Hospitalization and colonization by methicillin-resistant Staphylococcus in the surgical department in 03 health facilities of the Ndé division, west-Cameroon

Abstract

Background: Commensal flora colonization during hospitalization by bacteria is the first step for a nosocomial infections while antibiotic resistance reduces therapeutic options. In aim to control this phenomenon, we initiated this study to describe the impact of hospitalization on colonization by methicillin-resistant Staphylococcus in the surgical department in 03 health facilities of the Ndé division, west-Cameroon. Methods: This quasi-experimental study was carried out on patients admitted for surgery in 03 health facilities of the Ndé division, west-Cameroon (District Hospital of Bangangté, Protestant Hospital of Bangwa and Cliniques Universitaires des Montagnes). After obtaining ethical clearance and authorizations, nasal swabs were performed at admission and discharge, with the aim of isolating bacteria and performing their antibiotic susceptibility tests. Information on each participant's antibiotic therapy was recorded. Laboratory investigations were carried out according to standard protocols (CASFM, 2019). Results: The most commonly used antibiotics were β-lactam antibiotics. Of the 52 patients who agreed to participate in the study, 104 nasal swabs were performed. From the analysis, 110 (57 at admission versus 53 at discharge) Staphylococcus isolates were obtained. Overall, susceptibility testing showed that antibiotic resistance rates were higher at discharge than at admission; with significant differences between the susceptibility profiles obtained at admission and discharge for β-lactam antibiotics and not significant for fluoroquinolones and aminoglycosides. The nasal flora of 13 (25%) patients was colonized with methicillin-resistant Staphylococcus at admission versus 39 (75%) at discharge and 14 (24.56%) of the isolates obtained at admission were methicillin-resistant versus 37 (69.81%) at discharge. Of the variables studied, hospital stay remained the only variable significantly (p=0.0080) associated with colonization by methicillin-resistant Staphylococcus.Conclusion: This work must be considered as an alarm bell regarding the role of health structures in the colonization and spread of multi-resistant bacteria in Ndé division. As a result, further investigations aimed at investigating the factors favouring this phenomenon should be carried out with an approach similar to that of the ONE HEALTH concept. Pending these investigations, we recommend strict compliance with hygiene rules, personalized antibiotic therapy (performing antibiotic susceptibility tests) and an updated antibiotic prophylaxis and probabilistic antibiotic therapy according to the studies carried out in the locality.