{"paper_id":"40a1d827-2e45-4cbe-a86f-4b7e55febd63","body_text":"Clonal Dissemination of Extended-Spectrum Beta-Lactamase (ESBL)- producing Klebsiella pneumoniae isolated from Medical devices and Hospital environments in the West region, Cameroon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clonal Dissemination of Extended-Spectrum Beta-Lactamase (ESBL)- producing Klebsiella pneumoniae isolated from Medical devices and Hospital environments in the West region, Cameroon Therese Espoir Ngo Mbog, Raspail Carrel Founou, Luria Leslie Founou, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5006261/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hospital-acquired infections (HAIs) caused by antibiotic resistant Klebsiella pneumoniae are serious public health concern globally. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL- K. pneumoniae ) are major contributors to life-threatening HAIs especially in surgery and intensive care unit wards. Suboptimal hygiene measures and the non-existence of infection prevention control programs and policies contribute to the dissemination of ESBL- K. pneumoniae from the inanimate surfaces, medical devices, healthcare workers to hospitalized patients. This study aimed at determining the prevalence, genotypic characteristics and clonal relatedness of ESBL- K. pneumoniae isolated from surgical patients, medical devices and hospital environments at the Annex Regional Hospital of Dschang in the West region in Cameroon. Methods A cross-sectional study was conducted over a four-month period from February to May 2022. A total of 91 samples were collected from hospitalized patients (n = 46), medical equipments (n = 20) and hospital environments (n = 25). Samples were cultured on Eosin Methylene Blue agar. After culture and biochemical identification with API 20E, antibiotic susceptibility testing was carried out using disc diffusion method on Müller Hinton agar. ESBL phenotype was screening using ChromAgar™ ESBL (CHROMagar, Paris, France) coupled with double discs synergy test. In addition, the detection of resistance genes was done with Polymerase Chain Reaction (PCR) methods, while the clonal relatedness of isolates was performed using the Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR method. Results The prevalences of ESBL- K. pneumoniae isolated from surgical patients was 23.9% (11/46). Only two Klebsiella pneumoniae were isolated from medical equipment of which one isolate was ESBL producer with 5% (n = 01/20). The result of the hospital environment revealed 28% (07/25) were positive for ESBL- K. pneumoniae . High level of resistance (100%) to cefuroxime, amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime were observed. In addition, the resistance rates to gentamicin and meropenem were (89.4%) and (42.1%) respectively. The leading β-lactam resistance gene detected was bla CTX−M (65.6%) followed by bla TEM (43.7%) and bla SHV (25%). The clonal relatedness revealed the likely circulation of ESBL- Klebsiella pneumoniae between wards and the hospital environment respectively. Conclusion Hospital environment remains a reservoir of ESBL- K. pneumoniae in this hospital setting and could be transmitted to the hospitalized patients. It is therefore imperative, even very urgent, to implement stringent infection prevention and control measures to curb the dissemination of ESBL- Klebsiella pneumoniae in hospital setting in West region. Klebsiella pneumoniae Medical devices Hospital environments Surgical patients Cameroon Figures Figure 1 Figure 2 Figure 3 BACKGROUND Hospital-acquired infections (HAIs) are a worldwide health concern with a disproportionately high burden in resource-limited countries [ 1 , 2 ]. They posed a significant public health problem by increasing hospital length of stay and healthcare-associated costs, higher morbidity and mortality rates, especially in Low- and Low-Middle-Income Countries (LLMICs) [ 2 , 3 , 4 ]. The global dissemination of antimicrobial resistance exacerbates the problem of HAIs. The major drivers of antimicrobial resistance in these settings remain inappropriate antimicrobial prescription practices and poor infection prevention and control measures in healthcare facilities [ 5 ]. The hospital environment (HE) remains an important reservoir for numerous pathogens that could lead to HAIs [ 6 ]. Klebsiella pneumoniae is a leading cause of opportunistic healthcare-associated infections, which are increasingly complicated by the presence of extended-spectrum beta-lactamases (ESBLs) [ 7 ]. It is thus clear that the heavy antibiotic usage among hospitalized and surgical patients in sub-Saharan Africa remain a major public health threat. The majority of these antibiotics are prescribed for prophylaxis purposes, thus increasing antimicrobial resistance, length of hospitalization and deaths. In 2019 a systematic review and meta-analysis shown that 51.0% of K. pneumonia was multi-drug resistant (MDR) in Cameroon, and that commonly prescribed antibiotics were highly resistant [ 8 ]. In 2022, a study of antibiotic susceptibility profile of germs responsible for nosocomial infections in the surgical and intensive care units at Military Hospital Region N° 1, Yaoundé, Cameroon reported a 60% prevalence of surgical site infections and a low sensitivity rate for the different antibiotics tested due to the systematic administration of antibiotics to patients [ 2 ]. More recently, a descriptive study investigating bacteriological profiles of surgical site infection at Deido District Hospital in Douala, Cameroon reported that the prevalence of post-surgical site infection was 32, 3%, the clinical spectrum and bacterial sensitivity was diverse in 2023[ 9 ]. Yet, data about K. pneumoniae in the Western region of the country remains scarce. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL- Kp ) were listed as critical priority bacteria for research and development of new antibiotics by the World Health Organisation (WHO) [ 10 ]. Extended-spectrum β-lactamase-producing K. pneumoniae is among the leading pathogens implicated in HAIs especially those with surgical operations [ 11 ]. A report in Algeria has shown a high prevalence of ESBL- Kp isolated from inanimate objects, hospital environment and revealed that bla CTX−M−1−group was the most prevalent genes detected [ 6 ]. To the best of our knowledge, no study has focused on the genetic diversity of ESBL- Kp in surgical patients, medical devices and hospital environment in the Western region of Cameroon. This study therefore aimed at determining the prevalence and genotypic characteristics of ESBL- Kp circulating among surgical patients, medical equipment, and hospital environment in the West region of Cameroon with view to invigorate infection prevention and control policies and serves as a proof of concept to implement the One Health Approach in hospital settings. MATERIALS AND METHODS 1. Study design, population and settings A cross-sectional study was conducted for four months, from February to May 2022. Samples were collected at Annex Regional Hospital of Dschang (ARHD) in the West region of Cameroon. The study population included patients older than 18 years old, hospitalized and scheduled to undergo a surgery at the different surgical wards of ARHD. In addition, medical equipment was composed of inanimate surfaces by tweezers, vacuum cleaners, oxygen masks and Farabeuf retractors. The hospital environments were composed of inanimate surfaces including bed-side tables and door handles of operating theatres, treatment room and gynaecology ward. 2. Sampling procedure and sample collection All hospitalized patients who met the inclusion criteria including: be at least 18 years old, have had or planned to have a surgery and consenting to participate in the study. Moreover, the participants were selected based on the length of stay post-operative. All participants were followed up to get samples and clinical information before and after surgery. All wound samples were collected using sterile swabs from included patients during or within five days after surgery. Hospital environment (tables, door handles, care cart and cyalidic) and medical equipment (Tweezers, vacuum cleaners, oxygen masks and Farabeuf retractors) were also sampled using sterile swabs moistened with sterile normal saline water (0.9% w/v NaCl) any time an operation was scheduled. 3. Ethical considerations Ethical clearance was granted by the West Regional Ethics Committee for Research in Human Health, Bafoussam, Cameroon under the number (638/26/07/2023/CE/CRERSH-OU/VP) and the authorization of the Director of the Hospital under the number (159/AR/MSP/DRSPO/DSD/HDD). Oral and written informed consent was obtained either from the participants directly or from the closest relative for patients of legal age who were critically ill and could not provide informed consent. All samples and information from patients were codified to ensure confidentiality. 4. Laboratory analysis 4.1. Phenotypical characterization and ESBL screening After sampling, samples collected were cultured onto Eosin Methylene Blue (EMB) agar and incubated overnight at 37°C for 18 to 24 hours in presence of oxygen. All growing colonies were subjected to biochemical tests using Enterosystem 18R kit (LIOFILCHEM, Scozia, Italia) according to the manufacturer’s instructions. Pure K. pneumoniae colonies were stored in 1.5ml Tryptone Soy Broth (TSB) supplemented with 20% glycerol (v/v) and stored at -20°C for further experiments. Klebsiella pneumoniae isolates were double screened for the production of ESBL enzyme using CHROMAgar ESBL™ (CHROMagar, Paris, France) and synergy test using the ceftazidime, cefotaxime- and clavulanic acid (30/10 µg) . 4.2. Antimicrobial Susceptibility Testing (AST) The Kirby-Bauer disc diffusion method was used to assess the susceptibility profiles of K. pneumoniae . Briefly, Mueller-Hinton agar was swabbed with a standardized 0.5 McFarland bacterial inoculum. Subsequently, a panel of nine antibiotics discs of four different families were tested including amoxicillin-clavulanic acid (20–10 µg), cefuroxime (30 µg), cefotaxime (30 µg), ceftriaxone (30 µg), meropenem (10µg), ofloxacin (5 mcg), gentamicin (30 µg), levofloxacin (5 µg), and chloramphenicol (10 µg). The plates were then incubated overnight at 37◦C for 18–24 h. The different diameters of inhibition zones were measured and interpreted as susceptible (S) or resistant (R) according to the Antibiogram Committee of the French Society of Microbiology’s recommendations (CA-SFM 2022). When reading the antibiogram, Klebsiella pneumoniae isolates that were resistant to at least 3 different antibiotic families were considered multi-drug resistant. 4.3. Genomic Extraction The genomic DNA of all ESBL- K. pneumoniae isolates was obtained using a modified boiling method as previously described [ 12 ]. Briefly, one or two pure ESBL- K. pneumoniae colonies were suspended into 400 µL of Tris-EDTA (10 mM Tris, 0.1 mM EDTA) and then vortexed for five seconds. The bacterial suspension was then incubated for 25 min at 95◦C in a dry bath digital (MIULab DKT200-1, Lasec International Ltd., Johannesburg, South Africa). After incubation, the suspension was centrifuged for 5 min at 9500 rpm and then, 300 µL of the supernatant containing genomic DNA was subsequently transferred to a new Eppendorf tube and then stored at − 40◦C for future experiments. 4.4. Conventional and multiplex polymerase chain reaction methods (PCRs) Polymerase chain reaction (PCR) methods were used to detect the genes conferring resistance to β-lactams family. The detection of bla SHV gene was done using conventional PCR method, the reaction took place in a 10 µl reaction mix consisting of 5 µl of Dream Green Taq polymerase 2X (Thermo Fisher Scientific, Lithuania), 2.8 µl of nuclease-free water, 0.1 µl of each forward and reverse primers [10 µM] and 2 µl of template DNA. The detection of the bla CTX−M and bla TEM genes was done using a multiplex PCR method. The reaction took place in a 10 µl reaction mixture made up of 5 µl of Dream Green Taq polymerase 2X (Thermo Fisher Scientific, Lithuania), 2.6 µl of nuclease-free water, 0.1 µl of each forward (CTX-MU1 and TEM-F) and reverse (CTX-MU2 and TEM-R) primers [50 µM] and 2 µL of template DNA. Each amplification was done in 30 cycles with PCR conditions of both conventional and multiplex PCR are presented as follows: Initial denaturation (95°C for 3min), cyclic denaturation at 95°C for 4s, annealing at 46.9°C for 1min, elongation at 72°C for 1min and final elongation at 72°C for 5min. The characteristics of selected primers are described in supplementary table. 4.5 Clonal relatedness of ESBL- K. pneumoniae Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) was used to establish the clonal relatedness between ESBL- K. pneumoniae isolates. It was carried out using the primers ERIC1 5’ATGTAAGCTC CTGGGGATTCAC3’ and ERIC2R 5’AAGTAAGTGAC TGGGGTGAGCG3’ [ 13 ]. Each reaction mixture consisted of 10 µl PCR mix made up of 5µl of DreamTaq Green Polymerase Master Mix 2X (Thermo Fisher Scientific, Johannesburg, South Africa), 2.8 µl of nuclease free water, 0.1 µl of each primer [100 Μm], and 2 µl of template DNA. Amplification conditions was done as previously described (R. C. Founou et al., 2018). The generated amplicons were resolved by agarose gel electrophoresis on a 1.5% (w/v) Tris-EDTA 1X (Thermofisher) agarose gels, together with 1-kb ladder (Biolabs, New England) and run in an electric field of 110 V for 2 h 30 min [ 14 ]. Electrophoresis gels were visualized by a UV light trans-illuminator, images were captured using a gel documentation system G-BOX chemi XL (Syngene, Cambridge, UK). The gel pictures were exported to GelJ software (version 2.0) where strains were allocated to different clusters by calculating the similarity coefficient from the homology matrix using the Dice method. Dendrograms were constructed based on the average linkages of the matrix and using the Unweighted Pair-Group Method (UPGMA). 4.6. DNA Electrophoresis and Visualization Electrophoresis was performed on 1.5% (v/v) agarose gel at 90V for 45 min along with a 100bp ladder (New England Biolabs, MA, USA). The gel was then stained in ethidium bromide solution (0.5 µg/mL) and rinsed with distilled water. PCR products were visualized under UV light using a gel documentation system G-BOX chemi XL (Syngene, Cambridge, UK). 4.7. Quality control The K. pneumoniae ATCC 700603 and E. coli ATCC 35218 were used as a positive control strains for quality assessment of antibiotics, chromogenic culture media, as well as for bla TEM and bla SHV genes detection. An internal control strain of ESBL- E. coli was used as positive control for bla CTX−M gene. 4.8. Data analysis Before recording for analysis all data were carefully checked. The data was reported and analyzed using the software Microsoft® Office Excel 2016 and SPSS® version 26. A participant was considered positive for ESBL- K. pneumoniae when at least one K. pneumoniae detected from the sample displayed ESBL phenotype. Categorical variables were compared using either the χ² test or Fischer's exact test where appropriate. A result was considered statistically significant at a p-value < 0.05. The results obtained were analyzed, interpreted and presented in the form of figures and tables. RESULTS 1. Socio-demographic and the clinical characteristics of patients A total of 58 hospitalized patients were contacted among surgical and gynaecology wards. Out of these, 57 were enrolled and 46 were sampled during the study period. The Table 1 illustrates the distribution of these participants according to socio-demographic and the clinical characteristics. The majority of the participants were women aged between [21-31] years old with a sex-ratio (0.43). The majority of participants were married (n= 33/46; 71.7%); most of them (n=26/46; 56.5%) lived in urban areas and had a secondary educational level (n=18/46; 39.1%). The factors associated with ESBL -K. pneumoniae among with significant p-value patients were the wards (p-value=0.042), antibiotic consumption (p-value=0.019), length of hospitalization (p-value=0.001) and history of previous infection (Table 1). 2. Description of medical equipment and hospital environment samples In addition, 20 samples were collected from medical equipment mainly the oxygen mask (n=3), tweezers (n= 14), vacuum cleaners (n= 2) and Farabeuf retractors (n=1). A total of 25 samples were collected in hospital environment including bedsides table (n= 4), care cart (n=6) door handles (n=13) and cyalidic (n=2) . 3. Distribution of ESBL- Klebsiella pneumoniae isolated from surgical patients, medical equipment and hospital environment The overall prevalence of ESBL- K. pneumoniae in the study was 20.87% (19/91). More specifically, of the 46 hospitalized patients who provided samples, 23.9% (11/46) were positive for ESBL- K. pneumoniae . Out of the 20 samples collected from medical equipment including oxygen mask and tweezers, 5% (n=01/20) being positive for ESBL-K. pneumoniae . The frequency of ESBL- K. pneumoniae in hospital environment was 28% (n=07/25). 4. Antimicrobial resistance profiles of ESBL- K. pneumoniae isolates Antimicrobial resistance profiles of ESBL- K. pneumoniae revealed an overall 100% resistance to amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime. It also shown a high resistance rates to gentamicin (89.4%) and meropenem (42.1%) (Figure 1). However, ciprofloxacin and chloramphenicol were the more susceptible antibiotics with 26.3% of resistance rates. The most common resistant patterns between three sources of samples was AMC-CRO-CTX-CTR-MER-OF-LEV-CN-CHL (5/32; 15.6%) with resistance to nine antibiotics tested during our study of different families: β-lactamines, phenicols, aminoglycosides and fluoroquinolone. More specifically, resistance to AMC-CRX-CTX-CTR-MER-LEV-CN-CHL predominated in patients while in medical equipment and environment, AMC-CRO-CTX-CTR-MER-OF-LEV-CN-CHL was the most resistant antibiotic. 5. Occurrence of β -lactamase genes Among three β-lactamase resistance genes screened, the leading β-lactam resistance gene detected in patients, medical devices and environment was b la CTX-M (65.6%) followed by bla TEM (43.7%) and bla SHV (25%). The distribution of these resistant genes is illustrated in Table 2 and Figure 2. 6. Genotypic relatedness Enterobacterial Repetitive Intergenic Consensus fingerprints revealed the association between ESBL- K. pneumoniae isolated from surgical patients, hospital environment and medical equipment as illustrated in figure 3. The phylogenetic tree constructed revealed that ESBL- K. pneumoniae were grouped into one cluster. Two ESBL- K. pneumoniae isolates (EV10A and EV10B) collected on bedside table from the surgery department shared 100% of similarity with another strain isolated after 21 days from a medical equipment (EQ3) within an operating theater. In addition, these batch of three isolates were MDR and harbored the same β-lactamase genes ( b la CTX-M and bla TEM ). Similar findings were observed where two isolates collected the same day from wound shared 100% of similarity with two MDR isolates (P4 and P7A) and harbored the same β-lactamase genes. However, an ESBL- Klebsiella pneumoniae isolate from an hospitalized patient was not typable. DISCUSSION The aim of this study was to perform the genotypic characterization and evidence the clonal dissemination of ESBL- Kp isolated from medical equipment, surgical patients and hospital environment at the Annex Regional Hospital of Dschang in the West region in Cameroon. The high incidence observed among the post-operative patients attending treatment room for dressing suggest to re-evaluate the antibiotic prophylaxis used in these services to reduce antimicrobial resistance level. Our results revealed that prevalence of ESBL and MDR- Kp circulating among hospitalized patients 5 days after surgery with 23.9% (n = 11/46) and 28.6% (13/46) respectively. Furthermore, these findings are similar to previous studies investigating ESBL- Kp which reported a high ESBL- Kp prevalence from the hospitalized patients in KwaZulu-Natal, South Africa (29%) in 2019 and Tertiary Care Hospital in Kurnool, India (17%) [13,15 ]. The prevalence of ESBL- Kp among medical equipment (5%, n = 1/20) and the hospital environment (20%, n = 05/25) are higher than that reported in the hospital environment in two referral hospitals in Yaoundé, Cameroon in 2015 where 2.02% (n = 3/148) of Klebsiella pneumoniae were detected in the hospital environment [ 16 ]. This discrepancy could be explained by the fact that the hospitals level’s following the health care level involved in this study was different and the biosecurity implemented in these hospitals were also different. The antimicrobial susceptibility profiles revealed that all ESBL -Kp isolates were resistant to amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime. These results are higher than those obtained in Ghana in 2020 where the resistance rates of theses antibiotic families have increased over the years ranging from 80%, 74%, 69% and 65–100% respectively [ 17 ]. The high resistance rates to gentamicin (89.4%) was also observed in our study. This is an agreement with several previous studies investigating on high prevalence of Multidrug Resistant Klebsiella Species and Evolution of antibiotic resistance of Enterobacteriaceae, where 75.7% and 72% of resistance rates to gentamicin were detected in the Yaoundé university teaching hospital and Douala general hospital in Cameroon from 2005 to 2012 in 2015 and 2021, respectively [ 18 , 19 ]. The high resistance rate to meropenem (42.1%) observed, is high compared to a study carried out in the Yaoundé university teaching hospital where the resistance to meropenem among patients was 2.7% in February 2019 to July 2019 [ 18 ]. The bla CTX−M was the leading β-lactamase resistance genes detected among our isolates. This result is agreement with previous studies which demonstrated that bla CTX−M is widely circulating in Africa [ 20 , 21 , 22 , 23 , 24 ]. These results can also be explained by the fact that, ESBLs are likely disseminating in hospital environment through horizontal transfer mechanisms involving mobile genetic elements such as plasmids, transposons, and insertion sequences, carrying frequently these β-lactam resistance genes [ 25 ]. The clonal relatedness showed that ESBL- Kp are likely circulating in this hospital setting reinforcing the need to strengthen infection prevention and control policy, instigate monitoring of HAI and antibiotic-resistant bacteria in healthcare settings, and heighten awareness on simple measures that can save lives [ 26 ]. Our study has several limitations. First, the population studied was delicate so we were not able to obtain all the information sought from patients such as the antibiotics consumed before the operation. This prevented us from providing an exact prevalence of nosocomial infections due to ESBL- K. pneumoniae linked to the previous ß-lactams usage. Second, in our geographical context, many people do not understand the importance of the “One Health” Approach in healthcare facilities and have not yet become aware of the impact of the emergence of ESBL on environmental interface. It was therefore became difficult to convince participants and healthcare workers of the importance of this study reducing thus our patient sample size which prevented us to determe meaningfully the risk factors for nosocomial infections. CONCLUSION This study reveals the high prevalence of ESBL- Kp among three interfaces. High clonal dissemination of ESBL- Kp has been demonstrated at the ARHD in the Western region, Cameroon. The principal risk factors were length of hospitalization, antibiotic consumption and history of previous infection as well as previous antibiotic treatment. The high incidence observed among the post-operative patients attending treatment room for dressing suggest to re-evaluate the antibiotic prophylaxis used in these services to reduce incidence of antimicrobial resistance. It is thus imperative to implement antimicrobial stewardship program and reinforce infection prevention and control coupled with strict hygiene measures in these wards in order to curb the dissemination of ESBL- K. pneumoniae. Abbreviations ARHD Annex Regional Hospital of Dschang AST Antibiotic Susceptibility Test ERIC Enterobacterial Repetitive Intergenic Consensus ESBL Extended Spectrum β-lactamase ESBL- Kp Extended Spectrum β-lactamase Klebsiella pneumoniae HAI Hospital Acquired Infections HE Hospital Environment MDR Multidrug Resistance MDR- Kp Multidrug Resistant Klebsiella pneumoniae LMICs Low Middle-Income Countries 3GC Third Generation Cephalosporin PCR Polymerase Chain Reaction SSIs Surgical Site Infections Declarations Ethics approval and consent to participate This research has been approved by the Regional Ethics Committee for Health Research for the Western region (N°638/26/07/2023/CE/CRERSH-OU/VP) and the authorization of the Director of the Hospital under the number (159/AR/MSP/DRSPO/DSD/HDD). The study was approved by the Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI) under the number (N° 004/06/22/LA/CEDBCAM-RI/DG). The study was conducted in accordance with the declaration of Helsinki. In addition, the research authorizations of the various healthcare structures have been granted. All methods and protocols used were approved by the CEDBCAM-RI in accordance with the relevant international guidelines and regulations for research laboratory ethics. Data availability The data are available upon request in accordance with confidentiality and privacy regulations from the corresponding author. Consent for publication Not applicable Competing of interest The authors declare no conflict of interest. Funding Raspail Carrel Founou received funding from the Mérieux Foundation, Lyon France for the CAREFOOD project. CAREFOOD project had supported all the molecular aspect of this study. This work was also supported by the Research Institute of the Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI). Dr Luria Founou received funding from the Thrasher Research Fund through the Thrasher Early Career Award (Award number 01364). The funders had no role in the study design, nor the decision to submit the work for publication. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Author information Authors and affiliations Department of Microbiology-Haematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon; Antimicrobial Research Unit, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; Antimicrobial Resistance and Infectious Disease (ARID) Research Unit, Research Institute of Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI), Yaoundé, Cameroon; Reproductive, Maternal, Newborn and Child Health (ReMARCH) Research Unit, Research Institute of the Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI); Yaoundé, Cameroon; Bioinformatics & Applied Machine Learning Research Unit, EDEN Biosciences Research Institute (EBRI), EDEN Foundation, Yaoundé Cameroon; Infection & Global Health Division, School of Medicine, University of St Andrews, St Andrews, United Kingdom; Annex Regional Hospital of Dschang (ARHD), Dschang, Cameroon Author contributions Conceptualizatio n: TEN, RCF and BK; Methodology : RCF, LLF; Software : TEN, PLK; Validation : RCF, LLF and BK; Formal analysis : TEN, LLF, RCF; Investigation : TEN, BDD, PLK, ADM, JRZ; Resources : RCF, LLF and BK; Writing original draft : TEN and RCF; Review and editing : RCF, LLF, NM and BK; Visualization : TEN, PLK, RCF; Supervision : RCF, LLF, MN, BK; Project administration : RCF and LLF. 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Front Microbiol. 2018;9:188. 10.3389/fmicb.2018.00188 . Sarojamma V, Ramakrishna V. (2011). Prevalence of ESBL-Producing Klebsiella pneumoniae Isolates in Tertiary Care Hospital. ISRN Microbiol, 2011 , 318348. 10.5402/2011/318348 Gonsu KH, Guenou E, Toukam M, Ndze VN, Mbakop CD, Tankeu DN, et al. Bacteriological assessment of the hospital environment in two referral hospitals in Yaoundé-Cameroon. Pan Afr Med J. 2015;20:224. 10.11604/pamj.2015.20.224.4433 . Bediako-Bowan AAA, Kurtzhals JAL, Mølbak K, Labi AK, Owusu E, Newman MJ. High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana. BMC Infect Dis. 2020;20(1):890. 10.1186/s12879-020-05631-1 . Mbamyah E, Enyeji F, Torimiro J, Mangum P, Djuissi M, Teukam A et al. (2021). High Prevalence of Multidrug Resistant Klebsiella Species Isolated from the Yaounde University Teaching Hospital, Cameroon. JMM, 11, 91–99. doi: 10.4236/ojmm.2021.112008. Ebongue CO, Tsiazok MD, Mefo'o JPM, Ngaba GP, Beyiha G, Adiogo D. Evolution of antibiotic resistance of Enterobacteriaceae isolated at the Douala General Hospital from 2005 to 2012. Pan Afr Med J. 2015;20:227. 10.11604/pamj.2015.20.227.4770 . Founou LL, Founou RC, Ntshobeni N, Govinden U, Bester LA, Chenia HY, et al. Emergence and Spread of Extended Spectrum β-Lactamase Producing Enterobacteriaceae (ESBL-PE) in Pigs and Exposed Workers: A Multicentre Comparative Study between Cameroon and South Africa. Pathogens. 2019;8(1). 10.3390/pathogens8010010 . Gangoué-Piéboji J, Bedenic B, Koulla-Shiro S, Randegger C, Adiogo D, Ngassam P, Hächler H. Extended-spectrum-beta-lactamase-producing Enterobacteriaceae in Yaounde, Cameroon. J Clin Microbiol. 2005;43(7):3273–7. 10.1128/jcm.43.7.3273-3277.2005 . Ouchar MO, Lounnas M, Hide M, Dumont Y, Tidjani A, Kamougam K, et al. High prevalence and characterization of extended-spectrum ß-lactamase producing Enterobacteriaceae in Chadian hospitals. BMC Infect Dis. 2019;19(1):205. 10.1186/s12879-019-3838-1 . Sonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Lund O, Kibiki G, Aarestrup FM. Meta-analysis of proportion estimates of Extended-Spectrum-Beta-Lactamase-producing Enterobacteriaceae in East Africa hospitals. Antimicrob Resist Infect Control. 2016;5:18. 10.1186/s13756-016-0117-4 . Tandé D, Jallot N, Bougoudogo F, Montagnon T, Gouriou S, Sizun J. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in a Malian orphanage. Emerg Infect Dis. 2009;15(3):472–4. 10.3201/eid1503.071637 . von Wintersdorff CJ, Penders J, van Niekerk JM, Mills ND, Majumder S, van Alphen LB, et al. Dissemination of Antimicrobial Resistance in Microbial Ecosystems through Horizontal Gene Transfer. Front Microbiol. 2016;7:173. 10.3389/fmicb.2016.00173 . Ouchar MO, Kempf M, Lounnas M, Tidjani A, Hide M, Benavides JA, et al. Epidemiology and prevalence of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae in humans, animals and the environment in West and Central Africa. Int J Antimicrob Agents. 2021;57(1):106203. 10.1016/j.ijantimicag.2020.106203 . Bassetti M, Righi E, Carnelutti A, Graziano E, Russo A. Multidrug-resistant Klebsiella pneumoniae: challenges for treatment, prevention and infection control. Expert Rev Anti-infect Ther 16. 2018. 10.1080/14787210.2018.1522249 . Tables Table 1: Distribution of ESBL- Klebsiella pneumoniae according to socio-demographic characteristics and the clinical characteristic of the participants ESBL-KP n (%) Variable Terms Frequency n (%) N=46 Negative N=35 Positive N=11 p-value Sex Female 32 (69.5) 26(74.3) 6(54.5) 0.493 Male 14 (30.4) 9(25.7) 5(45.5) Age group ≤20 03 (06.5) 3(8.6) 0(0.0) 0.911 [21-31] 20 (43.4) 14(40.0) 6(54.5) [31-41] 12 (26.0) 9(25.7) 3(27.3) [41-51] 3 (06.5) 2(5.7) 1(9.1) >51 8 (17.3) 7(20.0) 1(9.1) Marital status Single 11 (23.9) 8(22.9) 3(27.3) 0.850 Married 33 (71.7) 26(74.3) 7(63.6) Widow 2 (04.3) 1(2.9) 1(9.1) Residence Rural 20 (43.4) 15(42.9) 5(45.5) 1 Urban 26 (56.5) 20(57.1) 6(54.5) Education Illiterate 2 (04.3) 0(0.0) 2(18.2) 0.093 Primary school 5 (10.8) 4(11.4) 1(9.1) Secondary school 18 (39.1) 15(42.9) 3(27.3) University 8 (17.3) 4(11.4) 4(36.4) Unknown 13 (28.2) 12(34.3) 1(9.1) Length of hospitalization <3 days 25 (54.3) 24(68.6) 1(9.1) 0.001 [3-5] days 9 (19.5) 5(14.3) 4(36.4) 1 week 4 (08.6) 1(2.9) 3(27.3) 2 weeks 6 (13.0) 3(8.6) 3(27.3) 3 weeks 2 (04.3) 2(5.7) 0(0.0) Hospital wards Bloc 1 9 (19.5) 8(22.9) 1(9.1) 0.042 Bloc 2 5 (10.8) 5(14.3) 0(0.0) Gynecology bloc 10 (21.7) 9(25.7) 1(9.1) Hospitalization ward 2 (04.3) 0(0.0) 2(18.2) Treatment room 20 (43.4) 13(37.1) 7(63.6) Surgery types Minor surgery 16 (34.7) 13(37.1) 3(27.3) 0.454 Major surgery 10 (21.7) 6(17.1) 4(36.4) Gynecological surgery 20 (43.4) 16(45.7) 4(36.4) Behaviors with Antibiotic consumption None 20 (43.4) 18(51.4) 2(18.2) 0.019 Self-medication 4 (8.6) 2(5.7) 2(18.2) Self-medication and medical prescription 2 (04.3) 0(0.0) 2(18.2) Medical prescription 20 (43.4) 15 (42.9) 5 (45.5) β -lactam intake before surgery Yes 44 (95.6) 33 (94.6) 11 (100) 0.501 No 2 (4.3) 2 (5.7) 0(0.0) β -lactam intake after surgery Yes 36 (78.2) 26 (74.6) 10 (91) 0.547 No 10 (21.7) 9 (25.7) 1 (9) History of previous infection Yes 24 (52.1) 15 (42.9) 9(81.8) 0.009 No 6 (13.0) 4 (11.4) 2(18.2) Unknown 16 (34.7) 16(45.7) 0(0.0) Table 2: Distribution of resistance genes among ESBL- K. pneumoniae Variable Environment Medical devices Patients Frequency n (%) Frequency n (%) Frequency n (%) CTX-M 8(25.0) 1(3.1) 12(37.5) TEM 5(15.6) 1(3.1) 8(25.0) SHV 1(3.1) 0(0.0)% 7(21.8) Total (N=32) 14 (43.7) 2(6.2) 20(62.5) Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5006261\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":359841959,\"identity\":\"2dde9304-edf3-468f-9b8d-252dad309178\",\"order_by\":0,\"name\":\"Therese Espoir Ngo Mbog\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Dschang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Therese\",\"middleName\":\"Espoir Ngo\",\"lastName\":\"Mbog\",\"suffix\":\"\"},{\"id\":359841960,\"identity\":\"729d210c-e41f-4941-aae6-48d5e8e3642a\",\"order_by\":1,\"name\":\"Raspail Carrel Founou\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBADOQYGHihNLDCGajEmXktiA9Fa+PsPP3v4tc0mfcPxswcffGAwyCeoReLAMXNj2ba03A1n8pINZzAYWDYQ0mLA2GAmLdl2OHfDgRwzaR6GPwYEbTFgZv8G1PI/3eD8G5AWAyK0sPGYSX5sO5BgcCOHSC0SZ3jKpBnOJRvOvPHG2HCGARFa+PuPb5P8UWYnz3c+x/DBhwoitIAAMyhGFA6A3UmUBgYGxh9AQr6BSNWjYBSMglEw8gAALAM3PcXD5WUAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"University of Dschang\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Raspail\",\"middleName\":\"Carrel\",\"lastName\":\"Founou\",\"suffix\":\"\"},{\"id\":359841961,\"identity\":\"5aa896e4-d66c-407f-9a78-d4b4f94a895f\",\"order_by\":2,\"name\":\"Luria Leslie Founou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of KwaZulu-Natal\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Luria\",\"middleName\":\"Leslie\",\"lastName\":\"Founou\",\"suffix\":\"\"},{\"id\":359841962,\"identity\":\"eca2f1f2-54eb-4dec-8700-bf8a963a338e\",\"order_by\":3,\"name\":\"Patrice Landry Koudoum\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Dschang\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Patrice\",\"middleName\":\"Landry\",\"lastName\":\"Koudoum\",\"suffix\":\"\"},{\"id\":359841963,\"identity\":\"46ab9603-06dd-49f3-8627-2adee720262b\",\"order_by\":4,\"name\":\"Jessica Ravanola Zemtsa\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Research Institute of The Centre of Expertise and Biological Diagnostic of Cameroon\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jessica\",\"middleName\":\"Ravanola\",\"lastName\":\"Zemtsa\",\"suffix\":\"\"},{\"id\":359841964,\"identity\":\"894546b2-af54-46db-b530-bdb664c7241b\",\"order_by\":5,\"name\":\"Brice Davy 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1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":10581,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAntimicrobial resistance profile of ESBL-\\u003c/strong\\u003e\\u003cem\\u003e\\u003cstrong\\u003eK. pneumoniae \\u003c/strong\\u003e\\u003c/em\\u003e\\u003cstrong\\u003eisolates\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Onlinedrawingimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5006261/v1/c0b33147aed89238662f3c0b.png\"},{\"id\":66930196,\"identity\":\"562d4e95-02b0-435c-93f1-01b3739339ad\",\"added_by\":\"auto\",\"created_at\":\"2024-10-18 06:53:37\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":83387,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFlow chart of participants enrolled and samples according to the interfaces\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5006261/v1/c21ee958c9bf6cec3c856142.png\"},{\"id\":66930243,\"identity\":\"6f597831-6535-4587-912c-16c36dc8b7ad\",\"added_by\":\"auto\",\"created_at\":\"2024-10-18 06:53:39\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":269914,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eClonal relatedness of ESBL-\\u003c/strong\\u003e\\u003cem\\u003e\\u003cstrong\\u003eKp\\u003c/strong\\u003e\\u003c/em\\u003e\\u003cstrong\\u003e isolated from patients, medical devices and the hospital environment at ARHD. Phylogenetic tree generated by GelJ (version 2.0) using algorithm method (UPMGA) and Dice similarity coefficient. \\u003c/strong\\u003eHospital wards 1: Treatment room; Hospital wards 2: Hospitalization room; Hospital wards 3: Operating Theater 1; Hospital wards 4: Operating Theater 2; Hospital wards 5: Gynecology\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage237.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5006261/v1/263d58fe29baca73447d250a.png\"},{\"id\":69234375,\"identity\":\"7f7f6700-f241-4c9e-a13f-f608636c0779\",\"added_by\":\"auto\",\"created_at\":\"2024-11-18 09:32:38\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1844490,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5006261/v1/6c3966ca-e762-4fdb-ac85-45bbdf616133.pdf\"},{\"id\":66930245,\"identity\":\"04baa582-aa81-4e21-899f-1f0560bb7300\",\"added_by\":\"auto\",\"created_at\":\"2024-10-18 06:53:40\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":16899,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"EspoiretalAdditionalfile.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5006261/v1/cefd56ea65bd8fdbd0674fa1.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Clonal Dissemination of Extended-Spectrum Beta-Lactamase (ESBL)- producing Klebsiella pneumoniae isolated from Medical devices and Hospital environments in the West region, Cameroon\",\"fulltext\":[{\"header\":\"BACKGROUND\",\"content\":\"\\u003cp\\u003eHospital-acquired infections (HAIs) are a worldwide health concern with a disproportionately high burden in resource-limited countries [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. They posed a significant public health problem by increasing hospital length of stay and healthcare-associated costs, higher morbidity and mortality rates, especially in Low- and Low-Middle-Income Countries (LLMICs) [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The global dissemination of antimicrobial resistance exacerbates the problem of HAIs. The major drivers of antimicrobial resistance in these settings remain inappropriate antimicrobial prescription practices and poor infection prevention and control measures in healthcare facilities [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. The hospital environment (HE) remains an important reservoir for numerous pathogens that could lead to HAIs [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e is a leading cause of opportunistic healthcare-associated infections, which are increasingly complicated by the presence of extended-spectrum beta-lactamases (ESBLs) [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. It is thus clear that the heavy antibiotic usage among hospitalized and surgical patients in sub-Saharan Africa remain a major public health threat. The majority of these antibiotics are prescribed for prophylaxis purposes, thus increasing antimicrobial resistance, length of hospitalization and deaths. In 2019 a systematic review and meta-analysis shown that 51.0% of \\u003cem\\u003eK. pneumonia\\u003c/em\\u003e was multi-drug resistant (MDR) in Cameroon, and that commonly prescribed antibiotics were highly resistant [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. In 2022, a study of antibiotic susceptibility profile of germs responsible for nosocomial infections in the surgical and intensive care units at Military Hospital Region N\\u0026deg; 1, Yaound\\u0026eacute;, Cameroon reported a 60% prevalence of surgical site infections and a low sensitivity rate for the different antibiotics tested due to the systematic administration of antibiotics to patients [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. More recently, a descriptive study investigating bacteriological profiles of surgical site infection at Deido District Hospital in Douala, Cameroon reported that the prevalence of post-surgical site infection was 32, 3%, the clinical spectrum and bacterial sensitivity was diverse in 2023[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Yet, data about \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e in the Western region of the country remains scarce.\\u003c/p\\u003e \\u003cp\\u003eExtended-spectrum β-lactamase-producing \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e (ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e) were listed as critical priority bacteria for research and development of new antibiotics by the World Health Organisation (WHO) [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Extended-spectrum β-lactamase-producing \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e is among the leading pathogens implicated in HAIs especially those with surgical operations [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. A report in Algeria has shown a high prevalence of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e isolated from inanimate objects, hospital environment and revealed that \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eCTX\\u0026minus;M\\u0026minus;1\\u0026minus;group\\u003c/sub\\u003e was the most prevalent genes detected [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. To the best of our knowledge, no study has focused on the genetic diversity of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e in surgical patients, medical devices and hospital environment in the Western region of Cameroon. This study therefore aimed at determining the prevalence and genotypic characteristics of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e circulating among surgical patients, medical equipment, and hospital environment in the West region of Cameroon with view to invigorate infection prevention and control policies and serves as a proof of concept to implement the One Health Approach in hospital settings.\\u003c/p\\u003e\"},{\"header\":\"MATERIALS AND METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e1. Study design, population and settings\\u003c/h2\\u003e \\u003cp\\u003eA cross-sectional study was conducted for four months, from February to May 2022. Samples were collected at Annex Regional Hospital of Dschang (ARHD) in the West region of Cameroon. The study population included patients older than 18 years old, hospitalized and scheduled to undergo a surgery at the different surgical wards of ARHD. In addition, medical equipment was composed of inanimate surfaces by tweezers, vacuum cleaners, oxygen masks and Farabeuf retractors. The hospital environments were composed of inanimate surfaces including bed-side tables and door handles of operating theatres, treatment room and gynaecology ward.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e2. Sampling procedure and sample collection\\u003c/h2\\u003e \\u003cp\\u003eAll hospitalized patients who met the inclusion criteria including: be at least 18 years old, have had or planned to have a surgery and consenting to participate in the study. Moreover, the participants were selected based on the length of stay post-operative. All participants were followed up to get samples and clinical information before and after surgery. All wound samples were collected using sterile swabs from included patients during or within five days after surgery. Hospital environment (tables, door handles, care cart and cyalidic) and medical equipment (Tweezers, vacuum cleaners, oxygen masks and Farabeuf retractors) were also sampled using sterile swabs moistened with sterile normal saline water (0.9% w/v NaCl) any time an operation was scheduled.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e3. Ethical considerations\\u003c/h2\\u003e \\u003cp\\u003e Ethical clearance was granted by the West Regional Ethics Committee for Research in Human Health, Bafoussam, Cameroon under the number (638/26/07/2023/CE/CRERSH-OU/VP) and the authorization of the Director of the Hospital under the number (159/AR/MSP/DRSPO/DSD/HDD). Oral and written informed consent was obtained either from the participants directly or from the closest relative for patients of legal age who were critically ill and could not provide informed consent. All samples and information from patients were codified to ensure confidentiality.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4. Laboratory analysis\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003e4.1. Phenotypical characterization and ESBL screening\\u003c/h2\\u003e \\u003cp\\u003eAfter sampling, samples collected were cultured onto Eosin Methylene Blue (EMB) agar and incubated overnight at 37\\u0026deg;C for 18 to 24 hours in presence of oxygen. All growing colonies were subjected to biochemical tests using Enterosystem 18R kit (LIOFILCHEM, Scozia, Italia) according to the manufacturer\\u0026rsquo;s instructions. Pure \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e colonies were stored in 1.5ml Tryptone Soy Broth (TSB) supplemented with 20% glycerol (v/v) and stored at -20\\u0026deg;C for further experiments. \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e isolates were double screened for the production of ESBL enzyme using CHROMAgar ESBL\\u0026trade; (CHROMagar, Paris, France) and synergy test using the ceftazidime, cefotaxime- and clavulanic acid (30/10 \\u0026micro;g) .\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.2. Antimicrobial Susceptibility Testing (AST)\\u003c/h2\\u003e \\u003cp\\u003eThe Kirby-Bauer disc diffusion method was used to assess the susceptibility profiles of \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e. Briefly, Mueller-Hinton agar was swabbed with a standardized 0.5 McFarland bacterial inoculum. Subsequently, a panel of nine antibiotics discs of four different families were tested including amoxicillin-clavulanic acid (20\\u0026ndash;10 \\u0026micro;g), cefuroxime (30 \\u0026micro;g), cefotaxime (30 \\u0026micro;g), ceftriaxone (30 \\u0026micro;g), meropenem (10\\u0026micro;g), ofloxacin (5 mcg), gentamicin (30 \\u0026micro;g), levofloxacin (5 \\u0026micro;g), and chloramphenicol (10 \\u0026micro;g). The plates were then incubated overnight at 37◦C for 18\\u0026ndash;24 h. The different diameters of inhibition zones were measured and interpreted as susceptible (S) or resistant (R) according to the Antibiogram Committee of the French Society of Microbiology\\u0026rsquo;s recommendations (CA-SFM 2022). When reading the antibiogram, \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e isolates that were resistant to at least 3 different antibiotic families were considered multi-drug resistant.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.3. Genomic Extraction\\u003c/h2\\u003e \\u003cp\\u003eThe genomic DNA of all ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e isolates was obtained using a modified boiling method as previously described [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Briefly, one or two pure ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e colonies were suspended into 400 \\u0026micro;L of Tris-EDTA (10 mM Tris, 0.1 mM EDTA) and then vortexed for five seconds. The bacterial suspension was then incubated for 25 min at 95◦C in a dry bath digital (MIULab DKT200-1, Lasec International Ltd., Johannesburg, South Africa). After incubation, the suspension was centrifuged for 5 min at 9500 rpm and then, 300 \\u0026micro;L of the supernatant containing genomic DNA was subsequently transferred to a new Eppendorf tube and then stored at \\u0026minus;\\u0026thinsp;40◦C for future experiments.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.4. Conventional and multiplex polymerase chain reaction methods (PCRs)\\u003c/h2\\u003e \\u003cp\\u003ePolymerase chain reaction (PCR) methods were used to detect the genes conferring resistance to β-lactams family. The detection of \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eSHV\\u003c/sub\\u003e gene was done using conventional PCR method, the reaction took place in a 10 \\u0026micro;l reaction mix consisting of 5 \\u0026micro;l of Dream Green Taq polymerase 2X (Thermo Fisher Scientific, Lithuania), 2.8 \\u0026micro;l of nuclease-free water, 0.1 \\u0026micro;l of each forward and reverse primers [10 \\u0026micro;M] and 2 \\u0026micro;l of template DNA. The detection of the \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eCTX\\u0026minus;M\\u003c/sub\\u003e and \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eTEM\\u003c/sub\\u003e genes was done using a multiplex PCR method. The reaction took place in a 10 \\u0026micro;l reaction mixture made up of 5 \\u0026micro;l of Dream Green Taq polymerase 2X (Thermo Fisher Scientific, Lithuania), 2.6 \\u0026micro;l of nuclease-free water, 0.1 \\u0026micro;l of each forward (CTX-MU1 and TEM-F) and reverse (CTX-MU2 and TEM-R) primers [50 \\u0026micro;M] and 2 \\u0026micro;L of template DNA. Each amplification was done in 30 cycles with PCR conditions of both conventional and multiplex PCR are presented as follows: Initial denaturation (95\\u0026deg;C for 3min), cyclic denaturation at 95\\u0026deg;C for 4s, annealing at 46.9\\u0026deg;C for 1min, elongation at 72\\u0026deg;C for 1min and final elongation at 72\\u0026deg;C for 5min. The characteristics of selected primers are described in supplementary table.\\u003c/p\\u003e \\u003ch2\\u003e 4.5 Clonal relatedness of ESBL-\\u003c/b\\u003eK. pneumoniae\\u003c/b\\u003e \\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003eEnterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) was used to establish the clonal relatedness between ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e isolates. It was carried out using the primers ERIC1 5\\u0026rsquo;ATGTAAGCTC CTGGGGATTCAC3\\u0026rsquo; and ERIC2R 5\\u0026rsquo;AAGTAAGTGAC TGGGGTGAGCG3\\u0026rsquo; [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Each reaction mixture consisted of 10 \\u0026micro;l PCR mix made up of 5\\u0026micro;l of DreamTaq Green Polymerase Master Mix 2X (Thermo Fisher Scientific, Johannesburg, South Africa), 2.8 \\u0026micro;l of nuclease free water, 0.1 \\u0026micro;l of each primer [100 Μm], and 2 \\u0026micro;l of template DNA. Amplification conditions was done as previously described (R. C. Founou et al., 2018). The generated amplicons were resolved by agarose gel electrophoresis on a 1.5% (w/v) Tris-EDTA 1X (Thermofisher) agarose gels, together with 1-kb ladder (Biolabs, New England) and run in an electric field of 110 V for 2 h 30 min [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Electrophoresis gels were visualized by a UV light trans-illuminator, images were captured using a gel documentation system G-BOX chemi XL (Syngene, Cambridge, UK). The gel pictures were exported to GelJ software (version 2.0) where strains were allocated to different clusters by calculating the similarity coefficient from the homology matrix using the Dice method. Dendrograms were constructed based on the average linkages of the matrix and using the Unweighted Pair-Group Method (UPGMA).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.6. DNA Electrophoresis and Visualization\\u003c/h2\\u003e \\u003cp\\u003eElectrophoresis was performed on 1.5% (v/v) agarose gel at 90V for 45 min along with a 100bp ladder (New England Biolabs, MA, USA). The gel was then stained in ethidium bromide solution (0.5 \\u0026micro;g/mL) and rinsed with distilled water. PCR products were visualized under UV light using a gel documentation system G-BOX chemi XL (Syngene, Cambridge, UK).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.7. Quality control\\u003c/h2\\u003e \\u003cp\\u003eThe \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e ATCC 700603 and \\u003cem\\u003eE. coli\\u003c/em\\u003e ATCC 35218 were used as a positive control strains for quality assessment of antibiotics, chromogenic culture media, as well as for \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eTEM\\u003c/sub\\u003e and \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eSHV\\u003c/sub\\u003e genes detection. An internal control strain of ESBL-\\u003cem\\u003eE. coli\\u003c/em\\u003e was used as positive control for \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eCTX\\u0026minus;M\\u003c/sub\\u003e gene.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e4.8. Data analysis\\u003c/h2\\u003e \\u003cp\\u003eBefore recording for analysis all data were carefully checked. The data was reported and analyzed using the software Microsoft\\u0026reg; Office Excel 2016 and SPSS\\u0026reg; version 26. A participant was considered positive for ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e when at least one \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e detected from the sample displayed ESBL phenotype. Categorical variables were compared using either the χ\\u0026sup2; test or Fischer's exact test where appropriate. A result was considered statistically significant at a \\u003cem\\u003ep-value\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. The results obtained were analyzed, interpreted and presented in the form of figures and tables.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e1.\\u0026nbsp; \\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;Socio-demographic\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eand the clinical\\u003c/strong\\u003e \\u003cstrong\\u003echaracteristics of patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 58 hospitalized patients were contacted among surgical and gynaecology wards. Out of these, 57 were enrolled and 46 were sampled during the study period. The Table 1 illustrates the distribution of these participants according to socio-demographic and the clinical characteristics. The majority of the participants were women aged between [21-31] years old with a sex-ratio (0.43). The majority of participants were married (n= 33/46; 71.7%); most of them (n=26/46; 56.5%) lived in urban areas and had a secondary educational level (n=18/46; 39.1%).\\u0026nbsp;The factors associated with ESBL\\u003cem\\u003e-K. pneumoniae\\u003c/em\\u003e among with significant p-value patients were the wards (p-value=0.042), antibiotic consumption (p-value=0.019), length of hospitalization (p-value=0.001) and history of previous infection (Table 1).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.\\u0026nbsp; \\u0026nbsp;Description of medical equipment and hospital environment samples\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIn addition, 20 samples were collected from medical equipment mainly the oxygen mask (n=3), tweezers (n= 14),\\u0026nbsp;vacuum cleaners\\u0026nbsp;(n= 2)\\u0026nbsp;and Farabeuf retractors\\u0026nbsp;(n=1). A total of 25 samples were collected in hospital environment including bedsides table (n= 4), care cart (n=6) door handles (n=13) and\\u0026nbsp;cyalidic (n=2)\\u003cem\\u003e.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.\\u0026nbsp; \\u0026nbsp;Distribution of ESBL-\\u003cem\\u003eKlebsiella pneumoniae\\u0026nbsp;\\u003c/em\\u003eisolated from surgical patients,\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003emedical equipment and hospital environment\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe overall prevalence of\\u0026nbsp;ESBL-\\u003cem\\u003eK. pneumoniae\\u0026nbsp;\\u003c/em\\u003ein the study was\\u0026nbsp;20.87% (19/91).\\u0026nbsp;More specifically, of the 46 hospitalized patients who provided samples,\\u0026nbsp;23.9% (11/46)\\u0026nbsp;were positive for ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e. Out of the 20 samples collected from medical equipment including oxygen mask and tweezers, 5% (n=01/20) being positive for ESBL-K. \\u003cem\\u003epneumoniae\\u003c/em\\u003e. The frequency of\\u0026nbsp;ESBL-\\u003cem\\u003eK. pneumoniae\\u0026nbsp;\\u003c/em\\u003ein hospital environment\\u0026nbsp;was 28% (n=07/25). \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e4.\\u0026nbsp; \\u0026nbsp;Antimicrobial resistance profiles of ESBL-\\u003cem\\u003eK. pneumoniae\\u0026nbsp;\\u003c/em\\u003eisolates\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAntimicrobial resistance profiles of ESBL-\\u003cem\\u003eK. pneumoniae\\u0026nbsp;\\u003c/em\\u003erevealed an overall 100% resistance to\\u0026nbsp;amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime. It also shown a high resistance rates to gentamicin (89.4%) and meropenem (42.1%) (Figure 1). However, ciprofloxacin and chloramphenicol were the more susceptible antibiotics with 26.3% of resistance rates.\\u0026nbsp;The most common resistant patterns\\u0026nbsp;between\\u0026nbsp;three sources of samples was\\u0026nbsp;\\u003cstrong\\u003eAMC-CRO-CTX-CTR-MER-OF-LEV-CN-CHL\\u003c/strong\\u003e (5/32; 15.6%) with resistance to nine antibiotics tested during our study of different families: \\u0026beta;-lactamines, phenicols, aminoglycosides and fluoroquinolone. More specifically, resistance to\\u0026nbsp;\\u003cstrong\\u003eAMC-CRX-CTX-CTR-MER-LEV-CN-CHL\\u003c/strong\\u003e predominated in patients while in medical equipment and environment, \\u003cstrong\\u003eAMC-CRO-CTX-CTR-MER-OF-LEV-CN-CHL\\u003c/strong\\u003e was the most resistant antibiotic.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e5.\\u0026nbsp; \\u0026nbsp;Occurrence of\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026beta;\\u003c/strong\\u003e\\u003cstrong\\u003e-lactamase genes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAmong three\\u0026nbsp;\\u0026beta;-lactamase resistance genes screened,\\u0026nbsp;the leading \\u0026beta;-lactam resistance gene detected in patients, medical devices and environment was \\u003cem\\u003eb\\u003c/em\\u003e\\u003cem\\u003ela\\u003c/em\\u003e\\u003csub\\u003eCTX-M\\u003cem\\u003e\\u0026nbsp;\\u003c/em\\u003e\\u003c/sub\\u003e(65.6%)\\u0026nbsp;followed by\\u0026nbsp;\\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eTEM\\u0026nbsp;\\u003c/sub\\u003e(43.7%)\\u003cem\\u003e\\u003csub\\u003e\\u0026nbsp;\\u003c/sub\\u003e\\u003c/em\\u003eand \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eSHV\\u003c/sub\\u003e (25%).\\u0026nbsp;The distribution of these resistant genes is illustrated in Table 2 and Figure 2.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e6.\\u0026nbsp; \\u0026nbsp;Genotypic relatedness\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEnterobacterial Repetitive Intergenic Consensus fingerprints revealed the association between\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003eESBL-\\u003cem\\u003eK. pneumoniae\\u0026nbsp;\\u003c/em\\u003eisolated from surgical patients, hospital environment and medical equipment as illustrated in figure 3. The phylogenetic tree constructed revealed that ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e were grouped into one cluster. Two ESBL-\\u003cem\\u003eK. pneumoniae\\u0026nbsp;\\u003c/em\\u003eisolates (EV10A and EV10B) \\u0026nbsp;collected on bedside table from the surgery department shared 100% of similarity with another strain isolated after 21 days from a medical equipment (EQ3) within an\\u0026nbsp;operating theater. \\u0026nbsp;In addition, these batch of three isolates were MDR and harbored the same\\u0026nbsp;\\u0026beta;-lactamase genes (\\u003cem\\u003eb\\u003c/em\\u003e\\u003cem\\u003ela\\u003c/em\\u003e\\u003csub\\u003eCTX-M\\u003c/sub\\u003e and\\u0026nbsp;\\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eTEM\\u003c/sub\\u003e). Similar findings were observed where two isolates collected the same day from wound shared 100% of similarity with two MDR isolates (P4 and P7A) and harbored the same \\u0026beta;-lactamase genes. However, an ESBL-\\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e isolate from an hospitalized patient was not typable.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThe aim of this study was to perform the genotypic characterization and evidence the clonal dissemination of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e isolated from medical equipment, surgical patients and hospital environment at the Annex Regional Hospital of Dschang in the West region in Cameroon. The high incidence observed among the post-operative patients attending treatment room for dressing suggest to re-evaluate the antibiotic prophylaxis used in these services to reduce antimicrobial resistance level.\\u003c/p\\u003e \\u003cp\\u003eOur results revealed that prevalence of ESBL and MDR-\\u003cem\\u003eKp\\u003c/em\\u003e circulating among hospitalized patients 5 days after surgery with 23.9% (n\\u0026thinsp;=\\u0026thinsp;11/46) and 28.6% (13/46) respectively. Furthermore, these findings are similar to previous studies investigating ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e which reported a high ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e prevalence from the hospitalized patients in KwaZulu-Natal, South Africa (29%) in 2019 and Tertiary Care Hospital in Kurnool, India (17%) [13,15 ].\\u003c/p\\u003e \\u003cp\\u003eThe prevalence of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e among medical equipment (5%, n\\u0026thinsp;=\\u0026thinsp;1/20) and the hospital environment (20%, n\\u0026thinsp;=\\u0026thinsp;05/25) are higher than that reported in the hospital environment in two referral hospitals in Yaound\\u0026eacute;, Cameroon in 2015 where 2.02% (n\\u0026thinsp;=\\u0026thinsp;3/148) of \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e were detected in the hospital environment [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. This discrepancy could be explained by the fact that the hospitals level\\u0026rsquo;s following the health care level involved in this study was different and the biosecurity implemented in these hospitals were also different.\\u003c/p\\u003e \\u003cp\\u003eThe antimicrobial susceptibility profiles revealed that all ESBL\\u003cem\\u003e-Kp\\u003c/em\\u003e isolates were resistant to amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime. These results are higher than those obtained in Ghana in 2020 where the resistance rates of theses antibiotic families have increased over the years ranging from 80%, 74%, 69% and 65\\u0026ndash;100% respectively [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. The high resistance rates to gentamicin (89.4%) was also observed in our study. This is an agreement with several previous studies investigating on high prevalence of Multidrug Resistant Klebsiella Species and Evolution of antibiotic resistance of Enterobacteriaceae, where 75.7% and 72% of resistance rates to gentamicin were detected in the Yaound\\u0026eacute; university teaching hospital and Douala general hospital in Cameroon from 2005 to 2012 in 2015 and 2021, respectively [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. The high resistance rate to meropenem (42.1%) observed, is high compared to a study carried out in the Yaound\\u0026eacute; university teaching hospital where the resistance to meropenem among patients was 2.7% in February 2019 to July 2019 [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eCTX\\u0026minus;M\\u003c/sub\\u003e was the leading β-lactamase resistance genes detected among our isolates. This result is agreement with previous studies which demonstrated that \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eCTX\\u0026minus;M\\u003c/sub\\u003e is widely circulating in Africa [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. These results can also be explained by the fact that, ESBLs are likely disseminating in hospital environment through horizontal transfer mechanisms involving mobile genetic elements such as plasmids, transposons, and insertion sequences, carrying frequently these β-lactam resistance genes [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe clonal relatedness showed that ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e are likely circulating in this hospital setting reinforcing the need to strengthen infection prevention and control policy, instigate monitoring of HAI and antibiotic-resistant bacteria in healthcare settings, and heighten awareness on simple measures that can save lives [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eOur study has several limitations. First, the population studied was delicate so we were not able to obtain all the information sought from patients such as the antibiotics consumed before the operation. This prevented us from providing an exact prevalence of nosocomial infections due to ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e linked to the previous \\u0026szlig;-lactams usage. Second, in our geographical context, many people do not understand the importance of the \\u0026ldquo;One Health\\u0026rdquo; Approach in healthcare facilities and have not yet become aware of the impact of the emergence of ESBL on environmental interface. It was therefore became difficult to convince participants and healthcare workers of the importance of this study reducing thus our patient sample size which prevented us to determe meaningfully the risk factors for nosocomial infections.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eThis study reveals the high prevalence of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e among three interfaces. High clonal dissemination of ESBL-\\u003cem\\u003eKp\\u003c/em\\u003e has been demonstrated at the ARHD in the Western region, Cameroon. The principal risk factors were length of hospitalization, antibiotic consumption and history of previous infection as well as previous antibiotic treatment. The high incidence observed among the post-operative patients attending treatment room for dressing suggest to re-evaluate the antibiotic prophylaxis used in these services to reduce incidence of antimicrobial resistance. It is thus imperative to implement antimicrobial stewardship program and reinforce infection prevention and control coupled with strict hygiene measures in these wards in order to curb the dissemination of ESBL-\\u003cem\\u003eK. pneumoniae.\\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eARHD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eAnnex Regional Hospital of Dschang\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eAST\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eAntibiotic Susceptibility Test\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eERIC\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eEnterobacterial Repetitive Intergenic Consensus\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eESBL\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eExtended Spectrum β-lactamase\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eESBL-\\u003cem\\u003eKp\\u003c/em\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eExtended Spectrum β-lactamase \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHAI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHospital Acquired Infections\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHE\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHospital Environment\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eMDR\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMultidrug Resistance\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eMDR-\\u003cem\\u003eKp\\u003c/em\\u003e\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMultidrug Resistant \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eLMICs\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eLow Middle-Income Countries\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003e3GC\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eThird Generation Cephalosporin\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePCR\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePolymerase Chain Reaction\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSSIs\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eSurgical Site Infections\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research has been approved by the Regional Ethics Committee for Health Research for the Western region (N\\u0026deg;638/26/07/2023/CE/CRERSH-OU/VP) and the authorization of the Director of the Hospital under the number (159/AR/MSP/DRSPO/DSD/HDD). The study was approved by the Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI) under the number (N\\u0026deg; 004/06/22/LA/CEDBCAM-RI/DG). The study was conducted in accordance with the declaration of Helsinki. In addition, the research authorizations of the various healthcare structures have been granted. All methods and protocols used were approved by the CEDBCAM-RI in accordance with the relevant international guidelines and regulations for research laboratory ethics.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data are available upon request in accordance with confidentiality and privacy regulations from the corresponding author.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting of interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflict of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRaspail Carrel Founou received funding from the M\\u0026eacute;rieux Foundation, Lyon France for the CAREFOOD project. CAREFOOD project had supported all the molecular aspect of this study. This work was also supported by the Research Institute of the Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI).\\u0026nbsp;Dr Luria Founou received funding from the Thrasher Research Fund through the Thrasher Early Career Award (Award number 01364).\\u0026nbsp;The funders had no role in the study design, nor the decision to submit the work for publication. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors and affiliations \\u0026nbsp; \\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDepartment of Microbiology-Haematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAntimicrobial Research Unit, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa;\\u003c/p\\u003e\\n\\u003cp\\u003eAntimicrobial Resistance and Infectious Disease (ARID) Research Unit, Research Institute of Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI), Yaound\\u0026eacute;, Cameroon;\\u003c/p\\u003e\\n\\u003cp\\u003eReproductive, Maternal, Newborn and Child Health (ReMARCH) Research Unit, Research\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eInstitute of the Centre of Expertise and Biological Diagnostic of Cameroon (CEDBCAM-RI); Yaound\\u0026eacute;, Cameroon;\\u003c/p\\u003e\\n\\u003cp\\u003eBioinformatics \\u0026amp; Applied Machine Learning Research Unit, EDEN Biosciences Research Institute (EBRI), EDEN Foundation, Yaound\\u0026eacute; Cameroon;\\u003c/p\\u003e\\n\\u003cp\\u003eInfection \\u0026amp; Global Health Division, School of Medicine, University of St Andrews, St Andrews, United Kingdom;\\u003c/p\\u003e\\n\\u003cp\\u003eAnnex Regional Hospital of Dschang (ARHD), Dschang, Cameroon\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConceptualizatio\\u003c/strong\\u003en: TEN, RCF and BK; \\u003cstrong\\u003eMethodology\\u003c/strong\\u003e: RCF, LLF; \\u003cstrong\\u003eSoftware\\u003c/strong\\u003e: TEN, PLK; \\u003cstrong\\u003eValidation\\u003c/strong\\u003e: RCF, LLF and BK; \\u003cstrong\\u003eFormal analysis\\u003c/strong\\u003e: TEN, LLF, RCF; \\u003cstrong\\u003eInvestigation\\u003c/strong\\u003e: TEN, BDD, PLK, ADM, JRZ; \\u003cstrong\\u003eResources\\u003c/strong\\u003e: RCF, LLF and BK; \\u003cstrong\\u003eWriting original draft\\u003c/strong\\u003e: TEN and RCF; \\u003cstrong\\u003eReview and editing\\u003c/strong\\u003e: \\u0026nbsp;RCF, LLF, NM and BK; \\u003cstrong\\u003eVisualization\\u003c/strong\\u003e: TEN, PLK, RCF; \\u003cstrong\\u003eSupervision\\u003c/strong\\u003e: RCF, LLF, MN, BK; \\u003cstrong\\u003eProject administration\\u003c/strong\\u003e: RCF and LLF. All authors have read and agreed to the published version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe thank all staff members and participants of this healthcare facility who agreed to participate to this study.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eGiraldi G, Montesano M, Sandorfi F, Iachini M, Orsi GB. Excess length of hospital stay due to healthcare acquired infections: methodologies evaluation. 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BMC Infect Dis. 2019;19(1):205. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12879-019-3838-1\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12879-019-3838-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Lund O, Kibiki G, Aarestrup FM. Meta-analysis of proportion estimates of Extended-Spectrum-Beta-Lactamase-producing Enterobacteriaceae in East Africa hospitals. 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Emerg Infect Dis. 2009;15(3):472\\u0026ndash;4. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3201/eid1503.071637\\u003c/span\\u003e\\u003cspan address=\\\"10.3201/eid1503.071637\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003evon Wintersdorff CJ, Penders J, van Niekerk JM, Mills ND, Majumder S, van Alphen LB, et al. Dissemination of Antimicrobial Resistance in Microbial Ecosystems through Horizontal Gene Transfer. 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Expert Rev Anti-infect Ther 16. 2018. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/14787210.2018.1522249\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/14787210.2018.1522249\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1: Distribution of ESBL-\\u003cem\\u003eKlebsiella pneumoniae\\u0026nbsp;\\u003c/em\\u003eaccording to socio-demographic characteristics and the clinical characteristic of the participants\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"84%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 29%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eESBL-KP n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTerms\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFrequency n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=46\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNegative\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=35\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePositive\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eN=11\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSex\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e32 (69.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e26(74.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e6(54.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.493\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e14 (30.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e9(25.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e5(45.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge group\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026le;20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e03 (06.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e3(8.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.911\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e[21-31]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20 (43.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e14(40.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e6(54.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e[31-41]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e12 (26.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e9(25.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e3(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e[41-51]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e3 (06.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2(5.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e8 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e7(20.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMarital status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eSingle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e11 (23.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e8(22.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e3(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.850\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e33 (71.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e26(74.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e7(63.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eWidow\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (04.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e1(2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eResidence\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20 (43.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e15(42.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e5(45.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e26 (56.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20(57.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e6(54.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEducation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eIlliterate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (04.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e2(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.093\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003ePrimary school\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e5 (10.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e4(11.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eSecondary school\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e18 (39.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e15(42.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e3(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eUniversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e8 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e4(11.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e4(36.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eUnknown\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e13 (28.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e12(34.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLength of hospitalization\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;3 days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e25 (54.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e24(68.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e[3-5] days\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e9 (19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e5(14.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e4(36.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e1 week\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e4 (08.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e1(2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e3(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e2 weeks\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e6 (13.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e3(8.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e3(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e3 weeks\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (04.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2(5.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHospital wards\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eBloc 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e9 (19.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e8(22.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.042\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eBloc 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e5 (10.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e5(14.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eGynecology bloc\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e10 (21.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e9(25.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1(9.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eHospitalization ward\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (04.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e2(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eTreatment room\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20 (43.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e13(37.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e7(63.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSurgery types\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eMinor surgery\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e16 (34.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e13(37.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e3(27.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.454\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eMajor surgery\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e10 (21.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e6(17.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e4(36.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eGynecological surgery\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20 (43.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e16(45.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e4(36.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBehaviors with Antibiotic consumption\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20 (43.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e18(51.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e2(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"4\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.019\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eSelf-medication\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e4 (8.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2(5.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e2(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eSelf-medication and medical prescription\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (04.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e2(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eMedical prescription\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e20 (43.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e15 (42.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e5 (45.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026beta;\\u003c/strong\\u003e\\u003cstrong\\u003e-lactam intake before surgery\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e44 (95.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e33 (94.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e11 (100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.501\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (4.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e2 (5.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026beta;\\u003c/strong\\u003e\\u003cstrong\\u003e-lactam intake after \\u0026nbsp;surgery\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e36 (78.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e26 (74.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e10 (91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e0.547\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e10 (21.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e9 (25.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e1 (9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHistory of previous infection\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e24 (52.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e15 (42.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e9(81.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"3\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.009\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e6 (13.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e4 (11.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e2(18.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 19%;\\\"\\u003e\\n \\u003cp\\u003eUnknown\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e16 (34.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 15%;\\\"\\u003e\\n \\u003cp\\u003e16(45.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 14%;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2: Distribution of resistance genes among ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"522\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEnvironment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMedical devices\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePatients\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFrequency n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFrequency n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFrequency n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCTX-M\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e8(25.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e1(3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e12(37.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTEM\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e5(15.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e1(3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e8(25.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSHV\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e1(3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e0(0.0)%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e7(21.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 96px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal (N=32)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e14 (43.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e2(6.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 142px;\\\"\\u003e\\n \\u003cp\\u003e20(62.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Klebsiella pneumoniae, Medical devices, Hospital environments, Surgical patients, Cameroon\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5006261/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5006261/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eHospital-acquired infections (HAIs) caused by antibiotic resistant \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e are serious public health concern globally. Extended-spectrum β-lactamase-producing \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e (ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e) are major contributors to life-threatening HAIs especially in surgery and intensive care unit wards. Suboptimal hygiene measures and the non-existence of infection prevention control programs and policies contribute to the dissemination of ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e from the inanimate surfaces, medical devices, healthcare workers to hospitalized patients. This study aimed at determining the prevalence, genotypic characteristics and clonal relatedness of ESBL- \\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e isolated from surgical patients, medical devices and hospital environments at the Annex Regional Hospital of Dschang in the West region in Cameroon.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA cross-sectional study was conducted over a four-month period from February to May 2022. A total of 91 samples were collected from hospitalized patients (n\\u0026thinsp;=\\u0026thinsp;46), medical equipments (n\\u0026thinsp;=\\u0026thinsp;20) and hospital environments (n\\u0026thinsp;=\\u0026thinsp;25). Samples were cultured on Eosin Methylene Blue agar. After culture and biochemical identification with API 20E, antibiotic susceptibility testing was carried out using disc diffusion method on M\\u0026uuml;ller Hinton agar. ESBL phenotype was screening using ChromAgar\\u0026trade; ESBL (CHROMagar, Paris, France) coupled with double discs synergy test. In addition, the detection of resistance genes was done with Polymerase Chain Reaction (PCR) methods, while the clonal relatedness of isolates was performed using the Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR method.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe prevalences of ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e isolated from surgical patients was 23.9% (11/46). Only two \\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e were isolated from medical equipment of which one isolate was ESBL producer with 5% (n\\u0026thinsp;=\\u0026thinsp;01/20). The result of the hospital environment revealed 28% (07/25) were positive for ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e. High level of resistance (100%) to cefuroxime, amoxicillin-clavulanic acid, cefuroxime, ceftriaxone and cefotaxime were observed. In addition, the resistance rates to gentamicin and meropenem were (89.4%) and (42.1%) respectively. The leading β-lactam resistance gene detected was \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eCTX\\u0026minus;M\\u003c/sub\\u003e (65.6%) followed by \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eTEM\\u003c/sub\\u003e (43.7%) and \\u003cem\\u003ebla\\u003c/em\\u003e\\u003csub\\u003eSHV\\u003c/sub\\u003e (25%). The clonal relatedness revealed the likely circulation of ESBL-\\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e between wards and the hospital environment respectively.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eHospital environment remains a reservoir of ESBL-\\u003cem\\u003eK. pneumoniae\\u003c/em\\u003e in this hospital setting and could be transmitted to the hospitalized patients. It is therefore imperative, even very urgent, to implement stringent infection prevention and control measures to curb the dissemination of ESBL-\\u003cem\\u003eKlebsiella pneumoniae\\u003c/em\\u003e in hospital setting in West region.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Clonal Dissemination of Extended-Spectrum Beta-Lactamase (ESBL)- producing Klebsiella pneumoniae isolated from Medical devices and Hospital environments in the West region, Cameroon\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-10-18 06:53:12\",\"doi\":\"10.21203/rs.3.rs-5006261/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"857788ed-2254-4a73-9976-c2a2279a008d\",\"owner\":[],\"postedDate\":\"October 18th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-11-18T09:24:16+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-10-18 06:53:12\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5006261\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5006261\",\"identity\":\"rs-5006261\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}