Proportion of extended-spectrum ß-lactamase-producing Enterobacteriaceae in community setting in Ngaoundere, Cameroon.

BACKGROUND: There is no information regarding the resistance mechanisms of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae in community setting in Cameroon. The current study aimed to determine the proportion of ESBLs in Enterobacteriaceae isolated in the community and to analyse some risk factors associated with ESBL carriage. METHODS: Faecal samples were collected from 208 different outpatients and 150 healthy student volunteers between 3 January and 3 April 2009. Enterobacterial isolates resistant to third-generation cephalosporins were screened for ESBL production by the double-disk synergy test. Presumptive ESBL-producing isolates with positive synergy test were identified by Mass Spectrometry using the BioTyper MALDI-TOF. For such ESBL positive isolates, antibiotic susceptibility was determined by the Vitek 2 system. PCR and sequencing were performed for the detection of different types of ESBL genes in presumptive ESBL-producing isolates. Statistical methods were used for the univariate calculation of risk factors. RESULTS: During the study period, a total of 358 faecal samples were analysed; 58 of such samples (16%) showed an ESBL phenotype and were confirmed by PCR. The proportion of ESBL producers in faecal carriage was statistically different between outpatients and student volunteers (23.1% vs. 6.7%: p < 0.000). According to a univariate analysis, previous use of antibiotics (ciprofloxacin) appeared to be a risk factor for ESBL carriage (p < 0.05).Escherichia coli was the species most frequently isolated among the ESBL producers in outpatients (66.7%) and student volunteers (90%). Isolates showed additional resistance to gentamicin, ciprofloxacin and trimethoprim/sulfamethoxazole but none of them was resistant to temocillin, amikacin or meropenem. Most of the strains (97%) produced a CTX-M group 1 enzymes [CTX-M-15 (98%) or CTX-M-1 (2%)] and the remaining strains produced SHV-12 enzyme (3%). CONCLUSIONS: The use of drugs such as amoxicillin, ciprofloxacin and trimethoprim/sulfamethoxazole does not seem appropriate for empirical treatment because of emerging resistance. The implementation in Cameroon or in other African countries of methods of screening ESBL-producing organisms in routine laboratories is of great importance in order for us to offer patients appropriate treatment and for infection control efforts to succeed.

Health gains from solar water disinfection (SODIS): evaluation of a water quality intervention in Yaoundé, Cameroon.

In developing countries, the burden of diarrhoea is still enormous. One way to reduce transmission of pathogens is by water quality interventions. Solar water disinfection (SODIS) is a low-cost and simple method to improve drinking water quality on household level. This paper evaluates the implementation of SODIS in slum areas of Yaoundé, Cameroon. Promoters trained 2,911 households in the use of SODIS. Two surveys with randomly selected households were conducted before (N=2,193) and after (N=783) the intervention. Using a questionnaire, interviewers collected information on the health status of children under five, on liquid consumption, hygiene and other issues. Prior to the intervention, diarrhoea prevalence amounted to 34.3% among children. After the intervention, it remained stable in the control group (31.8%) but dropped to 22.8% in the intervention group. Households fully complying with the intervention exhibited even less diarrhoea prevalence (18.3%) and diarrhoea risk could be reduced by 42.5%. Multivariate analyses revealed that the intervention effects are also observed when other diarrhoea risk factors, such as hygiene and cleanliness of household surroundings, are considered. According to the data, adoption of the method was associated with marital status. Findings suggest health benefits from SODIS use. Further promotional activities in low-income settings are recommended.

The in-vitro antimicrobial activity of some medicinal plants against beta-lactam-resistant bacteria.

BACKGROUND: In effort to identify novel bacterial agents, this study was initiated to evaluate the antimicrobial properties of 17 crude extracts from 12 medicinal plants against beta-lactam-resistant bacteria. METHODOLOGY: The antimicrobial activities of plant extracts were evaluated against clinically proved beta-lactam-resistant bacteria (Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Serratia marcescens, Acinetobacter baumannii, Staphylococcus aureus and Enterococcus sp.) and reference strains of bacteria (Escherichia coli ATCC 35218, Enterobacter aerogenes ATCC 29751, E. aerogenes ATCC 13048, Pseudomonas aeruginosa ATCC 27853 and Enterococcus hirae ATCC 9790) by using disc-diffusion and agar-dilution assays. RESULTS: The crude plant extracts demonstrated broad spectrum activity against all bacteria tested with inhibition zones in the range of 8-30 mm. The minimal inhibitory concentration (MIC) values of different plant extracts against the tested bacteria were found to range from or= 10 mg ml(-1). The most active plant extracts were from Dortenia picta and Bridelia micrantha (MIC: 1.25-10 mg ml(-1)) on beta-lactam-resistant Gram-negative bacilli and the extracts from B. micrantha, Mallotus oppositifolius, Garcinia lucida, Garcinia. kola, Campylospermum densiflorum (leaves) and C. zenkeri (root) on beta-lactam-resistant Gram-positive cocci (MIC:

Nitrile glucosides and serotobenine from Campylospermum glaucum and Ouratea turnarea.

Two nitrile glucosides (1S,3S,4S,5R)-4-benzoyloxy-2-cyanomethylene-3,5-dihydroxycyclohexyl-1-O-beta-glucopyranoside (campyloside A) and (1S,3S,4S,5R)-5-benzoyloxy-2-cyanomethylene-3-hydroxy-4-(2-pyrrolcarboxyloxy)cyclohexyl-1-O-beta-glucopyranoside (campyloside B) were isolated from the stem roots of Campylospermum glaucum, whereas serotobenine was isolated from Ouratea turnarea. The structure elucidations were based on spectroscopic evidence. The biological assays of compounds and crude extract of plant species showed good antimicrobial activity of crude extracts against Gram-positive cocci.

Screening of some medicinal plants from cameroon for beta-lactamase inhibitory activity.

In efforts to find new bioactive beta-lactamase inhibitors, this study investigated 16 Cameroonian plants belonging to 10 families which were evaluated for anti-beta-lactamase activity. The investigation showed that extracts 2, 6, 3 and 5 of the 16 plants investigated presented interesting in vitro beta-lactamase inhibition (over 90%), respectively, of the beta-lactamases TEM-1, OXA-10, IMP-1 and P99. These extracts were from Mammea africana (all beta-lactamases), Garcinia lucida, G. kola (OXA-10, IMP-1 and P99), Bridelia micrantha (OXA-10, P99), Ochna afzelii (OXA-10, P99), Prunus africana (IMP-1) and Adenia lobata (TEM-1). After elimination of tannins (according to the European Pharmacopoeia) the extracts from B. micrantha, G. lucida and M. africana were tested further for their anti-beta-lactamase activity. The extracts from B. micrantha and G. lucida exhibited potent inhibitory activity, respectively, of beta-lactamase OXA-10 (IC(50) = 0.02 mg/mL) and P99 (IC(50) = 0.01 mg/mL). The anti-beta-lactamase activity of M. africana extract was weak. The isolation and the structural elucidation of the active constituents of G. lucida and B. micrantha will provide useful leads in the development of beta-lactamase inhibitors.

Two biflavonoids from Ouratea nigroviolacea.

The leaves of Ouratea nigroviolacea (Ochnaceae) afforded two biflavonoids, ouratine A and B together with agathisflavone and stigmasterol. The biflavonoids were characterized as 4'-O-methylated apigeninyl-(I-6, II-8)-4'-O-methylatedapigenin and 4'-O-methylated apigeninyl-(I-6, II-8) apigenin by spectral and chemical transformation studies.

Antimicrobial activity against gram negative bacilli from Yaounde Central Hospital, Cameroon.

BACKGROUND: Antimicrobial resistance among bacteria pathogens is a world-wide issue. The antimicrobial susceptibility patterns of common pathogenic bacteria are essential to guide empirical and pathogen-specific therapy; unfortunately, these data are scarse in Cameroon. OBJECTIVE: To determine the antimicrobial susceptibility patterns of Gram-negative bacilli isolated in Yaounde Central Hospital Laboratory of Bacteriology. METHODS: Gram-negative bacilli isolates (n = 505), obtained from a wide range of clinical specimens (urine, pus and blood) in Yaoundé Central Hospital Laboratory of Bacteriology between March 1995 and April 1998, were evaluated for resistance to antibiotics (amoxicillin, amoxicillin/clavulanate, piperacillin, cefazolin, cefoxitin, cefotaxime, ceftazidime, aztreonam, imipenem, gentamicin, tobramicin, ofloxacin and trimethoprim/sulfamethoxazole) by the Kirby-Bauer disk diffusion method. RESULTS: High rates of resistance were found in most of the bacteria studied. Resistance to all isolates was mostly observed for amoxicillin (87%), piperacillin (74%) and trimethoprim/sulfamethoxazole (73%). Susceptibilities to third generation cephalosporins (cefotaxime, ceftazidime) and monobactame (aztreonam) were = 91% for Escherichia coli, = 71% for Klebsiella spp., = 98% for Proteus mirabilis, = 50% for Enterobacter spp. and Citrobacter spp. Pseudomonas aeruginosa was less susceptible to cefotaxime (2%) and aztreonam (33%), and highly susceptible to ceftazidime (72%) whereas Acinetobacter baumannii was highly resistant to aztreonam (100%), to cefotaxime (96%) and cetazidime (62%). Imipenem (98%) was the most active antibiotic followed by the ofloxacine (88%). Susceptibility of all isolates to gentamicin was 67%. CONCLUSION: These results indicate that surveillance to antimicrobial resistance in Cameroon is necessary to monitor microbial trends, antimicrobial resistance pattern, and provide information for choosing empirical or direct therapy to physicians.

Extended-spectrum-beta-lactamase-producing Enterobacteriaceae in Yaounde, Cameroon.

Organisms producing extended-spectrum beta-lactamases (ESBLs) have been reported in many countries, but there is no information on the prevalence of ESBL-producing members of the family Enterobacteriaceae in Cameroon. A total of 259 Enterobacteriaceae strains were isolated between 1995 and 1998 from patients at the Yaounde Central Hospital in Cameroon. Enterobacterial isolates resistant to extended-spectrum cephalosporin and monobactam were screened for ESBL production by the double-disk (DD) synergy test. Thirty-one (12%) of these Enterobacteriaceae strains were shown to be positive by the DD synergy test, suggesting the presence of ESBLs. Resistance to oxyimino-cephalosporins and monobactams of 12 (38.7%) of the 31 strains-i.e., 6 Klebsiella pneumoniae, 4 Escherichia coli, 1 Citrobacter freundii, and 1 Enterobacter cloacae strain-was transferred to E. coli HK-225 by conjugation. Resistance to gentamicin, gentamicin plus trimethoprim-sulfamethoxazole, or trimethoprim-sulfamethoxazole was cotransferred into 6, 2, and 1 of these transconjugants, respectively. All 12 transconjugants were resistant to amoxicillin, piperacillin, all of the cephalosporins, and aztreonam but remained susceptible to cefoxitin and imipenem. Crude extracts of beta-lactamase-producing transconjugants were able to reduce the diameters of inhibition zones around disks containing penicillins, narrow- to expanded-spectrum cephalosporins or monobactams when tested against a fully susceptible E. coli strain but had no effect on such zones around cefoxitin, imipenem, and amoxicillin-clavulanate disks. The beta-lactamases produced by the 12 tranconjugants turned out to be SHV-12 by DNA sequencing. Therefore, the ESBL SHV-12 is described for the first time in Cameroon.