Prevalence and Associated Risk Factors of Fecal Carriage of Multidrug-resistant Enterobacteriaceae in a Community Setting in Touboro, Northern Cameroon

Abstract

Background: This study reports a high prevalence of intestinal carriage of multidrug-resistant Enterobacteriaceae (MDR-E) in the rural district of Touboro in Northern Cameroon. Methodology: A community-based cross-sectional study was conducted from May 29 to December 30, 2024. Fecal samples were collected and processed using standard microbiological methods for bacterial isolation and identification. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using R software, and a p < 0.05 was considered statistically significant. Bivariate analyses were performed to identify potential risk factors associated with MDR-E carriage. Results: Among the 470 fecal samples analyzed, 161 Enterobacteriaceae isolates were recovered. E. coli was the most prevalent species, accounting for 68.3% (110/161) of isolates, followed by E. cloacae (16.1%) and K. pneumoniae (15.5%). Of these, 83 isolates were identified as multidrug-resistant, corresponding to an overall MDR-E prevalence of 17.7% in the study population and 51.6% among the isolates. The MDR isolates exhibited extremely high resistance rates to ampicillin and cefixime (100% each). High resistance was also observed to other β-lactams, including ceftazidime (90.4%), ceftriaxone (89.2%), cefotaxime (80.7%), cefepime (86.7%), amoxicillin–clavulanic acid (83.1%), and cefoxitin (79.5%). Resistance to quinolones and fluoroquinolones was similarly high, particularly norfloxacin (84.3%), ciprofloxacin (83.1%), and nalidixic acid (79.5%). Lower resistance rates were observed for chloramphenicol (49.4%), aztreonam (55.4%), meropenem (45.8%), trimethoprim–sulfamethoxazole (48.2%), amikacin (68.7%), and nitrofurantoin (68.7%). Multiple antibiotic resistance (MAR) index analysis revealed that 35.0% of the isolates had a MAR index ≥ 0.6, indicating substantial antibiotic selection pressure. Bivariate analysis showed that male sex, marital status, Hospitalization (previous year), lack of recent antibiotic use, residence in livestock areas, and non-consumption of wild animals were significantly associated with MDR-E carriage. Conclusion: This study demonstrates a high burden of intestinal carriage of multidrug-resistant Enterobacteriaceae in a rural community of Northern Cameroon, reflecting intense antimicrobial pressure and potential community-level transmission. These findings underscore the urgent need for One Health oriented surveillance, rational antibiotic use, and targeted public health interventions to limit the spread of antimicrobial resistance in community settings.