Sepsis (septicaemia) is a life-threatening condition having a high prevalence in middle and low-income countries [1]. For its management, a timely and effective application of antibiotics is crucial to preside over the morbidity and mortality of the infection [2] [3]. Antibiotics are useful for infection control, but their misuse and overuse have induced antibiotic resistance in various pathogens putting the world at risk [4]. This growing threat prompted the World Health Organization to issue a global action plan for antimicrobial resistance [4]. The Centre for Disease Control and Prevention (CDC) has classified Methicillin-Resistant Staphylococcus aureus (MRSA) and Extended-spectrum beta-lactamase-producing Enterobacteriaceae together with other Multidrug-Resistant (MDR) bacteria as serious threats [4]. Several studies have demonstrated the high mortality attributable to bloodstream infections due to these MDR organisms [5] [6] [7] [8]. The emergence and global spread of multidrug resistant bacteria, in hospital and community settings, limits the use of therapeutic options, especially for people with co-morbidity conditions such as cancers and Human Immunodeficiency Virus (HIV) [9].

In Cameroon, previous studies reported a high prevalence rate of septicaemia [10] [11], yet there is limited information on the aetiology of MDR bacteria causing septicaemia. This study was therefore carried out to determine the antimicrobial resistance patterns of bacterial isolates associated with sepsis among hospitalized patients including the detection of MRSA and Extended Spectrum Beta lactamases (ESBLs) at the Yaoundé University Teaching Hospital. This research will contribute to the knowledge of drug-resistant bacteria causing septicaemia and the factors predisposing the infection in our hospital setting. It will also contribute to ensuring appropriate treatment of patients and prevent further development of drug resistance.

This study aimed at determining the antimicrobial resistance pattern of bacteria associated with sepsis among hospitalized patients at the Yaoundé University Teaching Hospital. We included patients of all age groups. Results showed that septicaemia was present in 16.0% of hospitalized patients. In comparison to other studies in Cameroon, this prevalence was lower than the 28.3% and 25.5% reported by Kamga et al. [10] and Zefack et al. [11] in Yaoundé, Cameroon respectively. Also, this finding was found lower than that reported in Ethiopia (24.2%) by Ali et al. [14], and in India (41.4%) by Kumar et al. [15]. Our result was quite similar to that of Dagnew et al. [15] in Northwest Ethiopia (18.2%) and that of Shitaye et al. [16] in Nigeria (18.2%), but was however higher than that of Marshall et al. [17] in Iran (4.1%). These varying proportions may be due to the different methodologies used and the area of study.

The range of microorganisms that invade the bloodstream has been systematically studied by several researchers. In our study, 75% of infections were caused by Gram-negative and 25% by Gram-positive bacteria. Studies in different countries; Nigeria (69.3% and 30.7%) and Tanzania (69.7% and 30.3%) reported

COR; Crude Odd Ratio, AOR; Adjusted Odd Ratio, Cl; Confidence interval.

similar higher proposition of Gram-negative bacteria than Gram-positive bacteria respectively [19] [20]. Conversely, Gram-positive bacteria have been reported as the commonest cause of bacteraemia in hospitalized patients than Gram-negative in studies carried out by Kamga et al. (56.2% and 43.8%) and Zefack et al. (62.2% and 30.8%) in Yaoundé Cameroon [10] [11]. The same findings have been reported in other developing countries [14] [16] [18]. The possible explanation for the difference could be the difference in the study design, nature of the patient population and seasonal variation.

In the case of Gram-negative bacteria, Klebsiella species (33.3%) was the predominant bacteria followed by E. coli (25%). This finding is comparable to other studies done in Yaoundé Cameroon [11] and Gondar Ethiopia [16] where the isolation rates of Klebsiella spp and E. coli were (12.3% and 10.8%) and (12.7% and 7.0%) respectively. However, our finding was contrary to what was obtained in Cameroon [10], Addis Ababa Ethiopia [19], and India [15] where E. coli was the predominant bacteria isolated among Gram-negative bacteria. Again, S. aureus (25%) was the only bacteria isolated. This finding is in contradiction with other studies in Cameroon [10] [11], Ethiopia [14] [16], India [15], and Nigeria [20]. However, quite similar to that of Habyarimana et al. in Kigali Rwanda [21] who found S. aureus as the predominant Gram-positive bacteria.

This study revealed that all cases of septicaemia in our study were caused by a single microorganism. This observation is in agreement with earlier studies [11] [17]. On the contrary, septicaemia of polymicrobial aetiology has been found in other studies [22] [23].

The antimicrobial susceptibility profile of the etiological agents of septicaemia has revealed that 66.7% of the S. aureus isolated were resistant to minocycline. Also, among Gram-negative bacteria, Klebsiella spp. showed highest resistance to amoxicillin clavulanic acid (87.5%) and E. coli showed a 100% resistance to amoxicillin clavulanic acid and tetracycline. In general, our Antimicrobial susceptibility pattern indicates that Gram-negative bacteria exhibited a greater level of antimicrobial resistance ranging between (22.2% - 88.9%) than Gram-positive bacteria (16.7% - 66.7%) to various antibacterial agents employed during the study period. This was similar to other studies done in Nigeria for which Gram-negative bacteria (19.8% - 92.3%) and Gram-positive (10% - 87%) [24] and in Gondar Ethiopia which had Gram-negative bacteria (20% - 100%) and Gram-positive (23.5% - 58.8%) [16] antimicrobial resistance. This situation raises serious concern and suggests a very high resistance gene pool perhaps due to gross misuse and inappropriate usage of the antibacterial agents [24].

Imipenem and Cefoxitin were found to be the most effective drug against Gram-negative bacteria. This finding is different from that reported in Kamga et al. [10] and Zefack et al. [11] in Cameroon where gentamicin was found to be the most effective drug, but similar to that of Kummar et al. [14] in India. Whereas, among Gram-positive bacteria, Gentamycin and Vancomycin were the most sensitive antibiotics. These findings are similar to that reported in Cameroon and Ethiopia [10] [11] [14] [16].

E. coli and Klebsiella spp. were the sole producers of ESBLs among the isolated Enterobacteriaceae. ESBL-producing E. coli accounted for 2 isolates (33.3% of the total E. coli isolated or 8.3% of the total blood isolates) and ESBL-producing Klebsiella spp. accounted for 3 isolates (37.5% of Klebsiella spp. isolated or 12.5% of blood isolates). This is contrary to that report in Malaysia [25] where ESBL-producing E. coli accounted for 9 isolates (5.2% of the total E. coli isolated or 0.5% of the total bloodstream isolates) and ESBL-producing Klebsiella spp. accounted for 23 isolates (15.5% of Klebsiella spp. isolated or 1.3% of bloodstream isolates). Furthermore, the proportion of Methicillin Resistant S. aureus (MRSA) among all S. aureus blood isolates and among all bacteria isolates was 50.0% and 8.3%, respectively. Karunakaran et al. [25] in Kuala lumper, Malaysia report different propositions of MRSA of 26.0% and 2.3% among all S. aureus blood isolates and all bacteria isolates respectively. The difference in rates could also have been due to different patient populations in the respective hospitals.

In our study, MDR was observed in the case of 76% of isolates, which is higher than reported by Wasihun et al. [26] and Birru et al. [12] in Ethiopia. Among the MDR, 73.7% were Gram-negative and 26.3% were Gram-positive. This finding is in contradiction to what was reported by Birru et al. [12] where instead 60% were Gram-positive and the rest were Gram-negative in Ethiopia.

Several risk factors of septicaemia were assessed during this study, and among the various risk factors assessed related to septicaemia, high body temperature was found to be significantly associated and it was seen that patients with a body temperature above 37.9˚C were 4.2 times more prone to infections. This finding is similar to that reported by Zefack et al. [11]. Again, patients on respiratory assistance were found to be significantly associated with septicaemia, where they had a 4.3 risk to have infection.

Male gender was significantly associated with septicaemia; however, these were not identified as independent risk factors in the multivariate analysis. Similarly, other socio-demographic characteristics and clinical factors of patients such as the presence of underlying disease, past operation, past hospitalization and antibiotic therapy were not identified as predisposing factors. The lack of association between septicaemia and the aforementioned factors has also been described in studies conducted in Cameroon [11], Ethiopia [12] and Egypt [27].

Our study reveals the prevalence of septicaemia at the University Teaching Hospital Yaoundé is high and also Klebsiella spp, E. coli and S. aureus were the leading cause of septicaemia among symptomatic hospitalized patients who attended the hospital during this period. Patients older than 50 years registered the highest number of septicaemia cases in this study. In general, Gram-negative bacilli were highly sensitive to imipenem and showed a high level of resistance to amoxicillin-clavulanic acid. S. aureus was highly sensitive to Gentamycin and Vancomycin and showed a high level of resistance to minocycline. Again, none of the antibiotics used singly showed high sensitivity to all the Gram-negative bacteria. So, a combination of two or more drugs (such as gentamicin, cefoxitin and ciprofloxacin) is needed to cover the broad range of Gram-negative bacilli. MDR bacteria were also observed during this study expressed by the presence of ESBLs and MRSA among the isolated bacteria. Further, high body temperature (>37.9˚C) and being on respiratory assistance were significantly associated with septicaemia.

We are grateful to the participants who agreed to take part in this study. The authors further express profound gratitude to the medical personnel of the different units of the Yaounde University Teaching Hospital for the conducive environment to carry out this study till the end.

LCNY, BDTP, AWB, WD conceived the study and designed it. LCNY carried out the sample collection, lab work and data analysis. AWB, ACB and HKG supervised the lab work and sample collection. The general supervision was carried out by BDTP and WD. AWB, LCNY and WD drafted the article. All the authors reviewed the article. All the authors read and agreed to the final manuscript.

The authors declare no conflicts of interest regarding the publication of this paper.

Yimtchi, L.C.N., Pokam, B.D.T., Baiye, A.W., Betbeui, A.C., Gonsu, H.K. and Djakissam, W. (2023) Antibiotic Susceptibility Patterns of Bacteria Associated with Sepsis among Hospitalized Patients in the Yaoundé University Teaching Hospital—Cameroon. Open Journal of Medical Microbiology, 13, 101-115. https://doi.org/10.4236/ojmm.2023.131009