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In this article, the author name Antoinette Ngandjio was incorrectly written as Antoinette Ngandijo. In this article, the affiliation details for Author Sara Cuadros-Orellana were incorrectly given as ‘Centro de Biotecnologνa de los Recursos Naturales, Facultad de Ciencias Agrarias y Forestales, Talca, Chile’ but should have been ‘Universidad Catolica del Maule, Centro de Biotecnología de los Recursos Naturales, Facultad de Ciencias Agrarias y Forestales, Talca, Chile’. The original article has been corrected.

Introduction. Antimicrobial resistance represents a growing public health threat. One of the World Health Organization’s strategic objectives is “strengthening knowledge through surveillance and research.” Sub-Saharan African countries are still far from achieving this objective. We aimed to estimate and compare the prevalence of antibacterial resistance in 2010 and 2017 in Cameroon. Methods. We conducted a retrospective study on all clinical specimens cultured in Centre Pasteur du Cameroun (CPC) in 2010 and 2017. Data were extracted from the CPC’s laboratory data information system software and then managed and analyzed using R. Bacterial resistance rates were calculated in each year and compared using chi-square or Fisher’s tests, and relative changes were calculated. Outcomes included acquired resistance (AR), WHO priority resistant pathogens, some specific resistances of clinical interest, and resistance patterns (multi, extensively, and pan drug resistances) for five selected pathogens. Results. A total of 10,218 isolates were analyzed. The overall AR rate was 96.0% (95% CI: 95.4–96.6). Most of WHO priority bacterial resistance rates increased from 2010 to 2017. The most marked increases expressed as relative changes concerned imipenem-resistant Acinetobacter (6.2% vs. 21.6%, +248.4%, p = 0.02 ), imipenem-resistant Pseudomonas aeruginosa (13.5% vs. 23.5%, +74.1%, p < 0.01 ), 3rd generation-resistant Enterobacteriaceae (23.8% vs. 40.4%, +65.8%, p < 10 − 15 ), methicillin-resistant Staphylococcus aureus (27.3% vs. 46.0%, +68.6%, p < 0.002 ), fluoroquinolone-resistant Salmonella (3.9% vs. 9.5%, +142.9%, p = 0.03 ), and fluoroquinolone-resistant Enterobacteriaceae (32.6% vs. 54.0%, +65.8%, p < 10 − 15 ). For selected pathogens, global multidrug resistance was high in 2010 and 2017 (74.9% vs. 78.0% +4.1%, p = 0.01 ), intensively drug resistance rate was 5.8% (7.0% vs. 4.7%; p = 0.07 ), and no pan drug resistance has been identified. Conclusion. Bacterial resistance to antibiotics of clinical relevance in Cameroon was high and appeared to increase between 2010 and 2017. There is a need for regular surveillance of antibacterial resistance to inform public health strategies and empirically inform prescription practices.

Wave upon wave of diseaseThe cholera pathogen,Vibrio cholerae, is considered to be ubiquitous in water systems, making the design of eradication measures apparently fruitless. Nevertheless, local and globalVibriopopulations remain distinct. Now, Weillet al.and Dommanet al.show that a surprising diversity between continents has been established. Latin America and Africa bear different variants of cholera toxin with different transmission dynamics and ecological niches. The data are not consistent with the establishment of long-term reservoirs of pandemic cholera or with a relationship to climate events.Science, this issue p.785, p.789

In this study, antibiotic resistance class 3 integrons in Gram-negative bacteria isolated from hospital sewage and sludge and their genetic contents were characterised. Two samples of hospital effluent from France and Luxembourg and one sample of sludge from a wastewater treatment plant in France were collected in 2010 and 2011. Bacteria were cultured on selective agar plates and integrons were detected in colonies by quantitative PCR. Integron gene cassette arrays and their genetic environments were analysed by next-generation sequencing. Three class 3 integron-positive isolates were detected, including Acinetobacter johnsonii LIM75 (French hospital effluent), Aeromonas allosaccharophila LIM82 (sludge) and Citrobacter freundii LIM86 (Luxembourg hospital effluent). The gene cassettes were all implicated in antibiotic (aminoglycoside and β-lactam) or antiseptic resistance. An oxacillinase gene cassette (blaOXA-10, blaOXA-368 or blaOXA-2) was found in each integron. All of the class 3 integrons were located on small mobilisable plasmids. This study highlights the role of class 3 integrons in the dissemination of clinically relevant antibiotic resistance genes, notably oxacillinase genes, in hospital effluent.

To the Editor: In HIV-infected persons in Cameroon (Central Africa), histoplasmosis is still misdiagnosed as tuberculosis because of clinical similarities (1,2). These patients are automatically given presumptive antituberculous therapy, although tuberculosis is not confirmed. The patients subsequently die of probable disseminated histoplasmosis (DH), and the fungal infection might finally be detected in postmortem tissue samples (3). In this context, 3 cases of DH were detected in HIV-infected patients within a 1-year period (2007–2008) in Yaounde, Cameroon. We initiated this study to investigate the occurrence of histoplasmosis in HIV-infected patients in 4 medical centers for AIDS treatment in Yaounde from December 2008 through December 2011.

Salmonella is one of the most common foodborne pathogens worldwide and chicken has been recognized as its main reservoir for human. The aim of this study was to investigate the occurrence of antimicrobial resistance genes in Salmonella isolates from chicken and human, and evaluate their genetic relationship. A total of 200 Salmonella strains (103 from Chicken and 97 from humans) were collected from 2006 to 2007 in Yaounde, and characterized for their antimicrobial susceptibility to a panel of 16 antimicrobials. Presence of antimicrobial resistance genes, class1 and class 2 integrons was investigated by PCR in Multidrug Resistant (MDR) isolates. Pulsed-Field Gel Electrophoresis (PFGE) analysis was used to investigate their genetic relatedness. Only serotypes Enteritidis, Hadar, Bareilly and II were recovered from both chicken and human. Overall, 16 isolates (8%) were susceptible to all antimicrobials including third generation cephalosporins and fluoroquinolons. Resistance was mostly observed to tetracycline (57%) in chicken isolates and to sulfonamides (78.3%) in human isolates. 78 (15.3%) strains were MDR. Class 1 integron was predominant in MDR Hadar and Typhimurium isolates. TEM-1 was the unique Extended Spectrum β-lactamase (ESBL) detected in the β-lactam resistant Typhimurium strain isolated from human. No qnr genes were identified in nalidixic acid resistant isolates. PFGE typing of Enteritidis isolates using XbaI restriction enzyme showed close genetic relationship between chicken and human isolates. For Hadar and Typhimurirum, variety of restriction patterns was observed. These results highlight the need for continuous surveillance of antimicrobial resistance in Salmonella isolates in Cameroon.

The prevalence of reported cholera was relatively low around the Lake Chad basin until 1991. Since then, cholera outbreaks have been reported every couple of years. The objective of this study was to investigate the 2010/2011 Vibrio cholerae outbreak in Cameroon to gain insight into the genomic make-up of the V. cholerae strains responsible for the outbreak. Twenty-four strains were isolated and whole genome sequenced. Known virulence genes, resistance genes and integrating conjugative element (ICE) elements were identified and annotated. A global phylogeny (378 genomes) was inferred using a single nucleotide polymorphism (SNP) analysis. The Cameroon outbreak was found to be clonal and clustered distant from the other African strains. In addition, a subset of the strains contained a deletion that was found in the ICE element causing less resistance. These results suggest that V. cholerae is endemic in the Lake Chad basin and different from other African strains.

From February 2006 to January 2007, 150 chickens were collected from eight retail markets in Yaounde, and 90 (60%) tested positive for Salmonella. Seventy-nine chickens were contaminated with only one Salmonella serotype, 10 with two different serotypes, and 1 with four serotypes. The most prevalent serotypes were Enteritidis (47 strains) and Hadar (29 strains). The isolates were tested for their susceptibilities to amoxicillin, amoxicillin/clavulanic acid, cefoxitin, cefotaxime, gentamicin, streptomycin, tetracycline, chloramphenicol, sulfonamides, nalidixic acid, ciprofloxacin, and trimethoprim/sulfamethazole by disk diffusion assay. Minimum inhibitory concentrations of ampicillin, streptomycin, tetracycline, sulfonamides, and nalidixic acid were determined for the resistant strains by agar dilution method. Eleven isolates (10.7%) of the 103 tested were susceptible to all antimicrobials. Resistance was most observed to tetracycline (84.5%), streptomycin (44.7%), and nalidixic acid (34%). Forty-one isolates (39.8%) were multidrug resistant (resistant to three or more antimicrobials from different classes), of which 68.3% were Hadar and 21.9% Enteritidis. The most frequent resistant pattern in Hadar was streptomycin-tetracycline-nalidixic acid. These results highlight once more the need for surveillance of Salmonella contamination in poultry.

International audience; We identified 3 lineages among multidrug-resistant (MDR) Salmonella enterica serotype Typhi isolates in the Gulf of Guinea region in Africa during the 2000s. However, the MDR H58 haplotype, which predominates in southern Asia and Kenya, was not identified. MDR quinolone-susceptible isolates contained a 190-kb incHI1 pST2 plasmid or a 50-kb incN pST3 plasmid.

Eighteen reference strains of Chlamydia trachomatis were differentiated by omp1 PCR- and nested PCR-based RFLP analysis, using two restriction digestions, one with AluI and the other with the three enzymes HpaII, EcoRI and HinfI. AluI digestion allowed the differentiation of 12 different profiles after CT1/CT5 PCR and 13 different profiles after the nested PCR. The triple hydrolysis permitted the identification of 15 different patterns. In all, 16/18 reference strains were clearly identified. These reference patterns were successfully used to genotype 34 of 35 (28 strains and 7 clinical specimens) samples from infected students, collected during a screening programme in Yaounde (Cameroon). Genotypes D, Da, E, F, G and J were found. The most prevalent omp1 genotype was E (n = 14; 40 %), followed by F (n = 7; 20 %). As RFLP patterns of reference strains are essential for typing clinical isolates, they will greatly facilitate C. trachomatis characterization in many resource-limited laboratories.

International audience; The molecular epidemiology of third-generation cephalosporin-resistant (3GC-R) Klebsiella pneumoniae in developing countries is poorly documented. From February 2007 to March 2008, we collected 135 3GC-R K. pneumoniae isolates from seven major towns in Maghreb (Morocco), West Africa (Senegal, Côte d'Ivoire), Central Africa (Cameroon), East Africa (Madagascar) and Southeast Asia (Vietnam). Their genetic diversity, assessed by multilocus sequence typing, was high (60 sequence types), reflecting multiclonality. However, two major clonal groups, CG15 (n = 23, 17% of isolates) and CG258 (n = 18, 13%), were detected in almost all participating centres. The two major clonal groups have previously been described in other parts of the world, indicating their global spread. The high diversity of enterobacterial repetitive intergenic consensus sequence-PCR banding patterns at the local level indicates that most isolates were epidemiologically unrelated. The isolates were characterized by the presence of multiple resistance determinants, most notably the concomitant presence of the aac(6')-Ib-cr, qnr and bla(CTX-M-15) genes in 61 isolates (45%) belonging to 31 sequence types. These isolates were detected across a large geographical area including Cameroon (n = 1), Vietnam (n = 4), Madagascar (n = 10), Côte d'Ivoire (n = 12), Morocco (n = 13) and Senegal (n = 21). These results have major implications for patient management and highlight a potential reservoir for resistance determinants.

The prevalence of Chlamydia trachomatis infection was 3.78% out of 1,277 volunteer students screened by direct fluorescence assay and Cobas Amplicor PCR. The infection was associated with the nonuse or inconsistent use of condoms in women ( P = 0.026) and a previous sexually transmitted infection in men ( P = 0.023). The most frequent genotypes determined by sequencing the omp1 genes of 25 clinical isolates were E (44%) and F (20%), and some strains harbored mutations, but E genotype strains did not.

The seventh cholera pandemic has heavily affected Africa, although the origin and continental spread of the disease remain undefined. We used genomic data from 1070 Vibrio cholerae O1 isolates, across 45 African countries and over a 49-year period, to show that past epidemics were attributable to a single expanded lineage. This lineage was introduced at least 11 times since 1970, into two main regions, West Africa and East/Southern Africa, causing epidemics that lasted up to 28 years. The last five introductions into Africa, all from Asia, involved multidrug-resistant sublineages that replaced antibiotic-susceptible sublineages after 2000. This phylogenetic framework describes the periodicity of lineage introduction and the stable routes of cholera spread, which should inform the rational design of control measures for cholera in Africa.

Integrons are bacterial genetic elements able to capture and express genes embedded within gene cassettes. They are widely described among Gram-negative bacteria and generally confer a multidrug resistance phenotype. Resistance integrons (RI) play an important role in the acquisition of antibiotic resistance. There are 3 main classes of RI. Class 3 RI has been poorly studied class with less than ten fully IR3 characterized. Objectives of this thesis were (i) to conduct an epidemiological study of class 3 RI in France and Cameroon and (ii) to better understand the modes of expression of the integrase and cassettes of IR3. We described 3 new class 3 RI isolated from environmental bacteria belonging to genus Aeromonas, Acinetobacter and Citrobacter. Gene cassettes encoded resistance to betalactams, aminoglycosides and quaternary ammonium compounds. We also described IR3 from three Delftia strains (2 D.acidovorans and 1 D.tsuruhatensis) in Africa containing cassettes that do not encode antibiotic resistance. The fundamental part of the work showed that the PintI3(1) promoter is involved in the expression of the intI3 gene. Furthermore, we demonstrated that variants of the Pc promoter and variants of the PintI3(1) promoter are functional with different strengths. These results showed that the environment may constitute a reservoir of class 3 integrons and that these genetic elements could play an important role in the spread of the resistance in this ecosystem.; Les intégrons sont des supports génétiques bactériens de capture, d’expression et de dissémination de gènes de résistance aux antibiotiques sous forme de cassettes. Ils sont majoritairement décrits chez les bactéries à Gram négatif chez qui ils confèrent généralement un phénotype de multirésistance. Les intégrons de résistance (IR) jouent un rôle majeur dans l’acquisition de la résistance dans le monde bactérien. Il existe 3 principales classes d’IR ; les IR de classe 1, les IR de classe 2 et les IR de classe 3 (IR3). Contrairement aux 2 premières classes, les IR3 représentent la classe d’intégrons de résistance la moins étudiée. Très peu de travaux s’intéressent à leur étude et on dénombre actuellement moins de 10 IR3 entièrement caractérisés. Les objectifs de ce travail de thèse étaient (i) d’effectuer une étude épidémiologique des IR3 en France et au Cameroun et (ii) d’étudier les modalités d’expression de l’intégrase et des cassettes de ces intégrons. Nos travaux ont permis d’isoler puis de décrire 3 nouveaux IR3 présents au sein de bactéries environnementales appartenant aux genres Aeromonas, Acinetobacter et Citrobacter. Les cassettes de ces IR3 codent des résistances aux bétalactamines, aminosides et ammoniums quaternaires. De plus, nous avons caractérisé des IR3 dans 3 souches de Delftia spp. (2 D.acidovorans et 1 D. tsuruhatensis) isolées en Afrique ; les cassettes de ces intégrons ne codent pas de résistance aux antibiotiques. L’axe plus fondamental de ce travail de thèse a permis de montrer que le PintI3(1) est le promoteur impliqué dans l’expression du gène intI3. De plus, nous avons montré que les variants du promoteur Pc, ainsi que les variants du promoteur PintI3(1) sont fonctionnels et de force différente. Il ressort de nos travaux que l’environnement constituerait un réservoir d’intégrons de classe 3 et que ces supports génétiques pourraient jouer un rôle important dans la dissémination de la résistance au sein de cet écosystème.

Integrons are bacterial genetic elements able to capture and express genes embedded within gene cassettes. They are widely described among Gram-negative bacteria and generally confer a multidrug resistance phenotype. Resistance integrons (RI) play an important role in the acquisition of antibiotic resistance. There are 3 main classes of RI. Class 3 RI has been poorly studied class with less than ten fully IR3 characterized. Objectives of this thesis were (i) to conduct an epidemiological study of class 3 RI in France and Cameroon and (ii) to better understand the modes of expression of the integrase and cassettes of IR3. We described 3 new class 3 RI isolated from environmental bacteria belonging to genus Aeromonas, Acinetobacter and Citrobacter. Gene cassettes encoded resistance to betalactams, aminoglycosides and quaternary ammonium compounds. We also described IR3 from three Delftia strains (2 D.acidovorans and 1 D.tsuruhatensis) in Africa containing cassettes that do not encode antibiotic resistance. The fundamental part of the work showed that the PintI3(1) promoter is involved in the expression of the intI3 gene. Furthermore, we demonstrated that variants of the Pc promoter and variants of the PintI3(1) promoter are functional with different strengths. These results showed that the environment may constitute a reservoir of class 3 integrons and that these genetic elements could play an important role in the spread of the resistance in this ecosystem., Les intégrons sont des supports génétiques bactériens de capture, d’expression et de dissémination de gènes de résistance aux antibiotiques sous forme de cassettes. Ils sont majoritairement décrits chez les bactéries à Gram négatif chez qui ils confèrent généralement un phénotype de multirésistance. Les intégrons de résistance (IR) jouent un rôle majeur dans l’acquisition de la résistance dans le monde bactérien. Il existe 3 principales classes d’IR ; les IR de classe 1, les IR de classe 2 et les IR de classe 3 (IR3). Contrairement aux 2 premières classes, les IR3 représentent la classe d’intégrons de résistance la moins étudiée. Très peu de travaux s’intéressent à leur étude et on dénombre actuellement moins de 10 IR3 entièrement caractérisés. Les objectifs de ce travail de thèse étaient (i) d’effectuer une étude épidémiologique des IR3 en France et au Cameroun et (ii) d’étudier les modalités d’expression de l’intégrase et des cassettes de ces intégrons. Nos travaux ont permis d’isoler puis de décrire 3 nouveaux IR3 présents au sein de bactéries environnementales appartenant aux genres Aeromonas, Acinetobacter et Citrobacter. Les cassettes de ces IR3 codent des résistances aux bétalactamines, aminosides et ammoniums quaternaires. De plus, nous avons caractérisé des IR3 dans 3 souches de Delftia spp. (2 D.acidovorans et 1 D. tsuruhatensis) isolées en Afrique ; les cassettes de ces intégrons ne codent pas de résistance aux antibiotiques. L’axe plus fondamental de ce travail de thèse a permis de montrer que le PintI3(1) est le promoteur impliqué dans l’expression du gène intI3. De plus, nous avons montré que les variants du promoteur Pc, ainsi que les variants du promoteur PintI3(1) sont fonctionnels et de force différente. Il ressort de nos travaux que l’environnement constituerait un réservoir d’intégrons de classe 3 et que ces supports génétiques pourraient jouer un rôle important dans la dissémination de la résistance au sein de cet écosystème.