Healthcare-associated infections in a resource-limited setting: Microbial contamination and antimicrobial resistance in a Cameroonian referral hospital

Abstract

Antimicrobial resistance is a silent pandemic threatening the lives of millions on the African continent. This exploratory study investigates microbial contamination of surfaces and medical devices, evaluates antibiotic resistance profiles, and identifies high-risk pathogens within a referral hospital in Yaoundé, Cameroon. A descriptive cross-sectional study was conducted from May to July 2024 in the obstetrics-gynecology department. Thirty samples were collected using sterile swabs from high-touch surfaces and from medical devices. Bacterial isolates were identified using standard culture and biochemical methods, and antibiotic susceptibility testing was performed through disk diffusion, with methicillin-resistant Staphylococcus aureus confirmed using cefoxitin discs. Data were analyzed using R Statistics version 4.4.2. The findings revealed that all samples were contaminated, yielding 55 bacterial isolates. Gram-positive bacteria were predominant (60%), primarily S. aureus (36%), and other Staphylococcus spp. (24%). Gram-negative pathogens included Proteus mirabilis (13%) and Klebsiella spp. (7%). Taps (14 isolates) and trolleys (100% contamination rate) were identified as the most contaminated sites. Antibiotic resistance was high: 70% of Staphylococcus species were methicillin-resistant, and 100% of Gram-negative isolates exhibited multidrug resistance (MDR), including resistance to penicillin (≥70%), cephalosporins (≥80%), and fosfomycin (≥75%). Carbapenems and quinolones remained effective against Gram-negative strains. These findings highlight widespread contamination of hospital environments with MDR pathogens, posing significant risks to maternal and neonatal health. The predominance of methicillin-resistant S. aureus and MDR Gram-negative bacteria underscores the urgent need to strengthen infection protocols, antimicrobial stewardship, and national antimicrobial resistance surveillance in Cameroon. Implementation of the World Health Organization infection prevention and control guidelines and targeted staff training is essential to reduce preventable healthcare-associated infections in resource-limited settings.

Keywords

Healthcare-associated infections / Antimicrobial resistance / Staphylococcus aureus / Methicillin-resistant Staphylococcus aureus / Infection prevention and control / Obstetrics-gynecology / Cameroon

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