Ameya G, Tsalla T, Getu F, Getu E. Antimicrobial susceptibility pattern, and associated factors of Salmonella and Shigella infections among under five children in Arba Minch, South Ethiopia. Ann Clin Microbiol Antimicrob. 2018; 17(1): 1.
[5]	Zhang S-X, Zhou Y-M, Tian L-G, Chen J-X, Tinoco-Torres R, Serrano E, et al. Antibiotic resistance and molecular characterization of diarrheagenic Escherichia coli and non-typhoidal Salmonella strains isolated from infections in Southwest China. Infect Dis Poverty. 2018; 7(1): 53.
[6]	Gebreegziabher G, Asrat D, W/Amanuel Y, Hagos T. Isolation and Antimicrobial Susceptibility Profile of Shigella and Salmonella Species from Children with Acute Diarrhoea in Mekelle Hospital and Semen Health Center, Ethiopia. Ethiop J Health Sci. 2018; 28(2): 197-206.
[7]	GebreSilasie YM, Tullu KD, Yeshanew AG. Resistance pattern and maternal knowledge, attitude and practices of suspected Diarrheagenic Escherichia coli among children under 5 years of age in Addis Ababa, Ethiopia: cross sectional study. Antimicrob Resist Infect Control. 2018; 7: 110.
[8]	Dagnew M, Tiruneh M, Moges F, Tekeste Z. Survey of nasal carriage of Staphylococcus aureus and intestinal parasites among food handlers working at Gondar University, Northwest Ethiopia. BMC Public Health. 2012; 12(1): 837.
[9]	Abera B, Yitayew G, Amare H. Salmonella serotype Typhi, Shigella, and intestinal parasites among food handlers at Bahir Dar University, Ethiopia. J Infect Dev Ctries. 2016; 10(2): 121-6.
[10]	Mama M, Alemu G. Prevalence, antimicrobial susceptibility patterns and associated risk factors of Shigella and Salmonella among food handlers in Arba Minch University, South Ethiopia. BMC Infect Dis. 2016; 16(1): 686.
[11]	Aklilu A, Kahase D, Dessalegn M, Tarekegn N, Gebremichael S, Zenebe S, et al. Prevalence of intestinal parasites, salmonella and shigella among apparently health food handlers of Addis Ababa University student’s cafeteria, Addis Ababa, Ethiopia. BMC Res Notes. 2015; 8: 17.
[12]	Abbasi E, Mondanizadeh M, van Belkum A, Ghaznavi-Rad E. Multi-Drug-Resistant Diarrheagenic Escherichia coli Pathotypes in Pediatric Patients with Gastroenteritis from Central Iran. Infect Drug Resist. 2020; 1: 1387-96.
[13]	Tadesse G. Prevalence of human Salmonellosis in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis. 2014; 14: 88.
[14]	Eltai NO, Al Thani AA, Al Hadidi SH, Al Ansari K, Yassine HM. Antibiotic resistance and virulence patterns of pathogenic Escherichia coli strains associated with acute gastroenteritis among children in Qatar. BMC Microbiol. 2020; 20(1): 54.
[15]	Taghadosi R, Shakibaie MR, Hosseini-Nave H. Antibiotic resistance, ESBL genes, integrons, phylogenetic groups and MLVA profiles of Escherichia coli pathotypes isolated from patients with diarrhea and farm animals in south-east of Iran. Comp Immunol Microbiol Infect Dis. 2019; 63: 117-26.
[16]	Verma S, Venkatesh V, Kumar R, Kashyap S, Kumar M, Maurya AK, et al. Etiological agents of diarrhea in hospitalized pediatric patients with special emphasis on diarrheagenic Escherichia coli in North India. J Lab Physicians. 2019; 11(1): 68-74.
[17]	Huang Z, Pan H, Zhang P, Cao X, Ju W, Wang C, et al. Prevalence and Antimicrobial Resistance Patterns of Diarrheagenic Escherichia coli in Shanghai, China. Pediatr Infect Dis J. 2016; 35(8): 835-9.
[18]	Ezeonu IM, Ntun NW, Ugwu KO. Intestinal candidiasis and antibiotic usage in children: case study of Nsukka, South Eastern Nigeria. Afr Health Sci. 2017; 17(4): 1178-84.
[19]	Konaté A, Dembélé R, Guessennd NK, Kouadio FK, Kouadio IK, Ouattara MB, et al. Epidemiology and Antibiotic Resistance Phenotypes of Diarrheagenic Escherichia Coli Responsible for Infantile Gastroenteritis in Ouagadougou, Burkina Faso. Eur J Microbiol Immunol (Bp). 2017 Sep; 7(3): 168-75.
[20]	Marbou WJT, Kuete V. Bacterial resistance and immunological profiles in HIV-infected and non-infected patients at Mbouda AD LUCEM Hospital in Cameroon. J Infect Public Health. 2017; 10(3): 269-76.
[21]	Ngalani OJT, Mbaveng AT, Marbou WJT, Ngai RY, Kuete V. Antibiotic Resistance of Enteric Bacteria in HIV-Infected Patients at the Banka Ad-Lucem Hospital, West Region of Cameroon. Can J Infect Dis Med Microbiol. 2019; 2019: 9381836.
[22]	Marbou WJT, Kuete V. Methicillin-resistant Staphylococcus aureus in Metabolic Syndrome Patients at the Mbouda Hospitals, West Region of Cameroon. Cureus. 2020; 12(3): e7274.
[23]	Mariani-Kurkdjian P, Bonacorsi S, Bingen E. Diagnostic bactériologique des infections gastro-intestinales. Bactériologie Médicale. 2016; 149-61.
[24]	Holmes B, Willcox WR, Lapage SP. Identification of Enterobacteriaceae by the API 20E system. J Clin Pathol. 1978; 31(1): 22-30.
[25]	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.
[26]	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.
[27]	Détermination de la sensibilité aux antibiotiques. In: CASFM/EUCAST: Société Française de Microbiologie. 2019. p. 6-25.
[28]	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.
[29]	Weinstein MP, Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 2019.
[30]	R. Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria, 2019. https://www.R-project.org/.
[31]	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.
[32]	Kebede A, Aragie S, Shimelis T. The common enteric bacterial pathogens and their antimicrobial susceptibility pattern among HIV-infected individuals attending the antiretroviral therapy clinic of Hawassa university hospital, southern Ethiopia. Antimicrob Resist Infect Control. 2017; 6: 128.
[33]	Mahmoudi S, Pourakbari B, Moradzadeh M, Eshaghi H, Ramezani A, Haghi Ashtiani MT, et al. Prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital. Microb Pathog. 2017; 109: 45-8.
[34]	Diriba K, Awulachew E, Ashuro Z. Prevalence and Antimicrobial Resistance Pattern of Salmonella, Shigella, and Intestinal Parasites and Associated Factor among Food Handlers in Dilla University Student Cafeteria, Dilla, Ethiopia. Int J Microbiol. 2020; 2020: 3150539.
[35]	Yang H, Chen G, Zhu Y, Liu Y, Cheng J, Hu L, et al. Surveillance of antimicrobial susceptibility patterns among Shigella species isolated in China during the 7-year period of 2005-2011. Ann Lab Med. 2013 Mar; 33(2): 111-5.
[36]	Wei Z, Xu X, Yan M, Chang H, Li Y, Kan B, et al. Salmonella Typhimurium and Salmonella Enteritidis Infections in Sporadic Diarrhea in Children: Source Tracing and Resistance to Third-Generation Cephalosporins and Ciprofloxacin. Foodborne Pathog Dis. 2019; 16(4): 244-55.
[37]	Sire J-M, Macondo EA, Perrier-Gros-Claude J-D, Siby T, Bahsoun I, Seck A, et al. Antimicrobial resistance in Shigella species isolated in Dakar, Senegal (2004-2006). Jpn J Infect Dis. 2008; 61(4): 307-9.
[38]	Awoyeni A, Olaniran O, Odetoyin B, Hassan-Olajokun R, Olopade B, Afolayan D, et al. Isolation and evaluation of Candida species and their association with CD4+ T cells counts in HIV patients with diarrhoea. Afr Health Sci. 2017; 17(2): 322-9.
[39]	Gu B, Cao Y, Pan S, Zhuang L, Yu R, Peng Z, et al. Comparison of the prevalence and changing resistance to nalidixic acid and ciprofloxacin of Shigella between Europe-America and Asia-Africa from 1998 to 2009. Int J Antimicrob Agents. 2012; 40(1): 9-17.
[40]	Kahsay AG, Muthupandian S. A review on Sero diversity and antimicrobial resistance patterns of Shigella species in Africa, Asia and South America, 2001-2014. BMC Res Notes. 2016; 9(1): 422.
[41]	Mengist A, Mengistu G, Reta A. Prevalence and antimicrobial susceptibility pattern of Salmonella and Shigella among food handlers in catering establishments at Debre Markos University, Northwest Ethiopia. Int J Infect Dis. 2018; 75: 74-9.
[42]	Awol N, Nigusse D, Ali M. Prevalence and antimicrobial susceptibility profile of Salmonella and Shigella among food handlers working in food establishment at Hawassa city, Southern Ethiopia. BMC Res Notes. 2019 Oct 30; 12(1): 712.
[43]	Bafa TA, Sherif EM, Hantalo AH, Woldeamanuel GG. Magnitude of enteropathogens and associated factors among apparently healthy food handlers at Wolkite University Student’s Cafeteria, Southern Ethiopia. BMC Res Notes. 2019; 12(1): 567.
[44]	Getie M, Abebe W, Tessema B. Prevalence of enteric bacteria and their antimicrobial susceptibility patterns among food handlers in Gondar town, Northwest Ethiopia. Antimicrob Resist Infect Control. 2019; 8: 111.
[45]	Pazhani GP, Ramamurthy T, Mitra U, Bhattacharya SK, Niyogi SK. Species diversity and antimicrobial resistance of Shigella spp. isolated between 2001 and 2004 from hospitalized children with diarrhoea in Kolkata (Calcutta), India. Epidemiol Infect. 2005 Dec; 133(6): 1089-95.
[46]	Li Y, Xie X, Xu X, Wang X, Chang H, Wang C, et al. Nontyphoidal salmonella infection in children with acute gastroenteritis: prevalence, serotypes, and antimicrobial resistance in Shanghai, China. Foodborne Pathog Dis. 2014; 11(3): 200-6.