Plasmid-mediated quinolone resistance among extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolated from hospitalized patients, hospital environment and wastewaters in Cameroon

Introduction Extended-spectrum β-lactamase-producing Escherichia coli (ESBL- Ec ) and Klebsiella pneumoniae (ESBL- Kp ) are among the leading cause of hospital-acquired infections globally. Fluoroquinolone-resistant ESBL- Ec and ESBL- Kp infections have limited therapeutic options. This study investigated the phenotypic and genotypic characteristics of plasmid-mediated quinolone resistance (PMQR) genes in ESBL- Ec and ESBL- Kp circulating among hospitalized patients, the hospital environment, and wastewaters in Cameroon. Method A cross-sectional study was conducted, from February to June 2024 in two healthcare facilities in Yaoundé, Cameroon. Clinical, inanimate surfaces and wastewater samples were collected. Bacteria identification was done using the API20E kit. The ESBL phenotype was detected using the double-disk synergy test and on CHROMagar™ ESBL. Antimicrobial susceptibility testing was performed using the disc diffusion method. Genes conferring resistance to β-lactams and fluoroquinolones were detected using polymerase chain reaction (PCR). Clonal relatedness was assessed using enterobacterial repetitive intergenic consensus (ERIC)-PCR. Results The overall ESBL prevalence across all sources was 16% (103/652). This ESBL prevalence was 10% (49/495) in hospitalized patients, 27% (38/141) in the hospital environment and 100% (16/16) in hospital wastewaters. Nearly all (99.5%) ESBL- Ec and ESBL- Kp were multidrug-resistant. The bla _CTX−M was the most prevalent β-lactamase gene with prevalence ranging from 74 to 85%. The main plasmid-mediated quinolone resistance gene was aac-(6’)-Ib with prevalence varying from 57 to 70%. The circulation of ESBL- Kp between both three interfaces as well as within and across the two healthcare facilities was evidenced. Conclusion Our results underscore the crucial need to implement real-time surveillance and monitoring antimicrobial resistance and implement antimicrobial stewardship programs to curb the circulating ESBL- Kp and ESBL- Ec responsible to neonatal sepsis in neonatology unit in healthcare facilities in Cameroon. Finally, genomic surveillance through the One Health approach is needed to fully understand the transmission dynamics of resistant bacteria in healthcare facilities in Cameroon.