Abstract

Introduction: Multidrug resistance bacteria (MDR) are becoming one of the major public health problem and especially in cancer patients. The principal MDR are: Escherichia coli and Klebsiella pneumoniae producing bêtalactamases, Acinetobacter baumannii and Pseudomonas aeruginosa resistant to imipénème. The aim of this study is to determine the influence of cancer in MDR acquire infection.

Methods: This was a case-control study performed in four large reference hospitals of the Centre Region in Yaoundé (GHY, UTHY, NSIFHY and GOPHY). Any cancer patient with anatomopathological confirmation and without other immunocompromize state was considered as cases, and his carer as control.

Results: The study involved 173 participants, 61, 11% was women and the most prevalent cancer was breast cancer (27,77%), the mean of age was 42,01. The MDR prevalence was 70% globally but 2,44% for Shigella sonnei (n=1); 14, 66% for Klebsiella pneumoniae (n=6); 9, 76% for Klebsiella oxcytoca (n=4); 60, 98% for Escherichia coli (n=25); 2,44% for Enterobacter cloacae (n=1); 2,44% for Citrobacter koseri (n=1); 4, 88% for Citrobacter freundii (n=2); 2,44% for Acinetobacter baumanii (n=1) for a P-value of 0,32 (>0,05) and 33,33% for Staphylococcus Aureus (n=1) for a P-value of 1 (>0,05) concerning cases whereas 44,58% globally but 3,13% for Citrobacter freundii (n=1); 6, 25% for Enterobacter agglomerans (n=2); 6,25% for Enterobacter cloacae (n=2); 50,00% for Escherichia coli (n=16); 6,25% for Klebsiella oxcytoca (n=2); 15,63% for Klebsiella pneumoniae (n=5); 3,13% for Pseudomonas pituda (n=1); 3,13% for Shigella flexneri (n=1); 6,25% for Shigella sonnei (n=2) for a P-value of 0,18 (>0,05) and 50% for Lactobacillus sp. (n=2) for a P-value of 1 (>0,05) concerning control. The risk of MDR acquire infection is 2 times smaller in case than control concerning Enterobacteria (RR=0,5), 10 times smaller in case than control concerning Staphylocoque (RR=0,1) et environ 3 times smaller in case than control concerning Lactobacilles (RR=0,4).

Conclusion: the difference between prevalence of MDR Enterobacteria in the two group is significative (p=0,0005<0,05) and not significative for Staphylocoque (p=0,10>0,05) and Lactobacilles (p=0,10>0,05).  Nevertheless, creation of antibiotics committee, the follow-up of MDR, the correct utilization of antibiotic and the improvement of control measure, especially in patients with comorbidity, are necessary to reduce the incidence of those germs.

CHAPTER ONE

INTRODUCTION

Bacteria resistance is the ability for every bacterium to grow in the presence of a concentration of antibiotics which previously inhibit the growth of the bacterium or bacteria of the same species (Goossens et al., 2006).

Bacteria are then said to be multiresistant when they are resistant to at least three antibiotics belonging to three different families (Martinez, 2009). Antibiotic resistance is one of the biggest threats to global health, food security, and development today (WHO, 2016).

Antimicrobial resistance increases the costs of health care with lengthen stays in hospitals and more intensive care required (WHO, 2016). As demonstrated in 2014 in a report sheet of world health organization, there is an increase level of infection to methicillin resistant Staphylococcus Aureus (90% of total cases), E. Coli and K. pneumoniae to thrid generation cephalosporin and fluoroquinolon.

Kouassi-M’bengue et al., report in 2004 on a study carry in abidjan under the topic neonatal urinary tract infecton, a resistance vis-à-vis to aminopenicylin associate with clavulanic acid of 25 % for E. coli whether 85.7 % for Klebsiella pneumoniae on the one hand and resistance of Staphylococcus Aureus to meticillin (38%) and to ciprofloxacin (68%), and of Streptococcus to erythromycin (25%) in the other hand.

In Cameroon, the rescent researches shows that E coli, Klebsiella spp., Enterobacter spp., (Nko’o et al., 2013; Njall et al., 2013; Marbou et Kuete, 2016), Enterococcus faecium (57,1% resistant to vancomycin) and Enterococcus faecalis (41% to vancomycin) (Kamga et al., 2015), are in expansion of infection and multiresistance.

Without effective antibiotics, the success of major surgery and cancer chemotherapy would be compromised (WHO, 2018). A dramatic evolution has recently occurred in the significance of infections caused by gram-negative bacteria (Safdar et Armstrong, 2011). Decades of progress in the care of patients with cancer, concomitant to the development of safe and effective antimicrobials, are being undermined (Safdar et Armstrong, 2011).

Patients with cancer, remain exquisitely vulnerable to infection with gram-negative bacteria as a result of neutropenia, lymphocyte dysfunction, mucositis, and the use of invasive devices (Safdar et Armstrong, 2011).

At the same time, the effectiveness of our current prophylactic and empiric antibiotic regimens is compromised by the emergence of gram-negative bacteria that exhibit multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) phenotypes (Magiorakos et al., 2012).

Regarding the immune suppression of cancers patients, a marker that correlates with stage of evolution of cancer is the decrease in the circulating B lymphocytes and CD4+/CD8+ ratio that clearly indicates a worse prognosis of the disease (Neagu et al., 2013).

Since Patients with cancer are at high risk for infections caused by antibiotic resistant gram-negative bacteria (Perez et al., 2014), this study would give us an idea under the problem of multidrug resistance bacterial infection in cancer patients in the centre region of Cameroon, and will contribute to improve the follow-up of these patients.

To put in place our study we choose the hypothesis that cancer suffering patients of the center region of Cameroon are prone to infection with multidrug resistance bacteria than non cancer patients. In other to obtain our data concerning multidrug resistance bacteria on such patients, our main objectives were to:

1. Determine the distribution of isolated bacteria among cancer patients;
2. Determine the resistance and multidrug résistance of isolated bacteria vis-à-vis to antibiotics.