Describing the bacterial resistance profile of paediatric laboratory specimens isolated in a resource limited setting

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Despite this alarming figure, the microorganism profile and their resistance pattern has not yet been widely studied in our setting till date. We aimed to identify commonly isolated bacteria and describe their antibiotic resistance pattern in Cameroon. METHODOLOGY: A retrospective cross-sectional study was conducted at Laquintinie Hospital Douala (LHD) on blood culture specimen collected from paediatric patients consulted at LHD over a 1-year period running from March 2021 to February 2022. Microbiological analysis was performed using the VITEK MD 2 compact automated machine. The reference for the interpretation of antibiotic susceptibility was the Antibiogram Committee of the French Society of Microbiology (CASFM) and the European committee EUCAST. RESULTS: We included 127 positive blood culture samples, that were mostly from neonates (n=52, 40.9%) with a mean age was 3.85 ± 5.55 years and a M/F sex ratio of 1.59. Klebsiella species (n=21, 16.5%) accounted for most isolates. Most isolates were extensively resistant (n=58, 45.7%), pan-resistant (n=30, 23.6%) and multi-drug resistant (n=28, 22.0%). Full sensitivity was only reported in eleven isolates (n=11, 8.7%). Isolates were sensitive to extended spectrum cephalosporins in 26.7% and Aminoglycosides in only 40.9% of cases. Pseudomonas luteola (n=1), Staphylococcus xylosus (n=1), Enterobacter dunanensis (n=1), Staphylococcus haemolyticus (n=2) exclusively exhibited pan-resistance profiles and were mostly found in neonates (n=2/5, 40%). CONCLUSION: Klebsiella spp. were the commonest isolates overall, although age-specific pathogens were identified. Only 8.7% of isolates exhibited full sensitivity at Laquintinie. This proportion is alarming and requires an urgent public health response. Paediatrics Bacterial resistance Cameroon Figures Figure 1 Figure 2 Key message The proportion of bacterial resistance in paediatric specimens is alarming in Cameroon and requires an urgent public health response. INTRODUCTION Infectious diseases are the leading cause of morbidity and mortality in developing countries. WHOs global report on antimicrobial resistance surveillance shows a two-fold increase in all case mortality[3]. This negatively impacts the health of the community and cost of health care. In WHO’s global action plan released in 2015, objectives that aimed at ensuring treatment and prevention of diseases with safe and effective medicine were outlined. Research into antimicrobial resistance pattern have reveal a constantly evolving phenomenon and this represents a threat to infection control of the ever-increasing range of infections as it reduces treatment options. It is crucial to conduct rapid microbiological investigations, which include antibiotic susceptibility testing (AST) and identification of the causal agent. 1) to modify antibiotic therapy and prevent ineffective treatment, 2) to narrow the antibiotic therapy's scope to prevent the spread of resistant strains, and 3) to reduce the toxicity and detrimental effects of some broad-spectrum antibiotics or combined therapy on helpful bacteria [4]. Antibiotic resistance is a major public health concern, particularly among children: according to WHO estimates, illness caused by multidrug resistant bacteria kills over 200,000 newborns. In Sub-Saharan Africa, antibiotic-resistant bacteria have been identified as the cause of 66% of infant sepsis and meningitis [5]. In 2019, Mouiche et al. demonstrated that, the level of resistance to commonly prescribed antibiotics was considerably high [6]. Antibiotic judicious utilization is crucial in order to reduce the development of antibiotic resistance in bacteria and extend the usable lifetime of effective antibiotics [7]. Despite all this, the microorganism profile and their resistance pattern has not yet been extensively studied in our setting till date. This study therefore set out to identify the bacteria commonly isolated from blood culture samples and describe their antibiotic resistance pattern. METHODOLOGY Study design and site: A retrospective cross-sectional study was conducted at Laquintinie Hospital Douala (LHD) on routine specimen collected from paediatric patients consulted at LHD over a 1-year period running from March 2021 to February 2022. LHD is located in Douala, the economic capital of Cameroon. It is a tertiary hospital with an inpatient capacity of 712 beds and has several departments that include the laboratory, internal medicine, surgery, paediatrics, and obstetrics and gynaecology. The laboratory comprises six specialized units: the clinical biology unit, virology unit, blood bank unit, HIV care unit, emergency/respiratory diseases unit, and the quality control unit, each overseen by a medical biologist with a total staff of 130 personnel, ranging from laboratory assistants to medical biologists. The clinical biology unit is further divided into six subunits: bacteriology unit, serology unit, parasitology unit, biochemistry unit, haematology unit, and the phlebotomy unit. Specifically, the bacteriology unit operates with seven personnel; three regular staff members work daily shifts, while four personnel follow a predetermined schedule to handle and analyse bacteriological specimens round the clock. The LHD laboratory participates in a bacteriology quality control program and has been accredited by the African Society for Laboratory Medicine (ASLM) [8,9]. Eligibility criteria: This study included all culture specimens collected during the study period from patients aged less than 18 years. Information on the patient’s gender, age, culture result (growth versus no growth on suitable media) needed to be available for all cases prior to inclusion. For cultures that reported growths, the name of the organism identified, and antibiotic susceptibility testing results on at least one antibiotic in each of the five antibiotic classes of interest (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were required prior to inclusion. Only susceptibility testing for bacteria isolates was of interest and susceptibility testing of other isolated organisms like fungi, parasites or viruses were not analysed. Furthermore, cases where any isolated organism was recorded without a species name, and or had incomplete information (i.e., lack of age, and gender of patient, and sample type) were excluded from the study. Procedure for microbiological culture, Identification and Antimicrobial susceptibility profile : The Microbiological analysis involved using VITEK MD 2 compact (Biomérieux, France) for specimen identification and antibiotics susceptibility. After isolation by using specific media related to specimen collected. The Antibiogram Committee of the French Society of Microbiology (CASFM) and the European committee EUCAST [1] were used as reference guidelines for the interpretation of antibiotic susceptibility, which classifies susceptibility as follows: Resistant: There is a high likelihood of therapeutic failure regardless of the type of therapy or antibiotic dosage utilized. Sensitive at standard dose (susceptible): A high likelihood of therapeutic effectiveness if systemic or oral medication is administered at conventional doses. Sensitive to high dose: There is a high likelihood of therapeutic effectiveness ONLY when systemic therapy with a high dosage is used or when the antibiotic concentrates at the site of infection. The concurrent use of the EUCAST and CASFM was justified by the diverse epidemiological landscape and varying resistance profiles in the region. This approach allowed healthcare professionals to benefit from a global perspective while also considering local resistance patterns, enabling more effective and tailored antibiotic treatment decisions [2]. For the purpose of this study, antibiotics that were tested twice or less per isolated species were not reported. Furthermore, antibiotics to which isolates have natural resistance were also excluded. This includes, but is not limited to, Ticarcillin for Klebsiella species; Cefalotin, Cefoxitin, Cefalexin, Amoxicillin and Clavulanic acid for Enterobacter species, Trimethoprim Sulfamethoxazole for Pseudomonas species etc. Antibiotic protocol: At Laquintinie, neonatal infections are managed with a combination of Cefotaxime and gentamicin as first line regimen, Ceftazidime and Vancomycin as second line, and Ofloxacin/Ciprofloxacin and Imipenem/Meropenem as third line regimen. In older paediatric patients, first line regimen is usually Amoxicillin and Clavulanic acid in case of bacterial upper or lower respiratory tract infections. In case of sepsis from other organs however, a combination of Ceftriaxone and Gentamicin is used. Second- and third-line regimens are same as for neonates. Addition of Metronidazole is common in case of suspected anaerobic gastrointestinal infection. Data collection and analysis: Data was collected from the laboratory registers and eligibility checking was performed. Information such as age, gender, name of the organism and the antibiotic susceptibility were collected. The collected data was entered, assorted, and coded using Microsoft Excel 2020 and then exported to Statistical Package for Social Science (SPSS) version 23 for analysis. Descriptive statistics was used to describe our data. Microsoft Excel 2020. Definition of operational terms Multi-drug resistance: A bacterial isolate was considered to be multi-drug resistant if it was found to be non-susceptible to at least one agent in three or more antimicrobial classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam)[10]. Extensively drug resistance: A bacterial isolate was considered to be extensively drug resistant if it was found to be non-susceptible to at least one agent in all but two or fewer antimicrobial classes[10]. Pan-resistance: A bacterial isolate was considered to be pan-resistant if it was found to be non-susceptible to all agents in all antimicrobial classes tested [10]. Paediatric age groups: patients were referred to as neonates if aged < 30 days, infants if aged 1-11 months, early childhood if aged 1-5 years, middle childhood if aged 6-11 years and adolescents if aged 12-17 years. Extended spectrum cephalosporins: ceftazidime, cefotaxime, cefdinir, cefditoren, cefetamet, cefotiam, cefixime, ceftriaxone. Fluoroquinolones: tosufloxacin, ciprofloxacin, pefloxacin, ofloxacin, levofloxacin Carbapenems: tetrapenem, feropenem, ertapenem, imipenem, and meropenem Aminoglycosides: Gentamicin, amikacin, Tobramycin Ethical consideration: This was a retrospective study that analyzed secondary data generated from routine laboratory specimens from both adult and pediatric departments at Laquintinie Hospital Douala. There was no human interaction, and no personal identifiers were included in the study, ensuring confidentiality and anonymity. (i) The study was approved by the Institutional Review Board of Laquintinie Hospital Douala who equally waived the need for informed consent due to retrospective nature of the study. (ii) All procedures were conducted in accordance with the relevant guidelines and regulations pertaining to the use of anonymized secondary data. RESULTS Study population We analysed samples from 1050 individuals. From these, a total of 529 blood culture results were explored, and only positive results (n=313) were further analysed. We excluded isolates with incomplete sensitivity analysis (n=186), and our final population was 127 blood samples with identified isolates. Our study population was mostly constituted of neonates (n=52, 40.9%) followed by patients in early childhood (n=26, 20.5%), adolescence (n=19, 14.9%), infancy (n=15, 11.8%), and middle childhood (n=15, 11.8%). The mean age was 3.85 ± 5.55 years. The median age was 0.46 years (IQR 0.01-6.25 years) with a range from 1 day of life to 17 years. Males were predominant (n=78, 61.4%), with a M/F sex ratio of 1.59 as shown in in Table I below. Bacterial isolates identified The five most commonly isolated bacteria from blood culture were Escherichia coli (n=19, 14.9%), Acinetobacter baumannii (n=17, 13.4%), Burkholderia cepacia (n=16, 12.6%), Klebsiella pneumoniae (n=14, 11.0%) and Staphylococcus aureus (n=11, 8.7%) as shown in in Table II below. The most commonly identified pathogen in neonates was Escherichia coli (n=9/51, 17.6%) , in infants, was Acinetobacter baumannii (n=5/18, 27.8%), in early childhood, was Staphylococcus aureus (n=5/27, 18.5%), and in middle childhood, was Klebsiella pneumoniae (n=3/15, 20%). In adolescence, Escherichia coli, Acinetobacter baumannii , and Klebsiella pneumoniae each had the same prevalence (n=3/19, 15.8% each) as shown in Table III. When analysed by species, Klebsiella pneumoniae, Klebsiella oxytoca and Klebsiella planticola representing the Klebsiella species (n=21, 16.5%) accounted for most isolates in paediatric patients at LHD. Susceptibility of pathogens to selected antibiotics. Most isolates were resistant to tested antibiotics: extensively resistant (n=58, 45.7%), pan-resistant (n=30, 23.6%) and multi-drug resistant (n=28, 22.0%). Full sensitivity was only reported in eleven isolates (n=11, 8.7%). The proportion of fully sensitive bacteria was highest amongst infants (n=2/15, 13.3%), followed by early childhood (n=3/26, 11.5%), adolescents (n=2/19, 10.5%), and neonates (n=4/52, 7.7%), and least in middle childhood with no isolated bacteria exhibiting full sensitivity as shown in Table I. Amongst the top five isolates, Escherichia coli (n=15/19, 78.9%), Acinetobacter baumannii (13/17, 76.5%) and Klebsiella pneumoniae (n=12/15, 80%) were most sensitive to carbapenems, while Burkholderia cepacia was most sensitive to extended spectrum cephalosporins (n=8/16. 50%) and Staphylococcus aureus to fluoroquinolones (4/11, 36.4%) as depicted in Table IV. Pan-resistance was observed in thirty (n=30, 23.6%) bacterial isolates with five (n=5) isolates only reporting pan-resistant profiles, namely: Pseudomonas luteola (n=1), Staphylococcus xylosus (n=1), Enterobacter dunanensis (n=1), Staphylococcus haemolyticus (n=2) as depicted in Figure 1. Two of these five pan-resistant isolates were found exclusively in neonates (n=2/5, 40%). According to the individual sensitivity profile in our study, isolates were sensitive to extended spectrum cephalosporins in 26.8% (n=34/127) and Aminoglycosides in only 40.9% of cases. Eight Staphylococcus aureus isolates (n=8/11, 72.7%) were Vancomycin-Resistant Staphylococcus aureus (VRSA). No Vancomycin-Resistant Enterococci (VRE) were reported in the two Enterococci isolates identified. Three Klebsiella pneumoniae isolates (n=3/15, 20%) were Carbapenem-Resistant Klebsiella pneumoniae (CRKP). Fourteen Enterobacteriaceae isolates (n=14/51, 25.5%) were found to be Carbapenem-Resistant Enterobacteriaceae (CRE). Pseudomonas aeruginosa with Multidrug Resistance was reported in one isolate (n=1/3, 33.3%). Acinetobacter baumannii with Multidrug Resistance was reported in four isolates (4/17, 33.3%). These findings are represented in Figure 2. DISCUSSION Our investigation into the microbial landscape of paediatric bloodstream infections at a second-category hospital in Cameroon reveals a pressing public health concern regarding antibiotic resistance. With a study population with mean age of 3.85 ± 5.55 years and a notable male predominance (M/F ratio of 1.59), our study provides a snapshot of the microbial threats and resistance patterns in the context of a developing world. The distribution of pathogens across different paediatric age groups was notably distinct. Neonates, comprising 40.9% of our sample, were most commonly infected with Escherichia coli (17.3%) as previously reported by other authors [11]. This probably reflects the immature immune system and higher exposure to vertical transmission from mothers or nosocomial transmission in hospitals in neonates. However, the notable absence of Group B streptococcus (GBS) in our sample calls for attention, especially as highest worldwide incidence of invasive GBS disease has previously been reported in Africa at 1.12 cases per 1000 live births [12]. This may be due to the lower prevalence (12.3% vs 18% worldwide) of GBS colonisation and the use of prophylactic antibiotics in 70% of GBS positive mothers in Cameroon [13,14]. Another possible explanation lies in the fact that not all patients hospitalised in African settings have blood cultures done before antibiotic therapy as some authors have reported 70% antibiotic use in neonates but only 6% blood culture use [15]. The absence of usually reported isolates like Streptococcus pneumoniae, Streptococcus pyogenes, and Salmonella Typhi probably stems from this lack of investigations and possible bias in sample selection. Nonetheless, this study findings highlights the need for policy changes in Cameroon to increase blood culture rates before antibiotic administration to better reflect local epidemiological data. Acinetobacter baumannii, the most virulent of all Acinetobacter species, with its most common and lethal clinical presentation being nosocomial pneumonia was the leading pathogen in infants [16]. On the other hand, Staphylococcus aureus dominated in childhood, probably as children might have more frequent skin breaches and poor hand hygiene [17]. This age-specific pathogen prevalence suggests that empirical treatment should be tailored according to the predominant bacteria in each age group. As our study utilised only one culture per patient, results may underestimate the true burden of infections in our population as some authors have reported that detection rate may increase by up to 19% after a second culture rather than a single one [18]. The resistance patterns we observed were alarming, with only a mere 6.9% isolates fully sensitive to the antibiotics tested. Though commonly reported that Burkholderia cepacia isolates rarely exhibit full sensitivity, an unexpected finding was their high sensitivity to extended spectrum cephalosporins (50%), which is probably linked to sensitivity to Ceftazidime, the only antibiotic in this antibiotic class to have reported activity to this isolate [19]. Klebsiella species, which were the most frequently isolated overall, showed a high rate of pan-resistance (15.4%), corroborating international reports that emphasize the emergence of highly resistant strains in clinical settings [20–25]. Despite high sensitivity rates to carbapenems among commonly MDR isolates, the overall effectiveness of these last-resort antibiotics was compromised by the presence of CRKP and CRE, at 20% and 25.5% respectively. This resistance threatens the effectiveness of carbapenems, particularly in neonatal units where the highest proportion of pan-resistant bacteria was found. The sensitivity to extended-spectrum cephalosporins was only 26.8%, and to aminoglycosides, it was 40.9%. These low figures are particularly concerning given that these antibiotics are often the first line therapies in treating paediatric infections. The observed resistance rates are consistent with previous studies from other regions highlighting the global challenge of treating infections with standard therapy [26,27]. The high resistance rates observed necessitate a shift from empirical to targeted antibiotic therapy based on susceptibility testing. Current treatment protocols at Laquintinie Hospital, including the use of cefotaxime and gentamicin as first-line treatments for neonatal infections, need urgent reassessment. The study's findings also call into question the sustainability of using ceftazidime, vancomycin, or fluoroquinolones as second and third-line treatments in scenarios where resistance is rampant. Cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, and imipenem-relabactam have the best support evidence for use in patients with MDR infections [33], however, these antibiotics are not readily available in Cameroon and makes curative approach to MDR challenging. The predominance of resistant strains especially in vulnerable neonates, poor access to medications and potential increased cost of care due to MDR pathogens, underscores the need for heightened preventive measures such as stringent infection control measures, including hand hygiene, and the promotion of antibiotic stewardship [28,29]. The type of bacteria isolated may suggest a high prevalence of nosocomial infections, and suggests that hospitals should prioritize hygiene protocols and limit the spread of resistance through environmental and procedural controls [30–32]. While our study provides a baseline for understanding local resistance patterns, its retrospective and monocentric design limits broader implications. The absence of certain antibiotics in our testing panels might have led to an underestimation of resistance. Moreover, this study carries a potential for selection bias as patients with missing information or those with incomplete bacterial identification were excluded from analysis. Nonetheless, this is the first study that explored resistance profile of isolates collected from paediatric specimen in Cameroon and serves as a baseline study. Future studies should incorporate a prospective, multicentre approach to validate these findings, assess clinical outcomes, and explore the efficacy of alternative treatment strategies or novel antibiotics. Additionally, research into the mechanisms of resistance could inform the development of new therapeutic options. CONCLUSION This study highlights a critical scenario in which pediatric bacterial infections in Cameroon would become increasingly hard to treat in light of widespread antibiotic resistance. The high prevalence of Klebsiella species coupled with high resistance to first-line medications necessitates urgent public health actions such as revising treatment protocols, enhancing infection control, and possibly researching new alternatives or preventive methods to address the impending threat of antimicrobial resistance in paediatric infections. Further exploration into the molecular mechanisms of resistance, clinical outcomes associated with these resistance patterns, and the long-term impact on paediatric health is important. Hospital and community-level interventions to curb the spread of resistance will be crucial in ensuring effective treatment options for generations to come. Declarations Competing interests The authors declare no potential conflicts of interest. Funding No funding was received for this study. Consent for publication: Not applicable Ethical approval and informed consent: Ethical clearance was not requested for this research, as it is retrospective in nature and involved anonymized (non-identifiable) laboratory data. Principles of respect for persons, beneficence, and justice were respected. Informed consent was not applicable. Availability of data and materials The data that support the findings of this study are available from the corresponding author, EMM, upon reasonable request. Authors' contributions Study concept and design: EENL, CEE and CIM. Data collection: EENL. Analysis and interpretation of data: EMM. Drafting of the manuscript: EMM. Critical revision of the manuscript: EENL, CEE, CIM, EMM, RA, NSVN, YDP, PE, HI, and DA. DA supervised the study. EENL, CEE and EMM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors agreed to submit the manuscript in its current form. Acknowledgement: The authors thank the administration of the hospital for permitting us to conduct this research. The authors also thank the hospital personnel for collaborating with us to ease data collection. Consent to Participate declaration: Not applicable. ORCID IDs Eposse Ekoube Charlotte: https://orcid.org/0000-0002-0451-6616 Mandeng Ma Linwa Edgar: https://orcid.org/0000-0002-4058-3509 References Díaz SGN, Robles OA, Moya JMGL. New definitions of susceptibility categories EUCAST 2019: clinic application. Rev. Esp. Quimioter. 2022;35:84–8. Katawa G, Agbemanyole KA, Tchopba CN, Ataba E, Amessoudji MO, Ameyapoh AH, et al. Antimicrobial susceptibility testing: Evaluation of the conformity of 3 medical bacteriology laboratories of Togo according to EUCAST/CA-SFM guidelines. J. Appl. Biosci. 2021;162:16795–803. WHO report shows rising antibiotic resistance, need for better data | CIDRAP [Internet]. 2022 [cited 2023 May 27];Available from: https://www.cidrap.umn.edu/antimicrobial-stewardship/who-report-shows-rising-antibiotic-resistance-need-better-data Opota O, Croxatto A, Prod’hom G, Greub G. Blood culture-based diagnosis of bacteraemia: state of the art. Clin. Microbiol. Infect. 2015;21:313–22. Okomo U, Akpalu ENK, Le Doare K, Roca A, Cousens S, Jarde A, et al. Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines. Lancet Infect. Dis. 2019;19:1219–34. Mouiche MMM, Moffo F, Akoachere JFTK, Okah-Nnane NH, Mapiefou NP, Ndze VN, et al. Antimicrobial resistance from a one health perspective in Cameroon: a systematic review and meta-analysis. BMC Public Health 2019;19:1135. Goossens H. Antibiotic consumption and link to resistance. Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis. 2009;15 Suppl 3:12–5. Maruta T, Motebang D, Mathabo L, Rotz PJ, Wanyoike J, Peter T. Impact of mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Afr. J. Lab. Med. 2012;1:6. Vounba P, Loul S, Tamadea LF, Siawaya JFD. Microbiology laboratories involved in disease and antimicrobial resistance surveillance: Strengths and challenges of the central African states. Afr. J. Lab. Med. 2022;11:1570. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012;18:268–81. Stoll BJ, Puopolo KM, Hansen NI, Sánchez PJ, Bell EF, Carlo WA, et al. Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies. JAMA Pediatr. 2020;174:e200593. Madrid L, Seale AC, Kohli-Lynch M, Edmond KM, Lawn JE, Heath PT, et al. Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am. 2017;65:S160–72. Russell NJ, Seale AC, O’Driscoll M, O’Sullivan C, Bianchi-Jassir F, Gonzalez-Guarin J, et al. Maternal Colonization With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am. 2017;65:S100–11. Subramaniam A, Blanchard CT, Ngek ESN, Mbah R, Welty E, Welty T, et al. Prevalence of group B streptococcus anogenital colonization and feasibility of an intrapartum screening and antibiotic prophylaxis protocol in Cameroon, Africa. Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet. 2019;146:238–43. Murless-Collins S, Kawaza K, Salim N, Molyneux EM, Chiume M, Aluvaala J, et al. Blood culture versus antibiotic use for neonatal inpatients in 61 hospitals implementing with the NEST360 Alliance in Kenya, Malawi, Nigeria, and Tanzania: a cross-sectional study. BMC Pediatr. 2023;23:568. Wong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B, Spellberg B. Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clin. Microbiol. Rev. 2016;30:409–47. Cassat JE, Thomsen I. Staphylococcus aureus infections in children. Curr. Opin. Infect. Dis. 2021;34:510–8. Zalmanovich A, Temkin E, Biran D, Carmeli Y. The Yield of One vs. Two Blood Cultures in Children: Under-Detection and Over-Testing. Antibiotics 2024;13:113. Schaumburg F, Idelevich EA, Mellmann A, Kahl BC. Susceptibility of Burkholderia cepacia Complex to Ceftazidime/Avibactam and Standard Drugs of Treatment for Cystic Fibrosis Patients. Microb. Drug Resist. Larchmt. N 2022;28:545–50. Avgoulea K, Di Pilato V, Zarkotou O, Sennati S, Politi L, Cannatelli A, et al. Characterization of Extensively Drug-Resistant or Pandrug-Resistant Sequence Type 147 and 101 OXA-48-Producing Klebsiella pneumoniae Causing Bloodstream Infections in Patients in an Intensive Care Unit. Antimicrob. Agents Chemother. 2018;62:e02457-17. Havan M, Kendirli T, Parlar ÖT, Özcan S, Yahşi A, Erat T, et al. Clinical Management of a Pandrug-Resistant OXA-48 Klebsiella pneumoniae Infection in the Pediatric Intensive Care Unit. Microb. Drug Resist. 2023;29:256–62. Lázaro-Perona F, Sotillo A, Troyano-Hernáez P, Gómez-Gil R, de la Vega-Bueno Á, Mingorance J. Genomic path to pandrug resistance in a clinical isolate of Klebsiella pneumoniae. Int. J. Antimicrob. Agents 2018;52:713–8. Longo LGA, de Sousa VS, Kraychete GB, Justo-da-Silva LH, Rocha JA, Superti SV, et al. Colistin resistance emerges in pandrug-resistant Klebsiella pneumoniae epidemic clones in Rio de Janeiro, Brazil. Int. J. Antimicrob. Agents 2019;54:579–86. Sieswerda E, van den Brand M, van den Berg RB, Sträter J, Schouls L, van Dijk K, et al. Successful rescue treatment of sepsis due to a pandrug-resistant, NDM-producing Klebsiella pneumoniae using aztreonam powder for nebulizer solution as intravenous therapy in combination with ceftazidime/avibactam. J. Antimicrob. Chemother. 2020;75:773–5. Zowawi HM, Forde BM, Alfaresi M, Alzarouni A, Farahat Y, Chong TM, et al. Stepwise evolution of pandrug-resistance in Klebsiella pneumoniae. Sci. Rep. 2015;5:15082. Belizán JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, et al. Neonatal death in Low-Middle Income Countries: A Global Network Study. Am. J. Perinatol. [Internet] 2012 [cited 2023 Aug 29];29:649–56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337792/ Milton R, Gillespie D, Dyer C, Taiyari K, Carvalho MJ, Thomson K, et al. Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study. Lancet Glob. Health [Internet] 2022 [cited 2023 Aug 29];10:e661–72. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00043-2/fulltext Lee CR, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int. J. Environ. Res. Public. Health 2013;10:4274–305. Mathur P. Prevention of Healthcare-Associated Infections in Low- and Middle-Income Countries: The ‘Bundle Approach.’ Indian J. Med. Microbiol. [Internet] 2018 [cited 2023 Aug 29];36:155–62. Available from: https://www.sciencedirect.com/science/article/pii/S0255085720304795 Saleem AF, Ahmed I, Mir F, Ali SR, Zaidi AK. Pan-resistant Acinetobacter Infection in Neonates in Karachi, Pakistan. J. Infect. Dev. Ctries. 2010;4:030–7. Hassuna NA, AbdelAziz RA, Zakaria A, Abdelhakeem M. Extensively-Drug Resistant Klebsiella pneumoniae Recovered From Neonatal Sepsis Cases From a Major NICU in Egypt. Front. Microbiol. 2020;11:1375. Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern. Health Neonatol. Perinatol. 2017;3:5. Windham S, Kollef MH. How to use new antibiotics in the therapy of serious multidrug resistant Gram-negative infections? Curr. Opin. Infect. Dis. 2022;35:561–7. Tables Table I Distribution of gender and age groups based on pattern of resistance of bacteria isolated from blood culture specimen of paediatric patients at Laquintinie Hospital Douala from March 2021 to February 2022 Fully sensitive Multidrug resistance Extensively drug resistance Pan-resistance Total Male 5 16 37 20 78 Female 6 12 21 10 49 Total 11 28 58 30 127 Neonate less than one month 4 14 20 14 52 Infant 1-11 months 2 2 9 2 15 Early Childhood 1-5 years 3 3 12 8 26 Middle Childhood 6-11 years 0 5 7 3 15 Adolescence 2 4 10 3 19 Total 11 28 58 30 127 Table II: Distribution of individual bacterium isolated from blood culture specimen of paediatric patients based on pattern of resistance at Laquintinie Hospital Douala from March 2021 to February 2022. Isolated bacterium Fully sensitive Multidrug resistance Extensively drug resistance Pan-resistance Total Escherichia coli 2 7 9 1 19 Acinetobacter baumannii 4 4 7 2 17 Burkholderia cepacia 0 0 12 4 16 Klebsiella pneumoniae 1 6 7 1 15 Staphylococcus aureus 0 0 5 6 11 Staphylococcus pseudintermedius 0 0 1 6 7 Klebsiella oxytoca 1 2 0 2 5 Enterobacter cloacae 1 1 3 0 5 Salmonella enterica 0 4 0 0 4 Ralstonia mannitolilytica 0 0 2 1 3 Pseudomonas aeruginosa 1 1 1 0 3 Staphylococcus haemolyticus 0 0 0 2 2 Pantoea agglomerans 0 0 2 0 2 Chryseobacterium oryzihabitans 0 1 1 0 2 Shigella dysenteriae 0 0 2 0 2 Tatumella ptyseos 1 0 0 1 2 Enterobacter aminigenus 0 0 1 0 1 Cronobacter sakazakii 0 0 1 1 2 Enterococcus faecalis 0 0 1 0 1 Enterobacter dunanensis 0 0 0 1 1 Staphylococcus xylosus 0 0 0 1 1 Bordetella enterica 0 1 0 0 1 Enterococcus faecium 0 0 1 0 1 Klebsiella planticola 0 1 0 0 1 Raoultella aerogenes 0 0 1 0 1 Achromobacter xylosoxidans 0 0 1 0 1 Pseudomonas luteola 0 0 0 1 1 Total 11 28 58 30 127 Table III: Distribution of individual bacterium isolated from blood culture specimen of paediatric patients based on age group at Laquintinie Hospital Douala from March 2021 to February 2022. Isolated bacterium Neonates Infants Early Childhood Middle Childhood Adolescence Total Escherichia coli 9 1 4 2 3 19 Acinetobacter baumannii 6 5 1 2 3 17 Burkholderia cepacia 6 3 4 1 2 16 Klebsiella pneumoniae 7 1 1 3 3 15 Staphylococcus aureus 3 2 5 0 1 11 Staphylococcus pseudintermedius 3 1 1 1 1 7 Klebsiella oxytoca 4 0 1 0 0 5 Enterobacter cloacae 3 0 1 0 1 5 Salmonella enterica 0 0 1 2 1 4 Ralstonia mannitolilytica 0 0 2 0 1 3 Pseudomonas aeruginosa 2 0 1 0 0 3 Staphylococcus haemolyticus 1 0 0 1 0 2 Pantoea agglomerans 1 1 0 0 0 2 Chryseobacterium oryzihabitans 1 0 1 0 0 2 Shigella dysenteriae 0 0 0 1 1 2 Tatumella ptyseos 1 0 1 0 0 2 Enterobacter aminigenus 0 0 1 0 0 1 Cronobacter sakazakii 0 0 1 1 0 2 Enterococcus faecalis 1 0 0 0 0 1 Enterobacter dunanensis 0 1 0 0 0 1 Staphylococcus xylosus 1 0 0 0 0 1 Bordetella enterica 0 0 0 0 1 1 Enterococcus faecium 1 0 0 0 0 1 Klebsiella planticola 0 0 0 0 1 1 Raoultella aerogenes 1 0 0 0 0 1 Achromobacter xylosoxidans 1 0 0 0 0 1 Pseudomonas luteola 0 0 0 1 0 1 Total 52 15 26 15 19 127 Table IV: Distribution of individual bacterium isolated from blood culture specimen of paediatric patients based on age group at Laquintinie Hospital Douala from March 2021 to February 2022. Isolated bacterium Extended spectrum cephalosporins Aminoglycosides Fluoroquinolones Piperacillin-tazobactam Carbapenems Total Escherichia coli 6 11 9 5 15 19 Acinetobacter baumannii 5 8 9 6 14 17 Burkholderia cepacia 8 0 2 1 4 16 Klebsiella pneumoniae 2 11 5 4 12 15 Staphylococcus aureus 0 3 4 0 0 11 Staphylococcus pseudintermedius 0 1 0 0 0 7 Klebsiella oxytoca 1 3 3 2 3 5 Enterobacter cloacae 2 3 4 1 2 5 Salmonella enterica 3 3 3 1 4 4 Ralstonia mannitolilytica 1 0 1 0 1 3 Pseudomonas aeruginosa 1 2 2 2 3 3 Staphylococcus haemolyticus 0 0 0 0 0 2 Pantoea agglomerans 0 0 1 0 1 2 Chryseobacterium oryzihabitans 1 1 1 1 1 2 Shigella dysenteriae 2 0 0 0 1 2 Tatumella ptyseos 1 1 1 1 1 2 Enterobacter aminigenus 0 1 0 0 1 1 Cronobacter sakazakii 0 1 0 0 1 2 Enterococcus faecalis 0 1 1 0 0 1 Enterobacter dunanensis 0 0 0 0 0 1 Staphylococcus xylosus 0 0 0 0 0 1 Bordetella enterica 1 0 1 1 1 1 Enterococcus faecium 0 1 0 0 0 1 Klebsiella planticola 0 1 1 0 1 1 Raoultella aerogenes 0 1 0 0 1 1 Achromobacter xylosoxidans 0 0 1 1 0 1 Pseudomonas luteola 0 0 0 0 0 1 Total 34 52 49 26 67 127 Additional Declarations No competing interests reported. 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Medicine and Pharmaceutical Sciences, University of Douala","correspondingAuthor":false,"prefix":"","firstName":"Charlotte","middleName":"Eposse","lastName":"Ekoube","suffix":""},{"id":443010168,"identity":"ad984ccb-19ae-11f0-91e4-06cc9d20a69f","order_by":2,"name":"Christiane Ingrid Medi","email":"","orcid":"","institution":"Faculty of Medicine and Biomedical Sciences, University of Yaounde","correspondingAuthor":false,"prefix":"","firstName":"Christiane","middleName":"Ingrid","lastName":"Medi","suffix":""},{"id":443010169,"identity":"b5a2d62e-19ae-11f0-91e4-06cc9d20a69f","order_by":3,"name":"Edgar Mandeng Ma 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10:42:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4200037/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4200037/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80727222,"identity":"9ae69b6b-7536-45d1-bd69-4200e647654f","added_by":"auto","created_at":"2025-04-16 12:00:04","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1964503,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4200037/v1/9529fde7a75122a8cd353b6b.jpg"},{"id":80727220,"identity":"beb458b0-f1b8-43ca-9610-90af272ef7bd","added_by":"auto","created_at":"2025-04-16 12:00:04","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":320857,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4200037/v1/4847d6a24ec97a4d9001ee9d.jpg"},{"id":80727988,"identity":"4e098856-c7e6-455f-aca8-51a588f399f6","added_by":"auto","created_at":"2025-04-16 12:08:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3304760,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4200037/v1/55134123-9b6c-474f-aa58-38ebb36d739f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Describing the bacterial resistance profile of paediatric laboratory specimens isolated in a resource limited setting","fulltext":[{"header":"Key message","content":"\u003cp\u003eThe proportion of bacterial resistance in paediatric specimens is alarming in Cameroon and requires an urgent public health response.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eInfectious diseases are the leading cause of morbidity and mortality in developing countries. \u0026nbsp;WHOs global report on antimicrobial resistance surveillance shows a two-fold increase in all case mortality[3]. This negatively impacts the health of the community and cost of health care. In WHO\u0026rsquo;s global action plan released in 2015, objectives that aimed at ensuring treatment and prevention of diseases with safe and effective medicine were outlined. Research into antimicrobial resistance pattern have reveal a constantly evolving phenomenon and this represents a threat to infection control of the ever-increasing range of infections as it reduces treatment options. It is crucial to conduct rapid microbiological investigations, which include antibiotic susceptibility testing (AST) and identification of the causal agent. 1) to modify antibiotic therapy and prevent ineffective treatment, 2) to narrow the antibiotic therapy\u0026apos;s scope to prevent the spread of resistant strains, and 3) to reduce the toxicity and detrimental effects of some broad-spectrum antibiotics or combined therapy on helpful bacteria [4].\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic resistance is a major public health concern, particularly among children: according to WHO estimates, illness caused by multidrug resistant bacteria kills over 200,000 newborns. In Sub-Saharan Africa, antibiotic-resistant bacteria have been identified as the cause of 66% of infant sepsis and meningitis [5]. In 2019, Mouiche et al. demonstrated that, the level of resistance to commonly prescribed antibiotics was considerably high [6]. Antibiotic judicious utilization is crucial in order to reduce the development of antibiotic resistance in bacteria and extend the usable lifetime of effective antibiotics [7]. Despite all this, the microorganism profile and their resistance pattern has not yet been extensively studied in our setting till date. This study therefore set out to identify the bacteria commonly isolated from blood culture samples and describe their antibiotic resistance pattern.\u0026nbsp;\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003eStudy design and site:\u0026nbsp;\u003c/strong\u003eA retrospective cross-sectional study was conducted at Laquintinie Hospital Douala (LHD) on routine specimen collected from paediatric patients consulted at LHD over a 1-year period running from March 2021 to February 2022. \u0026nbsp;LHD is located in Douala, the economic capital of Cameroon. It is a tertiary hospital with an inpatient capacity of 712 beds and has several departments that include the laboratory, internal medicine, surgery, paediatrics, and obstetrics and gynaecology. The laboratory comprises six specialized units: the clinical biology unit, virology unit, blood bank unit, HIV care unit, emergency/respiratory diseases unit, and the quality control unit, each overseen by a medical biologist with a total staff of 130 personnel, ranging from laboratory assistants to medical biologists. The clinical biology unit is further divided into six subunits: bacteriology unit, serology unit, parasitology unit, biochemistry unit, haematology unit, and the phlebotomy unit. Specifically, the bacteriology unit operates with seven personnel; three regular staff members work daily shifts, while four personnel follow a predetermined schedule to handle and analyse bacteriological specimens round the clock. The LHD laboratory participates in a bacteriology quality control program and has been accredited by the African Society for Laboratory Medicine (ASLM) [8,9].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria:\u0026nbsp;\u003c/strong\u003eThis study included all culture specimens collected during the study period from patients aged less than 18 years. Information on the patient\u0026rsquo;s gender, age, culture result (growth versus no growth on suitable media) needed to be available for all cases prior to inclusion. For cultures that reported growths, the name of the organism identified, and antibiotic susceptibility testing results on at least one antibiotic in each of the five antibiotic classes of interest (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were required prior to inclusion. Only susceptibility testing for bacteria isolates was of interest and susceptibility testing of other isolated organisms like fungi, parasites or viruses were not analysed. Furthermore, cases where any isolated organism was recorded without a species name, and or had incomplete information (i.e., lack of age, and gender of patient, and sample type) were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure for microbiological culture, Identification and Antimicrobial susceptibility profile\u003c/strong\u003e:\u0026nbsp;The Microbiological analysis involved using VITEK\u003csup\u003eMD\u0026nbsp;\u003c/sup\u003e2 compact (Biom\u0026eacute;rieux, France) for specimen identification and antibiotics susceptibility. After isolation by using specific media related to specimen collected.\u003c/p\u003e\n\u003cp\u003eThe Antibiogram Committee of the French Society of Microbiology (CASFM) and the European committee EUCAST [1] were used as reference guidelines for the interpretation of antibiotic susceptibility, which classifies susceptibility as follows:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eResistant: There is a high likelihood of therapeutic failure regardless of the type of therapy or antibiotic dosage utilized.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSensitive at standard dose (susceptible): A high likelihood of therapeutic effectiveness if systemic or oral medication is administered at conventional doses.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSensitive to high dose: There is a high likelihood of therapeutic effectiveness ONLY when systemic therapy with a high dosage is used or when the antibiotic concentrates at the site of infection.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe concurrent use of the EUCAST and CASFM was justified by the diverse epidemiological landscape and varying resistance profiles in the region. This approach allowed healthcare professionals to benefit from a global perspective while also considering local resistance patterns, enabling more effective and tailored antibiotic treatment decisions [2].\u003c/p\u003e\n\u003cp\u003eFor the purpose of this study, antibiotics that were tested twice or less per isolated species were not reported. Furthermore, antibiotics to which isolates have natural resistance were also excluded. This includes, but is not limited to, Ticarcillin for Klebsiella species; Cefalotin, Cefoxitin, Cefalexin, Amoxicillin and Clavulanic acid for Enterobacter species, Trimethoprim Sulfamethoxazole for Pseudomonas species etc.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAntibiotic protocol:\u0026nbsp;\u003c/strong\u003eAt Laquintinie, neonatal infections are managed with a combination of Cefotaxime and gentamicin as first line regimen, Ceftazidime and Vancomycin as second line, and Ofloxacin/Ciprofloxacin and Imipenem/Meropenem as third line regimen. In older paediatric patients, first line regimen is usually Amoxicillin and Clavulanic acid in case of bacterial upper or lower respiratory tract infections. In case of sepsis from other organs however, a combination of Ceftriaxone and Gentamicin is used. Second- and third-line regimens are same as for neonates. Addition of Metronidazole is common in case of suspected anaerobic gastrointestinal infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and analysis:\u0026nbsp;\u003c/strong\u003eData was collected from the laboratory registers and eligibility checking was performed. Information such as age, gender, name of the organism and the antibiotic susceptibility were collected. The collected data was entered, assorted, and coded using Microsoft Excel 2020 and then exported to Statistical Package for Social Science (SPSS) version 23 for analysis. Descriptive statistics was used to describe our data. Microsoft Excel 2020.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDefinition of operational terms\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMulti-drug resistance: A bacterial isolate was considered to be multi-drug resistant if it was found to be non-susceptible to at least one agent in three or more antimicrobial classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam)[10].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExtensively drug resistance: A bacterial isolate was considered to be extensively drug resistant if it was found to be non-susceptible to at least one agent in all but two or fewer antimicrobial classes[10].\u003c/p\u003e\n\u003cp\u003ePan-resistance: A bacterial isolate was considered to be pan-resistant if it was found to be non-susceptible to all agents in all antimicrobial classes tested [10].\u003c/p\u003e\n\u003cp\u003ePaediatric age groups: patients were referred to as neonates if aged \u0026lt; 30 days, infants if aged 1-11 months, early childhood if aged 1-5 years, middle childhood if aged 6-11 years and adolescents if aged 12-17 years.\u003c/p\u003e\n\u003cp\u003eExtended spectrum cephalosporins: ceftazidime, cefotaxime, cefdinir, cefditoren, cefetamet, cefotiam, cefixime, ceftriaxone.\u003c/p\u003e\n\u003cp\u003eFluoroquinolones: tosufloxacin, ciprofloxacin, pefloxacin, ofloxacin, levofloxacin\u003c/p\u003e\n\u003cp\u003eCarbapenems: tetrapenem, feropenem, ertapenem, imipenem, and meropenem\u003c/p\u003e\n\u003cp\u003eAminoglycosides: Gentamicin, amikacin, Tobramycin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration:\u0026nbsp;\u003c/strong\u003eThis was a retrospective study that analyzed secondary data generated from routine laboratory specimens from both adult and pediatric departments at Laquintinie Hospital Douala. There was no human interaction, and no personal identifiers were included in the study, ensuring confidentiality and anonymity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(i) The study was approved by the Institutional Review Board of Laquintinie Hospital Douala who equally waived the need for informed consent due to retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e(ii) All procedures were conducted in accordance with the relevant guidelines and regulations pertaining to the use of anonymized secondary data.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe analysed samples from 1050 individuals. From these, a total of 529 blood culture results were explored, and only positive results (n=313) were further analysed. We excluded isolates with incomplete sensitivity analysis (n=186), and our final population was 127 blood samples with identified isolates. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study population was mostly constituted of neonates (n=52, 40.9%) followed by patients in early childhood (n=26, 20.5%), adolescence (n=19, 14.9%), infancy (n=15, 11.8%), and middle childhood (n=15, 11.8%). The mean age was 3.85 \u0026plusmn; 5.55 years. The median age was 0.46 years (IQR 0.01-6.25 years) with a range from 1 day of life to 17 years. \u0026nbsp; Males were predominant (n=78, 61.4%), with a M/F sex ratio of 1.59 as shown in in Table I below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBacterial isolates identified\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe five most commonly isolated bacteria from blood culture were\u0026nbsp;\u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(n=19, 14.9%),\u003cem\u003e\u0026nbsp;Acinetobacter baumannii\u003c/em\u003e (n=17, 13.4%), \u003cem\u003eBurkholderia cepacia\u003c/em\u003e (n=16, 12.6%), \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (n=14, 11.0%) and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (n=11, 8.7%) as shown in in Table II below. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most commonly identified pathogen in neonates was \u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(n=9/51, 17.6%)\u003cem\u003e,\u0026nbsp;\u003c/em\u003ein infants, was\u003cem\u003e\u0026nbsp;Acinetobacter baumannii\u003c/em\u003e (n=5/18, 27.8%), in early childhood, was \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (n=5/27, 18.5%), and in middle childhood, was \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (n=3/15, 20%). In adolescence, \u003cem\u003eEscherichia coli, Acinetobacter baumannii\u003c/em\u003e, and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e each had the same prevalence (n=3/19, 15.8% each) as shown in Table III.\u003c/p\u003e\n\u003cp\u003eWhen analysed by species, \u003cem\u003eKlebsiella pneumoniae, Klebsiella oxytoca and Klebsiella planticola\u0026nbsp;\u003c/em\u003erepresenting the \u003cem\u003eKlebsiella species\u003c/em\u003e (n=21, 16.5%) accounted for most isolates in paediatric patients at LHD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSusceptibility of pathogens to selected antibiotics.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost isolates were resistant to tested antibiotics: extensively resistant (n=58, 45.7%), pan-resistant (n=30, 23.6%) and multi-drug resistant (n=28, 22.0%). Full sensitivity was only reported in eleven isolates (n=11, 8.7%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe proportion of fully sensitive bacteria was highest amongst infants (n=2/15, 13.3%), followed by early childhood (n=3/26, 11.5%), adolescents (n=2/19, 10.5%), and neonates (n=4/52, 7.7%), and least in middle childhood with no isolated bacteria exhibiting full sensitivity as shown in Table I. \u0026nbsp;Amongst the top five isolates,\u003cem\u003e\u0026nbsp;Escherichia coli\u0026nbsp;\u003c/em\u003e(n=15/19, 78.9%), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (13/17, 76.5%) and \u003cem\u003eKlebsiella pneumoniae\u0026nbsp;\u003c/em\u003e(n=12/15, 80%)\u003cem\u003e\u0026nbsp;\u003c/em\u003ewere most sensitive to carbapenems, while \u003cem\u003eBurkholderia cepacia\u003c/em\u003e was most sensitive to extended spectrum cephalosporins (n=8/16. 50%) and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e to fluoroquinolones (4/11, 36.4%) as depicted in Table IV. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePan-resistance was observed in thirty (n=30, 23.6%) bacterial isolates with five (n=5) isolates only reporting pan-resistant profiles, namely: \u003cem\u003ePseudomonas luteola\u003c/em\u003e (n=1), \u003cem\u003eStaphylococcus xylosus\u003c/em\u003e (n=1), \u003cem\u003eEnterobacter dunanensis\u003c/em\u003e (n=1), \u003cem\u003eStaphylococcus haemolyticus\u003c/em\u003e (n=2) as depicted in Figure 1. Two of these five pan-resistant isolates were found exclusively in neonates (n=2/5, 40%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the individual sensitivity profile in our study, isolates were sensitive to extended spectrum cephalosporins in 26.8% (n=34/127) and Aminoglycosides in only 40.9% of cases. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEight Staphylococcus aureus isolates (n=8/11, 72.7%) were Vancomycin-Resistant Staphylococcus aureus (VRSA). No Vancomycin-Resistant Enterococci (VRE) were reported in the two Enterococci isolates identified. Three Klebsiella pneumoniae isolates (n=3/15, 20%) were Carbapenem-Resistant Klebsiella pneumoniae (CRKP). Fourteen Enterobacteriaceae isolates (n=14/51, 25.5%) were found to be Carbapenem-Resistant Enterobacteriaceae (CRE). Pseudomonas aeruginosa with Multidrug Resistance was reported in one isolate (n=1/3, 33.3%). Acinetobacter baumannii with Multidrug Resistance was reported in four isolates (4/17, 33.3%). These findings are represented in Figure 2. \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur investigation into the microbial landscape of paediatric bloodstream infections at a second-category hospital in Cameroon reveals a pressing public health concern regarding antibiotic resistance. With a study population with mean age of 3.85 \u0026plusmn; 5.55 years and a notable male predominance (M/F ratio of 1.59), our study provides a snapshot of the microbial threats and resistance patterns in the context of a developing world.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe distribution of pathogens across different paediatric age groups was notably distinct. Neonates, comprising 40.9% of our sample, were most commonly infected with Escherichia coli (17.3%) as previously reported by other authors [11]. This probably reflects the immature immune system and higher exposure to vertical transmission from mothers or nosocomial transmission in hospitals in neonates. However, the notable absence of Group B streptococcus (GBS) in our sample calls for attention, especially as highest worldwide incidence of \u0026nbsp;invasive GBS disease has previously been reported in Africa at \u0026nbsp;1.12 cases \u0026nbsp;per 1000 live births [12]. This may be due to the lower prevalence (12.3% vs 18% worldwide) of GBS colonisation and the use of prophylactic antibiotics in 70% of GBS positive mothers in Cameroon [13,14]. Another possible explanation lies in the fact that not all patients hospitalised in African settings have blood cultures done before antibiotic therapy as some authors have reported 70% antibiotic use in neonates but only 6% blood culture use [15]. The absence of usually reported isolates like Streptococcus pneumoniae, Streptococcus pyogenes, and Salmonella Typhi probably stems from this lack of investigations and possible bias in sample selection. Nonetheless, this study findings highlights the need for policy changes in Cameroon to increase blood culture rates before antibiotic administration to better reflect local epidemiological data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcinetobacter baumannii, the most virulent of all \u003cem\u003eAcinetobacter\u003c/em\u003e species, with its most common and lethal clinical presentation being nosocomial pneumonia was the leading pathogen in infants [16]. On the other hand, Staphylococcus aureus dominated in childhood, probably as children might have more frequent skin breaches and poor hand hygiene [17]. This age-specific pathogen prevalence suggests that empirical treatment should be tailored according to the predominant bacteria in each age group. As our study utilised only one culture per patient, results may underestimate the true burden of infections in our population as some authors have reported that detection rate may increase by up to 19% after a second culture rather than a single one [18]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe resistance patterns we observed were alarming, with only a mere 6.9% isolates fully sensitive to the antibiotics tested. Though commonly reported that \u003cem\u003eBurkholderia cepacia\u003c/em\u003e isolates rarely exhibit full sensitivity, an unexpected finding was their high sensitivity to extended spectrum cephalosporins (50%), which is probably linked to sensitivity to Ceftazidime, the only antibiotic in this antibiotic class to have reported activity to this isolate [19]. Klebsiella species, which were the most frequently isolated overall, showed a high rate of pan-resistance (15.4%), corroborating international reports that emphasize the emergence of highly resistant strains in clinical settings [20\u0026ndash;25]. Despite high sensitivity rates to carbapenems among commonly MDR isolates, the overall effectiveness of these last-resort antibiotics was compromised by the presence of CRKP and CRE, at 20% and 25.5% respectively. This resistance threatens the effectiveness of carbapenems, particularly in neonatal units where the highest proportion of pan-resistant bacteria was found.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sensitivity to extended-spectrum cephalosporins was only 26.8%, and to aminoglycosides, it was 40.9%. These low figures are particularly concerning given that these antibiotics are often the first line therapies in treating paediatric infections. The observed resistance rates are consistent with previous studies from other regions highlighting the global challenge of treating infections with standard therapy [26,27]. The high resistance rates observed necessitate a shift from empirical to targeted antibiotic therapy based on susceptibility testing. Current treatment protocols at Laquintinie Hospital, including the use of cefotaxime and gentamicin as first-line treatments for neonatal infections, need urgent reassessment. The study\u0026apos;s findings also call into question the sustainability of using ceftazidime, vancomycin, or fluoroquinolones as second and third-line treatments in scenarios where resistance is rampant.\u0026nbsp;Cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, and imipenem-relabactam have the best support evidence for use in patients with MDR infections\u0026nbsp;[33], however, these antibiotics are not readily available in Cameroon and makes curative approach to MDR challenging.\u003c/p\u003e\n\u003cp\u003eThe predominance of resistant strains especially in vulnerable neonates, poor access to medications and potential increased cost of care due to MDR pathogens, underscores the need for heightened preventive measures such as stringent infection control measures, including hand hygiene, and the promotion of antibiotic stewardship [28,29]. The type of bacteria isolated may suggest a high prevalence of nosocomial infections, and suggests that hospitals should prioritize hygiene protocols and limit the spread of resistance through environmental and procedural controls [30\u0026ndash;32]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile our study provides a baseline for understanding local resistance patterns, its retrospective and monocentric design limits broader implications. The absence of certain antibiotics in our testing panels might have led to an underestimation of resistance. Moreover, this study carries a potential for selection bias as patients with missing information or those with incomplete bacterial identification were excluded from analysis. Nonetheless, this is the first study that explored resistance profile of isolates collected from paediatric specimen in Cameroon and serves as a baseline study. Future studies should incorporate a prospective, multicentre approach to validate these findings, assess clinical outcomes, and explore the efficacy of alternative treatment strategies or novel antibiotics. Additionally, research into the mechanisms of resistance could inform the development of new therapeutic options.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights a critical scenario in which pediatric bacterial infections in Cameroon would become increasingly hard to treat in light of widespread antibiotic resistance. The high prevalence of Klebsiella species coupled with high resistance to first-line medications necessitates urgent public health actions such as revising treatment protocols, enhancing infection control, and possibly researching new alternatives or preventive methods to address the impending threat of antimicrobial resistance in paediatric infections. Further exploration into the molecular mechanisms of resistance, clinical outcomes associated with these resistance patterns, and the long-term impact on paediatric health is important. Hospital and community-level interventions to curb the spread of resistance will be crucial in ensuring effective treatment options for generations to come.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and informed consent:\u0026nbsp;\u003c/strong\u003eEthical clearance was not requested for this research, as it is retrospective in nature and involved anonymized (non-identifiable) laboratory data. Principles of respect for persons, beneficence, and justice were respected. Informed consent was not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;data\u0026nbsp;that\u0026nbsp;support\u0026nbsp;the findings of this\u0026nbsp;study\u0026nbsp;are available from the corresponding author, EMM, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design: EENL, CEE and CIM. Data collection: \u0026nbsp;EENL. \u0026nbsp;Analysis and interpretation of data: EMM. Drafting of the manuscript: EMM. Critical revision of the manuscript: EENL, CEE, CIM, EMM, RA, NSVN, YDP, PE, HI, and DA. DA supervised the study. EENL, CEE and EMM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors agreed to submit the manuscript in its current form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the administration of the hospital for permitting us to conduct this research. The authors also thank the hospital personnel for collaborating with us to ease data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eORCID IDs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEposse Ekoube Charlotte: https://orcid.org/0000-0002-0451-6616\u003c/p\u003e\n\u003cp\u003eMandeng Ma Linwa Edgar: https://orcid.org/0000-0002-4058-3509\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eD\u0026iacute;az SGN, Robles OA, Moya JMGL. New definitions of susceptibility categories EUCAST 2019: clinic application. Rev. Esp. Quimioter. 2022;35:84\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKatawa G, Agbemanyole KA, Tchopba CN, Ataba E, Amessoudji MO, Ameyapoh AH, et al. Antimicrobial susceptibility testing: Evaluation of the conformity of 3 medical bacteriology laboratories of Togo according to EUCAST/CA-SFM guidelines. J. Appl. Biosci. 2021;162:16795\u0026ndash;803. \u003c/li\u003e\n\u003cli\u003eWHO report shows rising antibiotic resistance, need for better data | CIDRAP [Internet]. 2022 [cited 2023 May 27];Available from: https://www.cidrap.umn.edu/antimicrobial-stewardship/who-report-shows-rising-antibiotic-resistance-need-better-data\u003c/li\u003e\n\u003cli\u003eOpota O, Croxatto A, Prod\u0026rsquo;hom G, Greub G. Blood culture-based diagnosis of bacteraemia: state of the art. Clin. Microbiol. Infect. 2015;21:313\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eOkomo U, Akpalu ENK, Le Doare K, Roca A, Cousens S, Jarde A, et al. Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines. Lancet Infect. Dis. 2019;19:1219\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eMouiche MMM, Moffo F, Akoachere JFTK, Okah-Nnane NH, Mapiefou NP, Ndze VN, et al. Antimicrobial resistance from a one health perspective in Cameroon: a systematic review and meta-analysis. BMC Public Health 2019;19:1135. \u003c/li\u003e\n\u003cli\u003eGoossens H. Antibiotic consumption and link to resistance. Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis. 2009;15 Suppl 3:12\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eMaruta T, Motebang D, Mathabo L, Rotz PJ, Wanyoike J, Peter T. Impact of mentorship on WHO-AFRO Strengthening Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Afr. J. Lab. Med. 2012;1:6. \u003c/li\u003e\n\u003cli\u003eVounba P, Loul S, Tamadea LF, Siawaya JFD. Microbiology laboratories involved in disease and antimicrobial resistance surveillance: Strengths and challenges of the central African states. Afr. J. Lab. Med. 2022;11:1570. \u003c/li\u003e\n\u003cli\u003eMagiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012;18:268\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eStoll BJ, Puopolo KM, Hansen NI, S\u0026aacute;nchez PJ, Bell EF, Carlo WA, et al. Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies. JAMA Pediatr. 2020;174:e200593. \u003c/li\u003e\n\u003cli\u003eMadrid L, Seale AC, Kohli-Lynch M, Edmond KM, Lawn JE, Heath PT, et al. Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am. 2017;65:S160\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eRussell NJ, Seale AC, O\u0026rsquo;Driscoll M, O\u0026rsquo;Sullivan C, Bianchi-Jassir F, Gonzalez-Guarin J, et al. Maternal Colonization With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am. 2017;65:S100\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eSubramaniam A, Blanchard CT, Ngek ESN, Mbah R, Welty E, Welty T, et al. Prevalence of group B streptococcus anogenital colonization and feasibility of an intrapartum screening and antibiotic prophylaxis protocol in Cameroon, Africa. Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet. 2019;146:238\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eMurless-Collins S, Kawaza K, Salim N, Molyneux EM, Chiume M, Aluvaala J, et al. Blood culture versus antibiotic use for neonatal inpatients in 61 hospitals implementing with the NEST360 Alliance in Kenya, Malawi, Nigeria, and Tanzania: a cross-sectional study. BMC Pediatr. 2023;23:568. \u003c/li\u003e\n\u003cli\u003eWong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B, Spellberg B. Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges. Clin. Microbiol. Rev. 2016;30:409\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eCassat JE, Thomsen I. Staphylococcus aureus infections in children. Curr. Opin. Infect. Dis. 2021;34:510\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eZalmanovich A, Temkin E, Biran D, Carmeli Y. The Yield of One vs. Two Blood Cultures in Children: Under-Detection and Over-Testing. Antibiotics 2024;13:113. \u003c/li\u003e\n\u003cli\u003eSchaumburg F, Idelevich EA, Mellmann A, Kahl BC. Susceptibility of Burkholderia cepacia Complex to Ceftazidime/Avibactam and Standard Drugs of Treatment for Cystic Fibrosis Patients. Microb. Drug Resist. Larchmt. N 2022;28:545\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eAvgoulea K, Di Pilato V, Zarkotou O, Sennati S, Politi L, Cannatelli A, et al. Characterization of Extensively Drug-Resistant or Pandrug-Resistant Sequence Type 147 and 101 OXA-48-Producing Klebsiella pneumoniae Causing Bloodstream Infections in Patients in an Intensive Care Unit. Antimicrob. Agents Chemother. 2018;62:e02457-17. \u003c/li\u003e\n\u003cli\u003eHavan M, Kendirli T, Parlar \u0026Ouml;T, \u0026Ouml;zcan S, Yahşi A, Erat T, et al. Clinical Management of a Pandrug-Resistant OXA-48 \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e Infection in the Pediatric Intensive Care Unit. Microb. Drug Resist. 2023;29:256\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eL\u0026aacute;zaro-Perona F, Sotillo A, Troyano-Hern\u0026aacute;ez P, G\u0026oacute;mez-Gil R, de la Vega-Bueno \u0026Aacute;, Mingorance J. Genomic path to pandrug resistance in a clinical isolate of Klebsiella pneumoniae. Int. J. Antimicrob. Agents 2018;52:713\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eLongo LGA, de Sousa VS, Kraychete GB, Justo-da-Silva LH, Rocha JA, Superti SV, et al. Colistin resistance emerges in pandrug-resistant Klebsiella pneumoniae epidemic clones in Rio de Janeiro, Brazil. Int. J. Antimicrob. Agents 2019;54:579\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eSieswerda E, van den Brand M, van den Berg RB, Str\u0026auml;ter J, Schouls L, van Dijk K, et al. Successful rescue treatment of sepsis due to a pandrug-resistant, NDM-producing Klebsiella pneumoniae using aztreonam powder for nebulizer solution as intravenous therapy in combination with ceftazidime/avibactam. J. Antimicrob. Chemother. 2020;75:773\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eZowawi HM, Forde BM, Alfaresi M, Alzarouni A, Farahat Y, Chong TM, et al. Stepwise evolution of pandrug-resistance in Klebsiella pneumoniae. Sci. Rep. 2015;5:15082. \u003c/li\u003e\n\u003cli\u003eBeliz\u0026aacute;n JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, et al. Neonatal death in Low-Middle Income Countries: A Global Network Study. Am. J. Perinatol. [Internet] 2012 [cited 2023 Aug 29];29:649\u0026ndash;56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337792/\u003c/li\u003e\n\u003cli\u003eMilton R, Gillespie D, Dyer C, Taiyari K, Carvalho MJ, Thomson K, et al. Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study. Lancet Glob. Health [Internet] 2022 [cited 2023 Aug 29];10:e661\u0026ndash;72. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00043-2/fulltext\u003c/li\u003e\n\u003cli\u003eLee CR, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int. J. Environ. Res. Public. Health 2013;10:4274\u0026ndash;305. \u003c/li\u003e\n\u003cli\u003eMathur P. Prevention of Healthcare-Associated Infections in Low- and Middle-Income Countries: The \u0026lsquo;Bundle Approach.\u0026rsquo; Indian J. Med. Microbiol. [Internet] 2018 [cited 2023 Aug 29];36:155\u0026ndash;62. Available from: https://www.sciencedirect.com/science/article/pii/S0255085720304795\u003c/li\u003e\n\u003cli\u003eSaleem AF, Ahmed I, Mir F, Ali SR, Zaidi AK. Pan-resistant Acinetobacter Infection in Neonates in Karachi, Pakistan. J. Infect. Dev. Ctries. 2010;4:030\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eHassuna NA, AbdelAziz RA, Zakaria A, Abdelhakeem M. Extensively-Drug Resistant Klebsiella pneumoniae Recovered From Neonatal Sepsis Cases From a Major NICU in Egypt. Front. Microbiol. 2020;11:1375. \u003c/li\u003e\n\u003cli\u003eRamasethu J. Prevention and treatment of neonatal nosocomial infections. Matern. Health Neonatol. Perinatol. 2017;3:5. \u003c/li\u003e\n\u003cli\u003eWindham S, Kollef MH. How to use new antibiotics in the therapy of serious multidrug resistant Gram-negative infections? Curr. Opin. Infect. Dis. 2022;35:561\u0026ndash;7. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable I Distribution of gender and age groups based on pattern of resistance of bacteria isolated from blood culture specimen of paediatric patients at Laquintinie Hospital Douala from March 2021 to February 2022\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1001\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003eFully sensitive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 181px;\"\u003e\n \u003cp\u003eMultidrug resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 194px;\"\u003e\n \u003cp\u003eExtensively drug resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePan-resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eNeonate less than one month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eInfant 1-11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eEarly Childhood 1-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eMiddle Childhood 6-11 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eAdolescence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 272px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable II: Distribution of individual bacterium isolated from blood culture specimen of paediatric patients based on pattern of resistance at Laquintinie Hospital Douala from March 2021 to February 2022.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"992\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eIsolated bacterium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eFully sensitive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMultidrug resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eExtensively drug resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePan-resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEscherichia coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAcinetobacter baumannii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eBurkholderia cepacia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eKlebsiella pneumoniae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus aureus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus pseudintermedius\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eKlebsiella oxytoca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterobacter cloacae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eSalmonella enterica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eRalstonia mannitolilytica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003ePseudomonas aeruginosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus haemolyticus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003ePantoea agglomerans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eChryseobacterium oryzihabitans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eShigella dysenteriae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eTatumella ptyseos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterobacter aminigenus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eCronobacter sakazakii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterococcus faecalis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterobacter dunanensis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus xylosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eBordetella enterica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterococcus faecium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eKlebsiella planticola\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eRaoultella aerogenes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAchromobacter xylosoxidans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003ePseudomonas luteola\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable III: Distribution of individual bacterium isolated from blood culture specimen of paediatric patients based on age group at Laquintinie Hospital Douala from March 2021 to February 2022.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"992\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eIsolated bacterium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNeonates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003eInfants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003eEarly Childhood\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMiddle Childhood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAdolescence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEscherichia coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAcinetobacter baumannii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eBurkholderia cepacia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eKlebsiella pneumoniae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus aureus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus pseudintermedius\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eKlebsiella oxytoca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterobacter cloacae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eSalmonella enterica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eRalstonia mannitolilytica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003ePseudomonas aeruginosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus haemolyticus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003ePantoea agglomerans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eChryseobacterium oryzihabitans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eShigella dysenteriae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eTatumella ptyseos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterobacter aminigenus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eCronobacter sakazakii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterococcus faecalis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterobacter dunanensis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eStaphylococcus xylosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eBordetella enterica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eEnterococcus faecium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eKlebsiella planticola\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eRaoultella aerogenes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eAchromobacter xylosoxidans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003ePseudomonas luteola\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable IV: Distribution of individual bacterium isolated from blood culture specimen of paediatric patients based on age group at Laquintinie Hospital Douala from March 2021 to February 2022.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1002\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eIsolated bacterium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eExtended spectrum cephalosporins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAminoglycosides\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFluoroquinolones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePiperacillin-tazobactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCarbapenems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEscherichia coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAcinetobacter baumannii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBurkholderia cepacia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eKlebsiella pneumoniae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eStaphylococcus aureus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eStaphylococcus pseudintermedius\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eKlebsiella oxytoca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEnterobacter cloacae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSalmonella enterica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eRalstonia mannitolilytica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePseudomonas aeruginosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eStaphylococcus haemolyticus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePantoea agglomerans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eChryseobacterium oryzihabitans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eShigella dysenteriae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTatumella ptyseos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEnterobacter aminigenus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCronobacter sakazakii\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEnterococcus faecalis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEnterobacter dunanensis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eStaphylococcus xylosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBordetella enterica\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEnterococcus faecium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eKlebsiella planticola\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eRaoultella aerogenes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAchromobacter xylosoxidans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePseudomonas luteola\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e127\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"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"[email protected]","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":"Paediatrics, Bacterial resistance, Cameroon ","lastPublishedDoi":"10.21203/rs.3.rs-4200037/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4200037/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION: \u003c/strong\u003eWHO estimates that multidrug resistant bacteria kill over 200,000 newborns. Despite this alarming figure, the microorganism profile and their resistance pattern has not yet been widely studied in our setting till date. We aimed to identify commonly isolated bacteria and describe their antibiotic resistance pattern in Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODOLOGY: \u003c/strong\u003eA retrospective cross-sectional study was conducted at Laquintinie Hospital Douala (LHD) on blood culture specimen collected from paediatric patients consulted at LHD over a 1-year period running from March 2021 to February 2022. Microbiological analysis was performed using the VITEK\u003csup\u003eMD \u003c/sup\u003e2 compact automated machine. The reference for the interpretation of antibiotic susceptibility was the Antibiogram Committee of the French Society of Microbiology (CASFM) and the European committee EUCAST.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS: \u003c/strong\u003eWe included 127 positive blood culture samples, that were mostly from neonates (n=52, 40.9%) with a mean age was 3.85 ± 5.55 years and a M/F sex ratio of 1.59. \u003cem\u003eKlebsiella species\u003c/em\u003e (n=21, 16.5%) accounted for most isolates. Most isolates were extensively resistant (n=58, 45.7%), pan-resistant (n=30, 23.6%) and multi-drug resistant (n=28, 22.0%). Full sensitivity was only reported in eleven isolates (n=11, 8.7%). Isolates were sensitive to extended spectrum cephalosporins in 26.7% and Aminoglycosides in only 40.9% of cases. \u003cem\u003ePseudomonas luteola\u003c/em\u003e (n=1), \u003cem\u003eStaphylococcus xylosus\u003c/em\u003e (n=1), \u003cem\u003eEnterobacter dunanensis\u003c/em\u003e (n=1), \u003cem\u003eStaphylococcus haemolyticus\u003c/em\u003e (n=2) exclusively exhibited pan-resistance profiles and were mostly found in neonates (n=2/5, 40%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION: \u003c/strong\u003e\u003cem\u003eKlebsiella\u003c/em\u003e spp. were the commonest isolates overall, although age-specific pathogens were identified. Only 8.7% of isolates exhibited full sensitivity at Laquintinie. This proportion is alarming and requires an urgent public health response.\u003c/p\u003e","manuscriptTitle":"Describing the bacterial resistance profile of paediatric laboratory specimens isolated in a resource limited setting","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-16 12:00:00","doi":"10.21203/rs.3.rs-4200037/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"1cd80ebf-d7b1-4f8e-bd68-5f395bad2f06","owner":[],"postedDate":"April 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-16T12:00:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-16 12:00:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4200037","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4200037","identity":"rs-4200037","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}