Rising Bloodstream Infections and Antibiotic Resistance in Cameroon

Bloodstream Infections (BSI) occur when bacteria enter the bloodstream, often leading to serious health issues such as sepsis. Sepsis is a severe reaction to infection that can cause organ failure and can be fatal. The problem of BSI and sepsis is a significant health challenge around the world, causing a large number of illnesses and deaths each year. Vulnerable groups, including pregnant women, the elderly, newborns, and those with other health issues, are at greater risk.

In 2017, the World Health Organization (WHO) reported that sepsis was responsible for about 20% of all deaths globally, affecting nearly 49 million individuals and resulting in approximately 11 million deaths. Most of these cases, particularly in low- and middle-income countries, saw a disproportionate number of infections and deaths. Alarmingly, some studies suggest that 85% of sepsis cases occur in these regions, with high rates of hospital deaths linked to sepsis.

Common bacteria linked to BSIs include strains from the Enterobacterales family, like Escherichia coli and Klebsiella species, as well as gram-positive bacteria such as Staphylococcus aureus. These bacteria can cause significant infections that are hard to treat, especially when they develop resistance to antibiotics.

The misuse of antibiotics has contributed to a rise in Antibiotic Resistance (AMR). Resistance occurs when bacteria adapt to survive despite the presence of drugs that should kill them or inhibit their growth. The global increase in drug resistance is a major concern, with some predictions stating it could become the leading cause of death by 2050 if no action is taken to address it.

In Cameroon, there is limited information on the rates of BSIs and the levels of antibiotic resistance among the bacteria that cause these infections. While some studies have been conducted, there is a need to summarize this information to provide a clearer picture for healthcare efforts.

The goal of the recent review was to estimate how common bacterial bloodstream infections are in Cameroon and to assess the rates of antibiotic resistance within the country. To achieve this, researchers followed a systematic approach. They searched multiple databases for studies published between 2010 and December 2023, focusing on those that reported BSI cases in Cameroon.

The research team independently reviewed the studies to determine which ones met their criteria, gathering data on blood cultures, types of bacteria found, and their resistance rates. After screening, they included ten studies in their analysis.

From the studies reviewed, a total of 4223 blood cultures were taken, with 888 (about 21.79%) being positive for bacterial infections. The overall rate of bloodstream infections in Cameroon was found to be approximately 26.36%. This figure indicates a high prevalence compared to other studies in Africa and Asia, suggesting more people are affected by BSIs in Cameroon than previously thought.

Among the bacteria identified, the most common were from the Enterobacterales group. Specifically, Klebsiella species were responsible for about 28.20% of the cases, while Escherichia coli accounted for approximately 18.94%. Other notable bacteria included Staphylococcus aureus and Coagulase-negative Staphylococcus.

The study also highlighted significant resistance to common antibiotics. Both Escherichia coli and Klebsiella species showed high resistance to drugs like amoxicillin and third-generation cephalosporins. This suggests that many of the bacteria causing infections might produce enzymes that break down the effects of these drugs, making treatment difficult.

Staphylococcus aureus also demonstrated high resistance, particularly to penicillin and erythromycin. However, it showed lower resistance levels to certain antibiotics, indicating that some options remain for treatment. The findings suggest that healthcare providers in Cameroon may need to reconsider their antibiotic prescribing practices, especially when treating bloodstream infections.

The review emphasized the need for more comprehensive data on AMR in Cameroon, as the available studies often did not report on several important antibiotics. The limited geographical focus of the studies (with a concentration on just two cities) means the findings might not reflect the full situation across the country.

Overall, the review indicates a high prevalence of bloodstream infections in both children and adults in Cameroon, with Enterobacterales being the primary culprits. The levels of antibiotic resistance are concerning, especially for commonly used treatments. The study's results can guide healthcare professionals in making better-informed decisions about treatment and highlight the need for ongoing research.

In conclusion, the fight against bloodstream infections and antibiotic resistance is crucial for improving health outcomes in Cameroon. Increased awareness, better data collection, and strategic public health approaches can help manage these serious health issues more effectively. The health community must continue to build on existing knowledge to address the challenges posed by BSIs and AMR in the country.