Antimicrobial resistance from a one health perspective in Cameroon: a systematic review and meta-analysis.

BACKGROUND: Antimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet in many parts of the world its magnitude is not well elucidated. A baseline assessment of the AMR prevalence is a priority for implementation of laboratory-based AMR surveillance This review, focused on a One health approach, aimed at describing the current status of AMR in Cameroon. METHODS: PubMed, Google Scholar and African Journals Online databases were searched for articles published in English and French in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search string with strict inclusion/exclusion criteria. Free-text and grey literature were obtained by contacting the authors directly. The pooled prevalence and 95% confidence intervals were calculated for each pathogen-antibiotic pairs using random-effects models. RESULT: Amongst 97 full-text articles reviewed, 66 met the eligibility criteria. The studies originated from the Centre (24; 36.4%), South-West (16; 24.2%), West (13; 19.7%), Littoral (9; 13.6%) and other (4; 6.1%) regions of Cameroon. These studies reported AMR in human (45; 68.2%), animals (9; 13.6%) and the environment (12; 18.2%). Overall, 19 species of bacteria were tested against 48 antibiotics. These organisms were resistant to all classes of antibiotics and showed high levels of multidrug resistance. Escherichia coli, Klebsiella pneumoniae and Staphylococcus spp were reported in 23, 19 and 18 of the human studies and revealed multidrug resistance (MDR) rates of 47.1% [95% CI (37.3-57.2%)], 51.0% [95% CI (42.0-59.9)] and 45.2% [95% CI (38.0-54.7)], respectively. Salmonella spp was reported in 6 of the animal studies and showed a MDR rate of 46.2% [95% CI (39.2-53.5%)] while Staphylococcus spp in 8 of environment studies showed MDR rate of 67.1% [95% CI (55.2-77.2%)]. CONCLUSION: This review shows that resistance to commonly prescribed antibiotics in Cameroon is high. The findings emphasize the urgent need to address gaps in the standardization of AMR diagnostics, reporting and use of available information to optimize treatment guidelines for the arsenal of antibiotics. Effective AMR surveillance through continued data sharing, large-scale collaboration, and coordination of all stakeholders is essential to understand and manage the AMR national burden.

Antibiotic Residues in Foods of Animal Origin in Cameroon: Prevalence, Consumers' Risk Perceptions, and attitudes.

The use of antibiotics in food animals and the nonobservance of the withdrawal period might result in the accumulation and persistence of residues in foods. The contamination of foods by antibiotic residues might induce health risks including allergy, gastrointestinal dysbiosis, antimicrobial resistance, and cancer to consumers. Therefore, this study was initiated to investigate the presence of antibiotic residues in raw eggs, raw milk, and beef collected at the wholesale and retail points in the three major cities of Cameroon and consumers' perceptions of the risk of antibiotic residues in foods. Qualitative antibiotic residue kits (PremiTest® and Delvotest®) were used to screen 407 samples of foods collected in markets of three towns (Ngaoundéré, Yaoundé, and Douala) in Cameroon. A structured questionnaire was used to evaluate the knowledge and attitudes of 1462 consumers toward microbial drug residues in foods of animal origin. Prevalence of residues of 70.55%, 17.39%, and 69.63% for beef, eggs, and milk, respectively, was observed. More than 1/3 of the respondents believed that the consumption of contaminated foods with antibiotic residues is a risk to their health and thought that allergies and intoxication they often experience are related to the consumption of contaminated foods. Most of them showed their willingness to pay more to acquire quality foods, free from antibiotic residues.

Associations between antimicrobial use and antimicrobial resistance of Escherichia coli isolated from poultry litter under field conditions in Cameroon.

Lack of hygiene and biosecurity measures in poultry farms has influence on the emergence of pathogens and antimicrobial use. Antimicrobial residues in poultry meat and their excretion by poultry can exert a selective pressure and the occurrence of multidrug resistant bacteria in litter. The objective of this study was to investigate the relationship between antimicrobial use and antimicrobial resistance using Escherichia coli as indicator isolated from poultry litter. From January to August, 2019, antimicrobial use was measured in 47 broiler farms based on daily dose (TIUDD) and animal daily dose (TIADD) methods. Antimicrobial susceptibility testing was performed on Escherichia coli isolated from poultry litter using the disk diffusion method. Overall, an average of 143.8 mg (ranging from 0.5 to 2061.79 mg/kg) of antimicrobials was used per kg of chicken produced, and treatment incidences of 69.7 daily doses per 1,000 broilers (44.44-106.35) and 87.3 daily doses per 1,000 broilers (1.74-376.43) were obtained for TIUDD and TIADD, respectively. After a susceptibility testing, 18 E. coli strains were resistant with a prevalence of 56.3% [95% CI: 39.1-73.5]. High levels of resistance were observed with doxycycline, ampicillin and norfloxacin which were observed to be mostly overdosed in farms. The high resistance of E. coli to ciprofloxacin (4/32: 13%), imipenem (6/32: 19%), levofloxacin (12/32: 38%) and ceftriaxone (22/32: 69%) which are second line treatment in hospital settings in Cameroon, and classified as Watch group by WHO, was associated to high AMR risk for public health in Cameroon. Intensification of health and educational sensitisation of farmers is essential to reduce widespread antimicrobial use in poultry farms and its impact public health.

Prescription Pattern of Antimicrobial Use in Small Animal Veterinary Practice in Cameroon.

Retrospective data on antimicrobial use (AMU) within the period ranging from January 2012-December 2015 was collected to assess the antimicrobial prescription patterns in pets (cats and dogs) treated by 16 veterinary private practitioners in the 2 main urban cities of Cameroon (Douala and Yaounde). The vet practitioners were interviewed in order to analyze prescribing behavior and factors influencing antimicrobial prescription. Out of a total of 3928 antimicrobial prescriptions, 3673(93.5%) were recorded in dogs and 255 (6.5%) in cats during the study period in 7 veterinary clinics. The most prescribed antimicrobials were sulfamethoxypyridazine-trimethoprim (dog: 31.2%; cat: 28.6%), benzylpenicillin-streptomycin (dogs:19.0%; cat:21.9%) and marbofloxacin (dogs:18.3%; cats:16.1%). Almost, 64.6% of antimicrobial prescription in dogs was categorized as highly important antimicrobials and 34.9% as critically important antimicrobial agents. In cats, 77.9% of antimicrobial prescription was categorized as highly important antimicrobials and 22.1% as critically important antimicrobial agents. Antimicrobials were mostly used for gastro-intestinal disorders (31.9%) and skin diseases (24. 1%) in dogs while they were mostly applied for surgical problems (29.8%), musculo-skeletal disease (20.4%) and gastro-intestinal tract diseases (19.6%) in cats. Fluoroquinolones were administered as first option instead of third option. Antimicrobials were associated with other veterinary drugs (anti-inflammatory, internal and external parasite therapy) in 75.3% of cases. The prescription of antimicrobials was based on clinical diagnosis (symptom-based), ease of drug administration, owner's purchasing power and antibiogram. This study highlights the necessity to promote antimicrobial stewardship in pet medicine in Cameroon. Confirmatory diagnosis and antibiotic susceptibility testing before antibiotic prescription should be encouraged. The uncontrolled use of critically important antimicrobials for human medicine and especially their indiscriminate use may favor the occurrence of AMR public health issues.

Poultry Litter Contamination by Escherichia coli Resistant to Critically Important Antimicrobials for Human and Animal Use and Risk for Public Health in Cameroon.

Residues of antimicrobials used in farm can exert selective pressure and accelerate the occurrence of multidrug resistant bacteria in litter. This study aimed to investigate the resistance profile of Escherichia coli isolated from poultry litter. A total of 101 E. coli strains was isolated from 229 litter samples collected and stored for two months in the laboratory at room temperature. Antimicrobial susceptibility testing was performed using the disk diffusion method. An overall resistance prevalence of 58.4% (95% CI: 48.8-68.0) was obtained with 59 E. coli strains resistant to various antimicrobial agents. High levels of resistance were observed with ciprofloxacin (21/59: 36%), imipenem (27/59: 45%), norfloxacin (44/59: 74%), ceftriaxone (44/59: 74%), and levofloxacin (44/59: 75%). These antimicrobials classified under the Watch group by WHO are indicators of the high AMR risk to public health in Cameroon. Multivariable logistic regression analysis revealed that a greater probability of high level of E. coli multidrug resistance was associated with lack of training in poultry farming (OR = 0.13, p = 0.01), less experience in poultry farming (OR = 11.66 p = 0.04), and the high frequency of digestive tract disease (OR = 0.10; p = 0.001). This study revealed that poultry litter constitutes a potential source of dissemination of resistant germs from farm animals to the environment and humans.

Knowledge, attitudes, practices and risk perception of rural poultry farmers in Cameroon to antimicrobial use and resistance.

There is wide use of antimicrobial products in rural poultry farms in most sub-Sahara African countries. However, little is known of the factors that motivate rural poultry farmers towards antimicrobial use (AMU) and their level of awareness about antimicrobial resistance (AMR). This cross sectional survey was conducted to investigate the knowledge, attitudes, practices, perception of poultry farmers in Cameroon about AMU and risk of AMR (KAPP) (n = 358). The data collection was conducted using questionnaires administered through face-to-face interview and the responses were recoded into binary scale. The sum of sufficient responses provided by each participant divided by the total number of items within the category gave a percentage of correct answers. One-way ANOVA was used to assess significant differences of mean KAPP scores across regions. Pearson correlations were used to calculate the association between KAPP scores across and within regions, while the linear regression was done to explore the relationship between demographics and farmer's dynamic characteristics. Overall, surveyed poultry farmers showed low mean score knowledge of AMU (0.30 ±â€¯0.24) and AMR (0.26 ±â€¯0.22), desirable attitude (0.29 ±â€¯0.29), appropriate practice (0.58 ±â€¯0.18) towards AMU and positive risk perception of AMR (0.37 ±â€¯0.21). Digestive tract infections and chronic respiratory diseases were the most common reasons for antimicrobial use and for preventive purposes. Gender, experience in poultry farming and stocking density were negatively associated with practice of antimicrobial use. Inappropriate combination of antimicrobials with diuretics or tetracyclines and minerals for treatment purposes were frequently observed. The findings revealed strong positive association between educational level and KAPP score and between biosecurity measures and AMU and risk perception of AMR. Thus, continuous education of rural poultry farmers on husbandry norms, drug use and microbial resistance in animal farms will enhance their knowledge and risk perception on AMU as well as enable them adopt suitable attitude and practices to control animal and human health hazards due to AMR.

Challenges of antimicrobial consumption surveillance in food-producing animals in sub-Saharan African countries: Patterns of antimicrobials imported in Cameroon from 2014 to 2019.

OBJECTIVE: Antimicrobial consumption surveillance is a useful tool for planning antimicrobial resistance control strategies and risk analysis. The present study was carried out to evaluate the consumption trends of antimicrobials for veterinary use in food-producing animals in Cameroon from 2014 to 2019. METHODS: Data on quantities of classes of active substances were collected from the records of the technical authorization to import veterinary drugs of suppliers' invoices at the Ministry of Livestock (MINEPIA); animal population data were collected from the FAO-Stat database. RESULTS: The study revealed that 217.67tonnes of antimicrobials (by weight of active substance) were imported during the 6-year period, with an average of 36.28±10.11tonnes per year. Tetracyclines (31.71%), sulfonamides (23.84%), quinolones (11.11%) and ß-lactams (10.17%) were the most commonly imported classes of antimicrobials. With regard to the importance of veterinary antimicrobials to human medicine, critically important antimicrobial (34.3%), reserve (4.6%) and watch (25.5%) groups as classified by the WHO AWaRe categorization were recorded. Overall, a mean of 5.24±1.40mg/PCU (population correction unit) was used in all food-producing animals during the 6-year period. However, the mean quantity of antimicrobials adjusted by animal biomass was highest in poultry (213.32±50.26mg/kg), followed by pigs (63.04±18.87mg/kg), cattle (4.11±2.20mg/kg), sheep (0.83±0.43mg/kg) and goats (0.47±0.24mg/kg). CONCLUSION: Strict surveillance systems of antimicrobial consumption in the country are vital to optimize control strategies. Monitoring importation data of veterinary antimicrobial products could be useful for sub-Saharan African countries to quantify consumption and estimate trends for antimicrobial usage effectively.