Bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli from the hospital environment of the University Hospital Centers of Benin

Bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli from the hospital environment of the University Hospital Centers of Benin | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli from the hospital environment of the University Hospital Centers of Benin Sènami Evelyne SOCLO DANSI, Comlan Cyriaque Degbey, Diane A. Agbokou, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7255149/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Antimicrobial resistance (AMR) represents a major global health threat, one that is exacerbated in sub-Saharan Africa by systemic shortcomings in hospital hygiene. This cross-sectional descriptive study was conducted in six University Teaching Hospitals in Benin, with the aim of mapping multidrug-resistant Gram-negative bacilli (GNB) present in the clinical environment and assessing the vectors of their spread. A total of 588 samples were collected from various environmental and clinical surfaces. More than half (54.08%) yielded GNB isolates, with a predominance of Pseudomonas spp. (23.7%) and Klebsiella spp. (18.3%). Multidrug resistance rates reached 91.3%, with a pan-resistance rate of 3.29%. High levels of resistance were observed against third-generation cephalosporins (100%), carbapenems (> 90%), and aminoglycosides (> 70%). The most contaminated surfaces included sinks (90%), staff gowns (76.47%), and surfaces (61.33%). Disinfection procedures proved largely ineffective, with similar positivity rates between disinfected sites (56.15%) and non-disinfected ones (57.51%). These findings highlight the massive presence of multidrug-resistant strains in the hospital environment in Benin and the urgent need to strengthen infection prevention and control (IPC) practices, particularly in critical care units. The study also reveals serious shortcomings in cleaning protocols and calls for a revision of disinfection strategies within a One Health framework. Gram-negative bacilli Multidrug resistance Hospital environment Mapping University Hospitals of Benin Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Antimicrobial resistance (AMR), now regarded as the silent pandemic of the 21st century, affects every continent. According to Murray et al. (2022), over 4.95 million deaths were associated with AMR in 2019, with 1.27 million directly attributable to it [1]. Without concrete measures, the World Health Organization (WHO) estimates that this figure could reach 10 million deaths per year by 2050, with a projected impact on global gross domestic product exceeding USD 3.4 trillion annually [2, 3]. Yet, there is a widely acknowledged, cost-effective area for immediate action: up to 70% of healthcare-associated infections are preventable through simple interventions such as hand hygiene and thorough disinfection practices [4]. The OECD (2023) estimates that for every dollar invested in AMR prevention, up to 16 dollars can be saved in avoided healthcare costs [5]. Among the pathogens at the core of this global health emergency are Gram-negative bacilli (GNB), particularly Enterobacteriaceae resistant to third- and fourth-generation cephalosporins and carbapenems, as well as non-fermenting bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii . These are part of the ESKAPE group, identified by WHO due to their ability to develop and disseminate complex resistance mechanisms-such as ESBLs, carbapenemases (KPC, NDM, VIM, OXA), efflux systems, and biofilm formation-that severely compromise the effectiveness of antimicrobial treatments [6, 7, 8, 9]. These pathogens are responsible for the majority of drug-resistant healthcare-associated infections worldwide, causing over 136 million cases annually [10]. Their impact is severe: mortality rates up to 50%, increasingly limited treatment options, and high healthcare costs. WHO ranks them among the top critical priority pathogens for global surveillance [4]. In Africa, over 70% of resistant hospital strains are GNB, with high levels of resistance to carbapenems [11]. In sub-Saharan Africa, the burden of AMR is even more pronounced. According to WHO Africa, the continent could face up to 4.1 million AMR-related deaths annually in the absence of a coordinated response [12]. Fewer than half of African countries have functional environmental surveillance systems, and the TrACSS report (WHO, 2023) reveals that while 97.8% have adopted a national AMR action plan, only 11% have dedicated funding for its implementation [2]. A major barrier to political decision-making is the lack of field data. According to ICARS (2023), generating contextualized local data through implementation research is crucial to effectively tailoring national strategies [13]. In West Africa, hospitals face numerous structural vulnerabilities: limited access to clean water, insufficient staff training, inadequate disinfection equipment, and a lack of microbial traceability. The regional MUSTPIC program (2018–2022) reported surface contamination rates exceeding 40%, despite the presence of disinfection protocols [14]. Furthermore, Gwenzi et al. (2022) highlighted the presence of multidrug-resistant bioaerosols in hospital air, linked to poor ventilation systems [15]. In Benin, the National AMR Action Plan 2019–2024 remains limited in its implementation due to the absence of local environmental data. A recent study by Delfosse et al. (2025) in two reference hospitals revealed an antibiotic prescription prevalence of 32.9%, with 70% of surgical prophylaxis being unnecessarily prolonged, and no antimicrobial stewardship program in place [16]. In this context, the likelihood of emergence and dissemination of multidrug-resistant strains in the hospital environment is high, although it has not yet been quantified in Benin’s university hospitals. This study aims to investigate the bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli in Benin’s university hospitals. Specifically, it seeks to identify dissemination vectors, describe resistance patterns, and detect gaps in surface, material, and device cleaning and disinfection practices. This approach aligns with the strategic recommendations of the World Health Organization (WHO), the Africa Centres for Disease Control and Prevention (Africa CDC 2023), and the African Union, which urge member states, within a “One Health” hospital-centered framework, to integrate hospital biosafety, IPC, and environmental surveillance dimensions into national AMR control policies [17, 18 ,19]. Materials and Methods Study Design This was a cross-sectional, exploratory study conducted from September to December 2024 in six university hospitals (CHU) in Benin. These institutions were selected based on their referral role, diversity of medical and surgical activities, and patient capacity. The participating centers were: National University Hospital Centre - Hubert Koutoukou Maga, Cotonou (CNHU-HKM) University Hospital - Mother and Child, Lagune (CHU-MEL) Departmental University Hospital of Ouémé (CHUD-Ouémé) Departmental University Hospital of Borgou (CHUD-Borgou) Zonal University Hospital of Abomey-Calavi (CHUZ-AC) Zonal University Hospital of Sourou-Léré (CHUZ-SL) Targeted Units Sampling was conducted in care units identified as high-risk for nosocomial transmission: Neonatology, Pediatric Intensive Care, Adult Intensive Care, Maternal Intensive Care, Surgical Operating Room, and Maternity Operating Room. Study Population and Inclusion Criteria The study focused on the immediate hospital environment of patients, including air, water, antiseptics, detergents and disinfectants, inert surfaces, medical devices, as well as healthcare workers' hands and gowns. All supports present in the units at the time of investigation, and posing a potential risk for multidrug-resistant bacterial dissemination, were included. Sampling Method A non-probability convenience sampling method was used. Sampling sites were selected according to the Good Practice Guide for Environmental Microbiological Surveillance in Healthcare Settings [20]. The sampling method varied based on the type of specimen: Air : Impaction on agar of 100 L of air using a bio-air collector. Water, antiseptics, detergents : Aseptic collection in sterile flasks. Surfaces, devices, hands, and gowns : Sterile swabs moistened with brain-heart infusion broth were swabbed across defined areas using close parallel streaks with gentle rotation, followed by perpendicular streaks (crosswise swabbing). Swabs were then aseptically placed in their protective tubes and transported to the laboratory. A total of 588 samples were transported at 4°C using ice packs in a cooler and analyzed at the Public Health Laboratory of the University Hospital Hygiene Clinic at CNHU-HKM in Cotonou. Bacterial Isolation and Identification Each sample was pre-enriched in brain-heart infusion broth and incubated at 37°C for 24 to 48 hours using a BINDER GmbH incubator ( www.binder-world.com ). In case of turbidity, subculturing was done on MacConkey agar. Suspect colonies underwent: Gram staining, Biochemical identification using API 20E test strips (bioMérieux®), Interpretative reading using the bioMérieux® Analytical Catalog . Antimicrobial Susceptibility Testing Susceptibility Testing Procedure Antimicrobial susceptibility of isolated bacterial strains was assessed using the disk diffusion method (Kirby-Bauer technique) on Mueller-Hinton agar. Bacterial suspensions were standardized to a 0.5 McFarland turbidity, prepared from fresh (18–24 h) colonies and adjusted using a densitometer. Inoculation was performed by uniform swabbing of the agar surface within 15 minutes of preparing the suspension. Antibiotic disks, impregnated with standardized concentrations, were placed using a sterile applicator. Plates were incubated at 37 ± 2°C for 18 to 24 hours under aerobic conditions. Inhibition zone diameters were measured with a graduated ruler. Results were interpreted based on the criteria of the Comité de l’Antibiogramme de la Société Française de Microbiologie (CA-SFM), 2024 version [21], considering critical diameters and susceptibility categories (Susceptible or Resistant). Tested antibiotics were grouped by pharmacological class (see Table 1 ), including β-lactams, quinolones/fluoroquinolones, aminoglycosides, phenicols, sulfonamides, and phosphonic acid derivatives, in accordance with standard guidelines. Table 1 Classification of tested antibiotics by pharmacological class Family Class Tested Antibiotics Beta-lactams Natural and semi-synthetic penicillins Ampicillin, Ticarcillin Penicillins + β-lactamase inhibitors Amoxicillin + Clavulanic acid, Ticarcillin + Clavulanic acid, Piperacillin + Tazobactam Cephalosporins Cefoxitin (2nd gen), Cefotaxime, Ceftriaxone, Cefixime, Ceftazidime (3rd gen), Cefepime (4th gen) Monobactams Aztreonam Carbapenems Ertapenem, Meropenem Phenicols - Chloramphenicol Quinolones 1st gen quinolone Nalidixic acid Fluoroquinolones Norfloxacin, Ciprofloxacin, Levofloxacin Aminoglycosides - Gentamicin, Tobramycin, Amikacin Sulfonamides - Cotrimoxazole (Sulfamethoxazole + Trimethoprim) Other Phosphonic acid derivative Fosfomycin Quality Control Quality control of antibiograms performed on Gram-negative bacilli was carried out according to CA-SFM/EUCAST (2024) recommendations [21]. Two standardized reference strains were used to validate technical performance: Escherichia coli ATCC® 25922 - reference for antibiotic-sensitive Enterobacteriaceae. Pseudomonas aeruginosa ATCC® 27853 - reference for testing antipseudomonal agents, including third-generation cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides. These strains were used to control the quality of culture media (Mueller-Hinton agar), antibiotic disk concentrations, and accuracy of inhibition zone measurements. The results obtained were within the expected ranges defined by CA-SFM/EUCAST, confirming the reliability and reproducibility of the susceptibility tests performed during the study. Operational Definitions A bacterial strain was classified as multidrug-resistant (MDR) if it exhibited resistance to at least one agent in three different antibiotic classes, and as pan-resistant if it was resistant to all tested antibiotics, according to the criteria of Magiorakos et al. [22]. Data Analysis Data were entered and analyzed using Excel 2016 and EPI Info 7.2.6.0. Results were expressed as absolute and relative frequencies. Proportion comparisons were made using Chi-squared or Fisher’s exact test, depending on conditions. The threshold for statistical significance was set at 5%. Results General Characteristics of Environmental Samples A total of 588 environmental samples were collected and analyzed from six university hospitals (CHUs) in Benin (see Table 2 below). The CNHU-HKM was the most represented with 141 samples (23.98%), followed by CHU-MEL (20.07%), CHUD-B/A (19.90%), CHUD-OP (19.56%), CHUZ Sourou-Léré (9.52%), and CHUZ-AC (6.97%). Samples were collected from a variety of clinical units, including: surgical operating room (21.77%), neonatology (21.26%), intensive care unit (20.92%), pediatric intensive care (18.37%), maternal intensive care (10.20%), and maternity operating room (7.48%). In terms of relative abundance of the sample types, the distribution was as follows: inert surfaces (43.54%), medical devices (18.03%), healthcare workers’ hands (11.73%) and gowns (5.78%), disinfectants/detergents (5.95%), water (5.78%), ambient air (5.10%), faucets (2.38%), and sinks (1.70%). Table 2 Characteristics of Environmental Samples Collected (n = 588) Variable n % Name of CHU CHU-MEL 118 20.07 CHUD-OP 115 19.56 CHUD-B/A 117 19.90 CHUZ-AC 41 6.97 CHUZ Sourou-Léré 56 9.52 CNHU-HKM 141 23.98 Clinical Units Surgical operating room 128 21.77 Maternity operating room 44 7.48 Neonatology 125 21.26 Intensive care 123 20.92 Maternal intensive care 60 10.20 Pediatric intensive care 108 18.37 Sample Type Air 30 5.10 Antiseptic/disinfectant/detergent 35 5.95 Healthcare worker gown 34 5.78 Medical device 106 18.03 Water 34 5.78 Sink 10 1.70 Healthcare worker hand 69 11.73 Faucet 14 2.38 Inert surface 256 43.54 Overall Positivity Rate for Gram-Negative Bacilli Isolation Out of the 588 samples, 318 (54.08%) yielded positive cultures for Gram-negative bacilli (GNB). The sample types most frequently found to be positive included: sinks (90%), gowns (76.47%), faucets (71.43%), exposed inert surfaces (61.33%), and medical devices (49.06%) (see Figs. 1 and 2 ). Diversity of Isolated Bacterial Species A total of 426 Gram-negative bacilli (GNB) strains were isolated. Enterobacteriaceae were predominant (257 strains; 60.33%), followed by non-fermenting Gram-negative bacteria (169 strains; 39.67%). The most frequently identified species included: Pseudomonas spp. (n = 101; 23.7%), Klebsiella spp. (n = 78; 18.3%), Enterobacter spp. (n = 54; 12.7%), Escherichia spp. (n = 40; 9.4%), Acinetobacter baumannii (n = 34; 8.0%), Serratia spp. (n = 29; 6.8%), and Pantoea spp. (n = 24; 5.6%) (see Fig. 3 ). Rare or emerging species were also identified, such as: Burkholderia cepacia , Raoultella spp. , Chromobacterium violaceum , Stenotrophomonas maltophilia , Yersinia pestis , Photobacterium damselae , and Chryseobacterium indologenes . Distribution of Isolated Species by Hospital Center Among the 426 isolated GNB strains from environmental samples collected in the six university hospitals (CHUs) included in the study, CNHU-HKM alone accounted for 33.3% of the isolates (n = 142), followed by CHUD-Ouémé (22.3%, n = 95) and CHU-MEL (18.1%, n = 77). The lowest proportions were observed at CHUZ Abomey-Calavi (4.7%) and CHUZ Sourou-Léré (14.6%). Overall, Pseudomonas spp. (23.7%), Klebsiella spp. (18.3%), and Enterobacter spp. (12.7%) were the three most frequently isolated species across all six CHUs (see Table 3 ). Table 3 Distribution of Isolated Gram-Negative Bacilli Species by Hospital (n = 426) Hospital Centers Bacterial species Total (%) A. baumannii B. cepacia Citrobacter spp. Enterobacter spp. Escherichia spp. Klebsiella spp. Pantoea spp. Pseudomonas spp. Raoultella spp. Salmonella spp. Serratia spp. Other GNB CHUD-OUEME 20 (21.1%) 3 (3.2%) - 7 (7.4%) 11 (11.6%) 15 (15.8%) 5 (5.3%) 28 (29.5%) 1 (1.1%) 2 (2.1%) 1 (1.1%) 2 (2.1%) 95 (22.30) CHUD-PARAKOU 1 (3.3%) - - 3 (10.0%) 11 (36.7%) 11 (36.7%) 1 (3.3%) 1 (3.3%) 1 (3.3%) 1 (3.3%) - - 30 (7.04) CHU-MEL 5 (6.5%) - - 6 (7.8%) 6 (7.8%) 11 (14.3%) 1 (1.3%) 29 (37.7%) 2 (2.6%) 5 (6.5%) 5 (6.5%) 7 (9.1%) 77 (18.08) CHUZ-ABOMEY CALAVI 3 (15.0%) - 1 (5.0%) 7 (35.0%) - 3 (15.0%) - 4 (20.0%) - 1 (5.0%) - 1 (5.0%) 20 (4.69) CHUZ-SOUROU LERE - - 3 (4.8%) 14 (22.6%) 7 (11.3%) 12 (19.4%) 6 (9.7%) 9 (14.5%) 2 (3.2%) - 8 (12.9%) 1 (1.6%) 62 (14.55) CNHU 5 (3.5%) 6 (4.2%) 4 (2.8%) 17 (12.0%) 5 (3.5%) 26 (18.3%) 11 (7.8%) 30 (21.1%) 1 (0.7%) 3 (2.1%) 15 (10.6%) 19 (13.4%) 142 (33.33) Total (%) 34 (8.0%) 9 (2.1%) 8 (1.9%) 54 (12.7%) 40 (9.4%) 78 (18.3%) 24 (5.6%) 101 (23.7%) 7 (1.6%) 12 (2.8%) 29 (6.8%) 30 (7.0%) 426 Distribution of Isolated Strains by Clinical Department The departments most affected by the isolated GNB strains were: Pediatric intensive care: 113 isolates (26.53%) Neonatology: 103 isolates (24.18%) Surgical operating room: 80 isolates (18.78%) Intensive care unit: 59 isolates (13.85%) Maternity operating room: 41 isolates (9.62%) Maternal intensive care: 30 isolates (7.04%) Pseudomonas spp. were dominant in neonatology (n = 24), pediatric intensive care (n = 23), intensive care (n = 20), and the surgical operating room (n = 18). Klebsiella spp. were primarily found in neonatology and intensive care units, while Enterobacter spp. and A. baumannii were isolated in nearly all departments (see Table 4 ). Table 4 Frequency of Isolates by Hospital Department in Benin CHUs (n = 426) Bacteria Hospital Departments Total n (%) Surgical Operating Room Maternity Operating Room Neonatology Intensive Care Unit Maternal ICU Pediatric ICU Pseudomonas spp. 18 (22.50%) 11 (26.83%) 24 (23.30%) 20 (33.90%) 5 (16.67%) 23 (20.35%) 101 (23.71%) Klebsiella spp. 8 (10.00%) 13 (31.71%) 21 (20.39%) 11 (18.64%) 5 (16.67%) 20 (17.70%) 78 (18.31%) Enterobacter spp. 14 (17.50%) 4 (9.76%) 11 (10.68%) 6 (10.17%) 4 (13.33%) 15 (13.27%) 54 (12.68%) Escherichia spp. 13 (16.25%) – 9 (8.74%) 4 (6.78%) 5 (16.67%) 9 (7.96%) 40 (9.39%) Acinetobacter baumannii 5 (6.25%) 3 (7.32%) 9 (8.74%) 6 (10.17%) 3 (10.00%) 8 (7.08%) 34 (7.98%) Serratia spp. 5 (6.25%) 4 (9.76%) 6 (5.83%) – 1 (3.33%) 13 (11.50%) 29 (6.81%) Pantoea spp. 4 (5.00%) 3 (7.32%) 6 (5.83%) – 2 (6.67%) 9 (7.96%) 24 (5.63%) Salmonella spp. 1 (1.25%) 2 (4.88%) 4 (3.88%) 2 (3.39%) 3 (10.00%) – 12 (2.82%) Burkholderia cepacia 1 (1.25%) – 3 (2.91%) 2 (3.39%) – 3 (2.65%) 9 (2.11%) Citrobacter spp. 4 (5.00%) – 2 (1.94%) 1 (1.69%) – 1 (0.88%) 8 (1.88%) Raoultella spp. – 1 (2.44%) 6 (2.91%) – – 3 (2.65%) 7 (1.64%) Other GNB 7 (8.75%) – 5 (4.85%) 7 (11.86%) 2 (6.67%) 9 (7.96%) 30 (7.04%) Total n (%) 80 (18.78%) 51 (11.97%) 103 (24.18%) 59 (13.85%) 30 (7.04%) 113 (26.53%) 426 (100.00%) Distribution of Isolated Strains by Sample Type The most frequently isolated species from inert surfaces were: Pseudomonas spp. (18.18%), Klebsiella spp. (17.70%), Enterobacter spp. (13.88%), and Escherichia spp. (10.05%). Medical devices were mainly colonized by Pseudomonas spp. (29.85%) and Klebsiella spp. (19.4%). Similarly, healthcare workers’ hands and gowns were colonized by Pseudomonas spp. , Enterobacter spp. , A. baumannii , and Klebsiella spp. (see Table 5 ). Table 5 Frequency of Isolates by Hospital Environmental Sampling Site in CHUs (n = 426) Bacteria Material Total n (%) Air Antiseptic/ Detergent Staff Gown Medical Device Water Sink Staff Hands Faucet Surface Pseudomonas spp. 5 (29.41%) 3 (30.00%) 5 (13.89%) 20 (29.85%) 9 (39.13%) – 8 (22.22%) 5 (35.71%) 38 (18.18%) 101 (23.71%) Klebsiella spp. 1 (5.88%) 5 (50.00%) 6 (16.67%) 13 (19.40%) 3 (13.04%) 4 (28.57%) 5 (13.89%) 4 (28.57%) 37 (17.70%) 78 (18.31%) Enterobacter spp. 2 (11.76%) – 6 (16.67%) 5 (7.46%) 3 (13.04%) 1 (7.14%) 8 (22.22%) – 29 (13.88%) 54 (12.68%) Escherichia spp. 1 (5.88%) – 2 (5.56%) 11 (16.42%) 3 (13.04%) – 2 (5.56%) – 21 (10.05%) 40 (9.39%) Acinetobacter baumannii 2 (11.76%) – 8 (22.22%) 4 (5.97%) 1 (4.35%) – 4 (11.11%) – 15 (7.78%) 34 (7.98%) Serratia spp. 1 (5.88%) – 2 (5.56%) 3 (4.48%) – – 3 (8.33%) 3 (21.43%) 17 (8.13%) 29 (6.81%) Pantoea spp. 2 (11.76%) – 2 (5.56%) 1 (1.49%) – – 1 (2.78%) – 18 (8.61%) 24 (5.63%) Salmonella spp. – 1 (10.00%) 1 (2.78%) 2 (2.99%) 1 (4.35%) – 3 (8.33%) 1 (7.14%) 3 (1.44%) 12 (2.82%) Burkholderia cepacia 2 (11.76%) – 1 (2.78%) – 2 (8.70%) 1 (7.14%) – 1 (7.14%) 2 (0.96%) 9 (2.11%) Citrobacter spp. – – – 2 (2.99%) – – – – 6 (2.87%) 8 (1.88%) Raoultella spp. – – – – – 8 (57.14%) – – 7 (3.35%) 7 (1.64%) Other GNB 1 (5.88%) 1 (10.00%) 3 (8.33%) 6 (8.96%) 1 (4.35%) – 2 (5.56%) – 16 (7.66%) 30 (7.04%) Total n (%) 17 (4.00%) 10 (2.35%) 36 (8.45%) 67 (15.73%) 23 (5.40%) 14 (3.29%) 36 (8.45%) 14 (3.29%) 209 (49.06%) 426 (100.00%) Phenotypic Resistance to Antibiotics Antimicrobial susceptibility profiles revealed high levels of resistance to cephalosporins, carbapenems, and aminoglycosides (see Table 6 ): Table 6 Resistance Rates (%) of Isolated Gram-Negative Bacilli to Various Antibiotics Antibiotics Bacteria (%) A. baumannii B. cepacia Citrobacter spp. Enterobacter spp. Escherichia spp. Klebsiella spp. Pantoea spp. Pseudomonas spp. Raoultella spp. Salmonella spp. Serratia spp. Other GNB Ampicillin 64.71 88.89 87.5 85.19 77.5 92.31 66.67 76.24 100 75 82.76 70 Amoxicillin–Clavulanic Acid 61.76 77.78 75 70.37 62.5 71.79 62.5 72.28 71.43 66.67 75.86 53.33 Piperacillin–Tazobactam 64.71 66.67 75 48.15 62.5 70.51 50 39.60 71.43 33.33 62.07 26.67 Ticarcillin 73.53 77.78 87.5 77.78 90 93.59 66.67 75.30 85.71 85 82.76 63.33 Ticarcillin–Clavulanic Acid 73.53 66.67 87.5 77.78 82.5 85.90 66.67 72.28 71.43 83.33 82.76 56.67 Cefoxitin 82.35 77.78 62.5 74.07 32.5 39.74 66.67 77.23 28.57 75 72.41 63.33 Cefotaxime 79.41 44.44 75 46.30 60 69.23 62.5 59.41 71.43 83.33 62.07 40 Ceftriaxone 88.24 66.67 100 70.37 77.5 71.79 79.17 71.29 71.43 66.67 58.62 63.33 Cefixime 100 100 100 100 100 100 100 100 100 100 100 100 Ceftazidime 79.41 88.89 87.5 66.67 77.5 76.92 75 60.40 71.43 41.67 68.97 43.33 Cefepime 100 100 100 100 100 100 100 100 100 100 100 100 Aztreonam 76.47 88.89 62.5 70.37 82.5 75.64 66.67 73.27 85.71 75 89.66 73.33 Ertapenem 91.18 77.78 87.5 42.59 50 50 54.17 78.22 28.57 83.33 68.97 66.67 Meropenem 55.88 88.89 37.5 27.78 45 42.31 37.5 35.64 28.57 25 24.14 40 Chloramphenicol 94.12 11.11 62.5 42.59 70 34.62 54.17 70.30 57.14 83.33 41.38 36.67 Nalidixic Acid 55.88 11.11 37.5 44.44 75 61.54 45.83 50.50 57.14 58.33 51.72 30 Norfloxacin 52.94 11.11 37.5 44.44 72.5 64.10 41.67 35.64 57.14 58.33 55.17 33.33 Ciprofloxacin 61.76 11.11 75 37.04 70 61.54 41.67 37.62 57.14 25 55.17 6.67 Levofloxacin 55.88 0 62.5 40.74 72.5 67.95 54.17 36.63 71.43 25 55.17 10 Gentamicin 73.53 77.78 50 53.70 75 73.08 62.5 58.42 85.71 100 58.62 23.33 Tobramycin 64.71 77.78 62.5 64.81 75 74.36 50 43.56 71.43 100 58.62 30 Amikacin 41.18 66.67 62.5 42.59 57.5 41.03 41.67 21.78 42.86 100 51.72 23.33 Cotrimoxazole 50 44.44 50 55.56 70 60.26 66.67 53.47 85.71 33.33 55.17 30 Fosfomycin 61.76 55.56 37.5 40.74 20 61.54 37.5 54.46 42.86 16.67 58.62 63.33 Ceftriaxone : 100% resistance in Citrobacter spp. , 88.24% in A. baumannii , 77.5% in Escherichia spp. , 71.79% in Klebsiella spp. Ertapenem : 91.18% resistance in A. baumannii , 87.5% in Citrobacter spp. Meropenem : 88.89% resistance in B. cepacia , 55.88% in A. baumannii Gentamicin & Tobramycin : >70% resistance in Klebsiella spp. , Escherichia spp. , and A. baumannii Amikacin : showed the best efficacy, with only 21.78% resistance in Pseudomonas spp. Fluoroquinolones : >60% resistance in A. baumannii and Klebsiella spp. Fosfomycin : 61.76% resistance in A. baumannii , only 20% in Escherichia spp. Prevalence of Multidrug Resistance (MDR) As shown in Fig. 4 , among the 426 isolated strains, 389 (91.31%) were classified as multidrug-resistant (MDR). The highest MDR rates were observed in maternal intensive care (96.67%), maternity operating room (95.12%), and neonatology (94.17%), indicating strong selective pressure in these critical care units. In contrast, the lowest MDR rates were recorded in intensive care (88.14%) and pediatric intensive care (87.61%) (see Fig. 5 ). Distribution of MDR Strains by CHU and Clinical Department The distribution of MDR strains across CHUs and hospital units revealed notable concentrations in neonatology (24.94%), pediatric intensive care (25.45%), and intensive care (13.37%). The CNHU and CHUZ-Sourou Léré recorded the highest proportions of MDR isolates, with 32.64% and 14.4% respectively of the total isolates (see Table 7 ). Table 7 Distribution of Multidrug-Resistant Strains by CHU and Clinical Departments (n = 389) CHU Name Departments Total n (%) Surgical Operating Room Maternity Operating Room Neonatology Intensive Care Unit Maternal ICU Pediatric ICU CHUD-OUEME 11 (13.10%) 12 (14.29%) 24 (28.57%) 13 (15.48%) – 24 (28.57%) 84 (21.59%) CHUD-PARAKOU 5 (17.24%) 1 (3.45%) 7 (24.14%) 3 (10.34%) 4 (13.79%) 9 (31.03%) 29 (7.45%) CHU-MEL 18 (24.00%) – 18 (24.00%) 4 (5.33%) 18 (24.00%) 17 (22.67%) 75 (19.28%) CHUZ-ABOMEY CALAVI 4 (22.22%) – 5 (27.78%) 4 (22.22%) 5 (27.78%) – 18 (4.63%) CHUZ-SOUROU LERE 22 (39.29%) 15 (26.79%) 12 (21.43%) – – 7 (12.50%) 56 (14.40%) CNHU 13 (10.24%) 11 (8.66%) 31 (24.41%) 28 (22.05%) 2 (1.57%) 42 (33.07%) 127 (32.64%) Total 73 (18.77%) 39 (10.03%) 97 (24.94%) 52 (13.37%) 29 (7.46%) 99 (25.45%) 389 (100.00%) Distribution of MDR Strains by Bacterial Species Figure 6 shows the proportions of MDR strains among the main Gram-negative species isolated from the hospital environment. The highest MDR prevalence rates were observed in Salmonella spp. and Raoultella spp. (100%), followed by Acinetobacter baumannii (97.5%) and Klebsiella spp. (97.44%). The lowest rates were found in Burkholderia cepacia (88.89%) and Pantoea spp. (83.33%). Pan-Resistant Strains The overall proportion of pan-resistant strains identified in the study was 3.3% (n = 14/426). However, this extreme resistance was not evenly distributed among the bacterial species. Acinetobacter baumannii exhibited the highest pan-resistance rate (14.7%), followed by Pantoea spp. (12.5%) and Klebsiella spp. (5.13%). Enterobacter cloacae and Pseudomonas spp. showed lower rates of 1.85% and 1%, respectively (see Table 8 ). Table 8 Pan-Resistance Rates by Bacterial Species Bacterial Species Non-Pan-Resistant n (%) Pan-Resistant n (%) Total n (%) Acinetobacter baumannii 29 (85.3) 5 (14.7) 34 (8.0) Other GNB 30 (100.0) 0 (0.0) 30 (7.0) Burkholderia cepacia 9 (100.0) 0 (0.0) 9 (2.1) Citrobacter spp. 8 (100.0) 0 (0.0) 8 (1.9) Enterobacter spp. 53 (98.2) 1 (1.9) 54 (12.7) Escherichia spp. 40 (100.0) 0 (0.0) 40 (9.4) Klebsiella spp. 74 (94.9) 4 (5.1) 78 (18.3) Pantoea spp. 21 (87.5) 3 (12.5) 24 (5.6) Pseudomonas spp. 100 (99.0) 1 (1.0) 101 (23.7) Raoultella spp. 7 (100.0) 0 (0.0) 7 (1.6) Salmonella spp. 12 (100.0) 0 (0.0) 12 (2.8) Serratia spp. 29 (100.0) 0 (0.0) 29 (6.8) Total 412 (96.7) 14 (3.3) 426 (100) Distribution of Pan-Resistant Strains by Department and Hospital Center Among the 14 pan-resistant strains identified, the highest proportions were observed in pediatric intensive care units (28.6%) and neonatology units (21.4%). CHUD-Ouémé alone accounted for more than one-third (35.7%) of the cases (see Table 9 ). The most frequently affected supports included exposed surfaces (8 strains), healthcare workers’ hands (4 strains), followed by staff gowns and ambient air (1 strain each). Table 9 Distribution of Pan-Resistant Strains by Hospital and Department Pan-resistance CHU / Department Surgical Operating Room Maternity Operating Room Neonatology Intensive Care Unit Maternal ICU Pediatric ICU Total (n, %) CHUD-OUÉMÉ 1 1 - - - 3 5 (35.7%) CHUD-PARAKOU - - 1 - - 1 2 (14.3%) CHU-MEL - - - 1 1 - 2 (14.3%) CHUZ-ABOMEY CALAVI - - - - 1 - 1 (7.1%) CHUZ-SOUROU LÉRÉ 1 - 1 - - - 2 (14.3%) CNHU - - 1 1 - - 2 (14.3%) Total (n, %) 2 (14.3%) 1 (7.1%) 3 (21.4%) 2 (14.3%) 2 (14.3%) 4 (28.6%) 14 (100%) Association Between Equipment Disinfection and Pathogen Isolation The analysis showed that among 550 disinfectable sites, 56.7% tested positive for bacterial isolation. Among the equipment disinfected prior to sampling, 178 (56.15%) yielded GNB, compared to 134 (57.5%) from non-disinfected equipment. No statistically significant association was found between prior disinfection and bacterial isolation (p = 0.79; two-tailed Fisher’s exact test). The rate of contamination remained high whether the equipment had been disinfected (56.2%) or not (57.5%), with a non-significant odds ratio (OR = 0.95; 95% CI: 0.67–1.33) (see Fig. 7 ). Discussion This study highlights a concerning level of environmental contamination by multidrug-resistant Gram-negative bacilli (MDR-GNB) in university hospitals (CHUs) in Benin. These findings underscore the urgent need to strengthen infection prevention and control (IPC) measures, particularly in critical care units where patients are most vulnerable. The hospital environment is recognized as a significant reservoir of pathogenic microorganisms, especially Gram-negative bacilli (GNB), which are frequently isolated in high-risk clinical settings such as operating rooms, intensive care units, and neonatal wards [23, 24]. Moreover, the ability of GNB to form biofilms increases their resistance to disinfection and extends their survival on surfaces. Abdallah et al. (2014) demonstrated that these biofilms develop on inert surfaces and in moist areas, often involving species such as Pseudomonas aeruginosa and Acinetobacter baumannii , and may persist despite routine cleaning procedures [25]. In addition, Bouhrour et al. (2024) reported biofilm formation on multidrug-resistant medical devices such as catheters, contributing to up to 70% of all healthcare-associated infections [26]. The overall positivity rate (54.08%) observed in this study exceeds levels reported in several African hospitals (43–47%), including a Tunisian study that recorded 52.6% contaminated surfaces [27]. This situation reflects the active circulation of resistant pathogens in critical units such as neonatology, intensive care, and operating theatres. These elevated rates could be attributed to inadequate disinfection, as evidenced by the minimal difference in contamination between disinfected and non-disinfected sites. This finding reinforces conclusions by WHO and Africa CDC, which emphasize that environmental hygiene remains a weak link in the fight against AMR [28, 29]. Globally, antimicrobial resistance (AMR) is recognized as one of the top ten public health threats, according to the World Health Organization (WHO). Balasubramanian et al. (2023) estimate that 136 million hospital-acquired resistant infections occur annually across 195 countries, with a disproportionate burden in middle-income countries [10]. In contrast, Zublenko et al. (2025) reported a positivity rate below 2% in a European hospital with stringent hygiene protocols, highlighting the direct impact of rigorous infection control measures [30]. The bacterial diversity observed in this study, characterized by the predominance of Pseudomonas spp ., Klebsiella spp ., Enterobacter spp ., and Acinetobacter baumannii , mirrors profiles identified in several African hospital settings. Studies from Ghana [31] and Ethiopia [32] confirm the significant role of these pathogens in nosocomial infections, driven by their multidrug resistance and biofilm-forming capabilities. These traits confer high persistence on exposed surfaces, rendering standard disinfection less effective when poorly executed. These findings align with data from international surveillance systems, such as the WHO’s GLASS and the Africa CDC network, which emphasize the ability of these pathogens to survive in hospital environments, colonize healthcare workers’ hands, and facilitate cross-transmission in the absence of rigorous hygiene and prevention measures [33,20]. The antibiotic resistance profiles observed reveal concerning resistance to third- and fourth-generation cephalosporins, carbapenems, and aminoglycosides, particularly in Citrobacter spp. , Acinetobacter baumannii , Klebsiella spp. , Escherichia spp. , and Pseudomonas spp. Complete resistance to ceftriaxone in Citrobacter spp. and high rates in other enterobacteria corroborate trends reported in African and international studies, notably in Nigeria, where a high prevalence of multidrug-resistant Gram-negative bacilli was documented [34]. These resistances are often linked to the production of extended-spectrum β-lactamases (ESBLs) and carbapenemases, as highlighted by Nordmann and Poirel (2014) [35]. From an environmental perspective, the high resistance rates identified in this study are consistent with the observed biosafety conditions in Benin’s CHUs. Soulaymani et al. (2021) reported high microbial density on hospital surfaces in Morocco, predominantly multidrug-resistant enterobacteria, recommending enhanced routine microbiological monitoring to curb pathogen spread [36]. Similarly, data from CPIAS Normandie in France underscore that environmental contamination is a significant vector for cross-transmission, particularly when sampling, cleaning, and disinfection protocols are not rigorously applied [37]. These findings support the notion that combating AMR relies heavily on strict hospital hygiene and environmental microbiological surveillance. In this study, over 91% of isolates were multidrug-resistant (MDR), and 3.29% were pan-resistant, surpassing the African average of 72% reported by Tadesse et al. [11] and aligning with trends observed in the United States, Asia, and the Middle East [31,38]. These strains, identified on surfaces, medical devices, and healthcare workers’ hands, pose a direct threat to patient safety. A notable finding is the identification of overlooked but critical reservoirs: 10 contaminated disinfectant samples, alongside positive samples from hospital water and ambient air. These results corroborate Lompo et al. (2023), who found Gram-negative bacilli (GNB) in 75% of hygiene products tested in Benin and Burkina Faso [39], and Gwenzi et al. (2023), who documented airborne contamination in African intensive care units [40]. Despite high GNB isolation rates on disinfected (56.2%) and non-disinfected (57.5%) materials, statistical analysis showed no significant association (OR = 0.95; 95% CI: 0.67–1.33; p = 0.79), raising concerns about the effectiveness of applied disinfection practices. These findings are supported by studies in resource-limited hospital settings. In The Gambia, a quasi-experimental study reported sustained or increased surface contamination after training and supervision interventions, attributed to structural and material deficiencies (water, supplies, staffing) [41]. This highlights the limitations of cleaning strategies focused solely on training without improving operational conditions. At the Université des Montagnes in Cameroon, a laboratory study demonstrated the efficacy of 0.12% sodium hypochlorite in eliminating bacterial loads on work surfaces, confirming that scientifically validated disinfectants are critical for success [42]. Similarly, an Egyptian study showed that an enhanced cleaning protocol (training, standardized methods, and audits) significantly reduced Gram-negative bacteria on critical surfaces (p 5 g/L), combined with awareness sessions, sustainably improved adherence to hospital hygiene practices [44]. These studies support our findings, suggesting that appropriate, scientifically validated disinfectants and operational supervision are essential for effective disinfection in our hospitals. These observations align with the African Union’s Landmark Report, which notes that over 70% of African hospitals lack verifiable disinfection protocols [45]. Beyond their microbiological significance, these results serve as a strategic wake-up call for policymakers. Preventing healthcare-associated infections through hand hygiene, rigorous disinfection, and environmental surveillance represents the first line of defense against antimicrobial resistance (AMR), as emphasized by the WHO, CDC, and American Society for Microbiology. According to the WHO’s 2024 global report, up to 70% of nosocomial infections could be prevented through simple hygiene and control measures. Each infection prevented reduces the need for antibiotic treatment, thereby lowering selection pressure. Conversely, every lapse in hospital hygiene fuels the AMR spiral. This positions hospital hygiene as a critical lever in combating AMR. Limitations The absence of genotypic evaluation of isolates limited a detailed characterization of antibiotic resistance mechanisms. Limitations Despite the relevant findings, this study has limitations that warrant mention. Its single cross-sectional design precludes assessment of contamination trends over time or the impact of potential corrective interventions. Environmental contamination is subject to seasonal or organizational variations (e.g., staff shortages, disinfectant stockouts). The study could not establish clonal links between environmental and clinical isolates from patients. The absence of molecular typing techniques limits the ability to confirm direct nosocomial transmission or epidemic spread and to provide a detailed characterization of antibiotic resistance mechanisms. Additionally, the lack of a before/after comparison of improved hygiene practices prevents evaluation of corrective actions’ efficacy. Finally, the six CHUs included differ significantly in human, technical, and organizational resources, which may influence infection prevention quality and the circulation of multidrug-resistant bacteria, complicating comparisons. Conclusion This study highlights persistent, multifactorial environmental contamination by multidrug-resistant Gram-negative bacilli (MDR-GNB) in Benin’s University Hospitals (CHUs). It reveals not only a diversity of isolated bacteria and high antimicrobial resistance rates but also the presence of overlooked reservoirs (disinfectants, air, water) and human vectors (hands, gowns) often neglected in conventional prevention strategies. These findings confirm that, in their current configuration, Benin CHU environments facilitate antimicrobial resistance (AMR) dissemination despite existing disinfection practices, suggesting deficiencies in procedure implementation, disinfectant quality, or efficacy monitoring. They align with epidemiological trends reported in Africa, Asia, Europe, and the Americas, underscoring the global and systemic nature of the threat. Given these observations, fully integrating the hospital environment into AMR control policies is essential. This requires strengthening infection prevention and control (IPC) programs in healthcare facilities, emphasizing standardized and validated disinfection procedures, regular environmental microbiological surveillance, continuous training for healthcare and cleaning staff, and quality control of disinfectants within a coherent, operational, and verifiable One Health framework. Abbreviations • AMR Antimicrobial Resistance • GNB Gram-Negative Bacilli • IPC Infection Prevention and Control • WHO World Health Organization • USD United States Dollar • OECD Organization for Economic Co-operation and Development • KPC, NDM, VIM, OXA Types of Carbapenemases:Klebsiella pneumoniae Carbapenemase (KPC), New Delhi Metallo-β-lactamase (NDM), Verona Integron-encoded Metallo-β-lactamase (VIM), Oxacillinase (OXA) • TrACSS Tracking Antimicrobial Resistance Country Self-Assessment Survey • ICARS International Centre for Antimicrobial Resistance Solutions • MUSTPIC Multisectoral Approach to Strengthen Surveillance and Prevention of Infections and AMR in West Africa • CDC Centers for Disease Control and Prevention • CHU Centre Hospitalier Universitaire (University Teaching Hospital) • CNHU-HKM Centre National Hospitalier Universitaire Hubert Koutoukou Maga (National University Hospital Center Hubert Koutoukou Maga) • CHU-MEL Centre Hospitalier Universitaire de la Mère et de l’Enfant Lagune (Mother and Child Lagoon University Hospital) • CHUD-Ouémé Centre Hospitalier Universitaire Départemental de l’Ouémé (Departmental University Hospital of Ouémé) • CHUD-Borgou Centre Hospitalier Universitaire Départemental du Borgou (Departmental University Hospital of Borgou) • CHUZ-AC Centre Hospitalier Universitaire de Zone d’Abomey-Calavi (University Zone Hospital of Abomey-Calavi) • CHUZ-SL Centre Hospitalier Universitaire de Zone Sourou-Léré (University Zone Hospital of Sourou-Léré) • CA-SFM Comité de l’Antibiogramme de la Société Française de Microbiologie (French Society for Microbiology Antibiogram Committee) • CA-SFM/EUCAST Joint Standard by CA-SFM and the European Committee on Antimicrobial Susceptibility Testing • ATCC American Type Culture Collection • MDR Multidrug Resistant • EPI Info Epidemiological Information Software (developed by the CDC) • WHO’s GLASS WHO’s Global Antimicrobial Resistance Surveillance System • ESBLs Extended-Spectrum Beta-Lactamases • CPIAS Centre d’appui pour la Prévention des Infections Associées aux Soins (French National Support Center for Healthcare-Associated Infection Prevention) • MDR-GNB Multidrug-Resistant Gram-Negative Bacilli Declarations Ethics Approval and Consent to Participate The research protocol was approved by the Local Ethics Committee for Biomedical Research of the University of Parakou (CLERB-UP). Reference number: 564/2024/CLERB-UP/P/SP/R/SA. Clinical trial number Not applicable Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding This research was self-funded by the authors and no external funding was provided. Author Contribution Conceptualization: SESD, CCD, and HSB; Methodology: SESD, CCD, and HSB; Validation: CCD and HSB; Investigation and data collection: SESD, DAA, OT, JBY; Laboratory sample analysis: SESD, CCD, and DAA; Statistical analyses: SESD and CCD; Data curation: SESD and CCD; Writing of the original version: SESD; Coursework and validation: CCD, DAA, OT, JBY, and HSB. All authors have read and approved the final version of the manuscript. Acknowledgement The authors would like to express their sincere gratitude to the Clinical Director and staff of the Public Health Laboratory Unit of the University Hospital Hygiene Clinic of the National University Hospital Center - Hubert Koutoukou MAGA in Cotonou for providing laboratory facilities and their contributions to sample analyses during the study. They are also grateful to the various administrations of the six University Hospital Centers of Benin involved in the study. References Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet . 2022;399(10325):629-655. https://doi.org/10.1016/S0140-6736(21)02724-0 World Health Organization (WHO). TrACSS 2023 - Tracking Antimicrobial Resistance Country Self-Assessment Survey [Internet]. Geneva: WHO; 2023. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7255149","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556550067,"identity":"199f1231-59b3-4a16-97a4-615416329a36","order_by":0,"name":"Sènami Evelyne SOCLO DANSI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYHACxgMgkg9EfKgAEszMDQT1gLWwgTTPOAPSwkiCFmbeNrC1+LXItzc/OPCh4rAcm0TuwQe882qj+duBWn5UbMOpxeDMMYODM84cNmaTyEs2kNx2PHfGYcYGxp4zt3FrkchhOMzblpbYJpFjJmG47VhuA1ALM2Mbbi3yM0Ba/qXVA7WY/0iccyx3PiEtDDdAWhpsEtiAtjAcbKjJ3UBIC8Qvx2wM23jeGEs2HDuQuxGo5SA+vwBD7OGDDzUS8vzsOYaf/9TU5c47f/jggx8VeBwGBwIJIPIwmH2ACPVAwA9WV0ec4lEwCkbBKBhRAACJKl2D21DbsQAAAABJRU5ErkJggg==","orcid":"","institution":"1. Clinique Universitaire d'Hygiène Hospitalière, Centre National Hospitalier Universitaire - Hubert Koutoukou Maga , Cotonou","correspondingAuthor":true,"prefix":"","firstName":"Sènami","middleName":"Evelyne SOCLO","lastName":"DANSI","suffix":""},{"id":556550068,"identity":"7924e699-2383-4d95-8ce0-f9fb8bea2bad","order_by":1,"name":"Comlan Cyriaque Degbey","email":"","orcid":"","institution":"1. Clinique Universitaire d'Hygiène Hospitalière, Centre National Hospitalier Universitaire - Hubert Koutoukou Maga , Cotonou","correspondingAuthor":false,"prefix":"","firstName":"Comlan","middleName":"Cyriaque","lastName":"Degbey","suffix":""},{"id":556550069,"identity":"e6277c7f-f77a-4ee6-a0fa-110f8e832032","order_by":2,"name":"Diane A. Agbokou","email":"","orcid":"","institution":"1. Clinique Universitaire d'Hygiène Hospitalière, Centre National Hospitalier Universitaire - Hubert Koutoukou Maga , Cotonou","correspondingAuthor":false,"prefix":"","firstName":"Diane","middleName":"A.","lastName":"Agbokou","suffix":""},{"id":556550070,"identity":"b2aada91-15a7-4d5d-9b91-19e5f5aabf81","order_by":3,"name":"Ounoussa Tapha","email":"","orcid":"","institution":"2. Institut Régional de Santé Publique - Comlan Alfred QUENUM, UAC , Ouidah","correspondingAuthor":false,"prefix":"","firstName":"Ounoussa","middleName":"","lastName":"Tapha","suffix":""},{"id":556550071,"identity":"bc4d946c-514e-492b-96af-309e82655c3d","order_by":4,"name":"Jean Blaise Yobo","email":"","orcid":"","institution":"2. Institut Régional de Santé Publique - Comlan Alfred QUENUM, UAC , Ouidah","correspondingAuthor":false,"prefix":"","firstName":"Jean","middleName":"Blaise","lastName":"Yobo","suffix":""},{"id":556550072,"identity":"e19e96ea-18d9-4fe9-9f25-2a1174baee5d","order_by":5,"name":"Honoré S Bankolé","email":"","orcid":"","institution":"3. Ecole Polytechnique d'Abomey-Calavi, UAC , Abomey-Calavi","correspondingAuthor":false,"prefix":"","firstName":"Honoré","middleName":"S","lastName":"Bankolé","suffix":""}],"badges":[],"createdAt":"2025-07-30 16:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7255149/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7255149/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97697559,"identity":"6c914673-5ca5-49ef-ac93-48dc559f8166","added_by":"auto","created_at":"2025-12-08 11:45:15","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96260,"visible":true,"origin":"","legend":"","description":"","filename":"ArticleBMCMicrobiology.docx","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/deed5c7bab45efb94e2efd1d.docx"},{"id":97697565,"identity":"4fcdc2f0-c7bb-40b1-89ee-c5f766853e36","added_by":"auto","created_at":"2025-12-08 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11:45:16","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":221066,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/c138550bd8108493105480a2.html"},{"id":97697555,"identity":"02596653-44e9-4390-9337-ad7e92ae1b12","added_by":"auto","created_at":"2025-12-08 11:45:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":453291,"visible":true,"origin":"","legend":"\u003cp\u003eContamination rates of samples based on the isolation of Gram-negative bacilli (n=588).\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/b1120973d22b83ddcc599ba6.jpg"},{"id":97894345,"identity":"3452623d-861d-4145-a3a8-4b55ea598c60","added_by":"auto","created_at":"2025-12-10 15:32:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":180972,"visible":true,"origin":"","legend":"\u003cp\u003eContamination rates of different sampled sites.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/6d3188b7c48ceb3e92850566.jpg"},{"id":97697557,"identity":"8fcb7ccb-d228-4897-a3c3-9e181a772963","added_by":"auto","created_at":"2025-12-08 11:45:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":210918,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequency of Gram-Negative Bacilli Species Isolated\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/368d30048c74fc0c77425cd2.jpg"},{"id":97697558,"identity":"af67a2d9-0b4f-4930-9ee0-cc38455c00c6","added_by":"auto","created_at":"2025-12-08 11:45:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":74974,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of Multidrug Resistance (n = 426)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/12d47beaf54971e43e617a08.jpg"},{"id":97697560,"identity":"ff0f7d2f-cc53-4ec6-a889-2e3cb98acf9e","added_by":"auto","created_at":"2025-12-08 11:45:15","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":156594,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of Multidrug Resistance by Department\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/300b1b21284073abdfbf0829.jpg"},{"id":97697562,"identity":"4c7247fa-f233-471a-bdce-fc069ab70351","added_by":"auto","created_at":"2025-12-08 11:45:16","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":196790,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence rates of multidrug resistance by bacterial species.\u003c/p\u003e","description":"","filename":"Picture6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/6b1f5ade043b5fd72ccfac53.jpg"},{"id":97892918,"identity":"81a49f3d-7da6-44bd-9228-231bbaee3772","added_by":"auto","created_at":"2025-12-10 15:24:11","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":161544,"visible":true,"origin":"","legend":"\u003cp\u003eIsolation rates of Gram-negative bacilli (GNB) by disinfection status of sampled sites.\u003c/p\u003e","description":"","filename":"Picture7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/4e5424a0b6c4a1cce4fb7cb4.jpg"},{"id":97902392,"identity":"0bb844f6-ac5c-4038-8107-d32ca0077d36","added_by":"auto","created_at":"2025-12-10 15:52:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4516570,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7255149/v1/945a9878-23fb-4238-93f6-18884f09ed39.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli from the hospital environment of the University Hospital Centers of Benin","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntimicrobial resistance (AMR), now regarded as the silent pandemic of the 21st century, affects every continent. According to Murray et al. (2022), over 4.95\u0026nbsp;million deaths were associated with AMR in 2019, with 1.27\u0026nbsp;million directly attributable to it [1]. Without concrete measures, the World Health Organization (WHO) estimates that this figure could reach 10\u0026nbsp;million deaths per year by 2050, with a projected impact on global gross domestic product exceeding USD 3.4 trillion annually [2, 3].\u003c/p\u003e\u003cp\u003eYet, there is a widely acknowledged, cost-effective area for immediate action: up to 70% of healthcare-associated infections are preventable through simple interventions such as hand hygiene and thorough disinfection practices [4]. The OECD (2023) estimates that for every dollar invested in AMR prevention, up to 16 dollars can be saved in avoided healthcare costs [5].\u003c/p\u003e\u003cp\u003eAmong the pathogens at the core of this global health emergency are Gram-negative bacilli (GNB), particularly Enterobacteriaceae resistant to third- and fourth-generation cephalosporins and carbapenems, as well as non-fermenting bacteria such as \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e. These are part of the ESKAPE group, identified by WHO due to their ability to develop and disseminate complex resistance mechanisms-such as ESBLs, carbapenemases (KPC, NDM, VIM, OXA), efflux systems, and biofilm formation-that severely compromise the effectiveness of antimicrobial treatments [6, 7, 8, 9]. These pathogens are responsible for the majority of drug-resistant healthcare-associated infections worldwide, causing over 136\u0026nbsp;million cases annually [10]. Their impact is severe: mortality rates up to 50%, increasingly limited treatment options, and high healthcare costs. WHO ranks them among the top critical priority pathogens for global surveillance [4]. In Africa, over 70% of resistant hospital strains are GNB, with high levels of resistance to carbapenems [11].\u003c/p\u003e\u003cp\u003eIn sub-Saharan Africa, the burden of AMR is even more pronounced. According to WHO Africa, the continent could face up to 4.1\u0026nbsp;million AMR-related deaths annually in the absence of a coordinated response [12]. Fewer than half of African countries have functional environmental surveillance systems, and the TrACSS report (WHO, 2023) reveals that while 97.8% have adopted a national AMR action plan, only 11% have dedicated funding for its implementation [2].\u003c/p\u003e\u003cp\u003eA major barrier to political decision-making is the lack of field data. According to ICARS (2023), generating contextualized local data through implementation research is crucial to effectively tailoring national strategies [13].\u003c/p\u003e\u003cp\u003eIn West Africa, hospitals face numerous structural vulnerabilities: limited access to clean water, insufficient staff training, inadequate disinfection equipment, and a lack of microbial traceability. The regional MUSTPIC program (2018\u0026ndash;2022) reported surface contamination rates exceeding 40%, despite the presence of disinfection protocols [14]. Furthermore, Gwenzi et al. (2022) highlighted the presence of multidrug-resistant bioaerosols in hospital air, linked to poor ventilation systems [15].\u003c/p\u003e\u003cp\u003eIn Benin, the National AMR Action Plan 2019\u0026ndash;2024 remains limited in its implementation due to the absence of local environmental data. A recent study by Delfosse et al. (2025) in two reference hospitals revealed an antibiotic prescription prevalence of 32.9%, with 70% of surgical prophylaxis being unnecessarily prolonged, and no antimicrobial stewardship program in place [16].\u003c/p\u003e\u003cp\u003eIn this context, the likelihood of emergence and dissemination of multidrug-resistant strains in the hospital environment is high, although it has not yet been quantified in Benin\u0026rsquo;s university hospitals.\u003c/p\u003e\u003cp\u003eThis study aims to investigate the bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli in Benin\u0026rsquo;s university hospitals. Specifically, it seeks to identify dissemination vectors, describe resistance patterns, and detect gaps in surface, material, and device cleaning and disinfection practices. This approach aligns with the strategic recommendations of the World Health Organization (WHO), the Africa Centres for Disease Control and Prevention (Africa CDC 2023), and the African Union, which urge member states, within a \u0026ldquo;One Health\u0026rdquo; hospital-centered framework, to integrate hospital biosafety, IPC, and environmental surveillance dimensions into national AMR control policies [17, 18 ,19].\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis was a cross-sectional, exploratory study conducted from September to December 2024 in six university hospitals (CHU) in Benin. These institutions were selected based on their referral role, diversity of medical and surgical activities, and patient capacity. The participating centers were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eNational University Hospital Centre - Hubert Koutoukou Maga, Cotonou (CNHU-HKM)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUniversity Hospital - Mother and Child, Lagune (CHU-MEL)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDepartmental University Hospital of Ou\u0026eacute;m\u0026eacute; (CHUD-Ou\u0026eacute;m\u0026eacute;)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDepartmental University Hospital of Borgou (CHUD-Borgou)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eZonal University Hospital of Abomey-Calavi (CHUZ-AC)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eZonal University Hospital of Sourou-L\u0026eacute;r\u0026eacute; (CHUZ-SL)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTargeted Units\u003c/h3\u003e\n\u003cp\u003eSampling was conducted in care units identified as high-risk for nosocomial transmission: Neonatology, Pediatric Intensive Care, Adult Intensive Care, Maternal Intensive Care, Surgical Operating Room, and Maternity Operating Room.\u003c/p\u003e\n\u003ch3\u003eStudy Population and Inclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe study focused on the immediate hospital environment of patients, including air, water, antiseptics, detergents and disinfectants, inert surfaces, medical devices, as well as healthcare workers' hands and gowns.\u003c/p\u003e\u003cp\u003eAll supports present in the units at the time of investigation, and posing a potential risk for multidrug-resistant bacterial dissemination, were included.\u003c/p\u003e\n\u003ch3\u003eSampling Method\u003c/h3\u003e\n\u003cp\u003eA non-probability convenience sampling method was used. Sampling sites were selected according to the \u003cem\u003eGood Practice Guide for Environmental Microbiological Surveillance in Healthcare Settings\u003c/em\u003e [20].\u003c/p\u003e\u003cp\u003eThe sampling method varied based on the type of specimen:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eAir\u003c/b\u003e: Impaction on agar of 100 L of air using a bio-air collector.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eWater, antiseptics, detergents\u003c/b\u003e: Aseptic collection in sterile flasks.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSurfaces, devices, hands, and gowns\u003c/b\u003e: Sterile swabs moistened with brain-heart infusion broth were swabbed across defined areas using close parallel streaks with gentle rotation, followed by perpendicular streaks (crosswise swabbing). Swabs were then aseptically placed in their protective tubes and transported to the laboratory.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eA total of 588 samples were transported at 4\u0026deg;C using ice packs in a cooler and analyzed at the Public Health Laboratory of the University Hospital Hygiene Clinic at CNHU-HKM in Cotonou.\u003c/p\u003e\n\u003ch3\u003eBacterial Isolation and Identification\u003c/h3\u003e\n\u003cp\u003eEach sample was pre-enriched in brain-heart infusion broth and incubated at 37\u0026deg;C for 24 to 48 hours using a BINDER GmbH incubator (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.binder-world.com\" target=\"_blank\"\u003ewww.binder-world.com\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.binder-world.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). In case of turbidity, subculturing was done on MacConkey agar. Suspect colonies underwent:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGram staining,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBiochemical identification using API 20E test strips (bioM\u0026eacute;rieux\u0026reg;),\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInterpretative reading using the \u003cem\u003ebioM\u0026eacute;rieux\u0026reg; Analytical Catalog\u003c/em\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAntimicrobial Susceptibility Testing\u003c/h2\u003e\u003cp\u003eSusceptibility Testing Procedure\u003c/p\u003e\u003cp\u003eAntimicrobial susceptibility of isolated bacterial strains was assessed using the disk diffusion method (Kirby-Bauer technique) on Mueller-Hinton agar. Bacterial suspensions were standardized to a 0.5 McFarland turbidity, prepared from fresh (18\u0026ndash;24 h) colonies and adjusted using a densitometer.\u003c/p\u003e\u003cp\u003eInoculation was performed by uniform swabbing of the agar surface within 15 minutes of preparing the suspension. Antibiotic disks, impregnated with standardized concentrations, were placed using a sterile applicator. Plates were incubated at 37\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u0026deg;C for 18 to 24 hours under aerobic conditions.\u003c/p\u003e\u003cp\u003eInhibition zone diameters were measured with a graduated ruler. Results were interpreted based on the criteria of the \u003cem\u003eComit\u0026eacute; de l\u0026rsquo;Antibiogramme de la Soci\u0026eacute;t\u0026eacute; Fran\u0026ccedil;aise de Microbiologie (CA-SFM), 2024 version\u003c/em\u003e [21], considering critical diameters and susceptibility categories (Susceptible or Resistant).\u003c/p\u003e\u003cp\u003eTested antibiotics were grouped by pharmacological class (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), including β-lactams, quinolones/fluoroquinolones, aminoglycosides, phenicols, sulfonamides, and phosphonic acid derivatives, in accordance with standard guidelines.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClassification of tested antibiotics by pharmacological class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClass\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTested Antibiotics\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBeta-lactams\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNatural and semi-synthetic penicillins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAmpicillin, Ticarcillin\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePenicillins\u0026thinsp;+\u0026thinsp;β-lactamase inhibitors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAmoxicillin\u0026thinsp;+\u0026thinsp;Clavulanic acid, Ticarcillin\u0026thinsp;+\u0026thinsp;Clavulanic acid, Piperacillin\u0026thinsp;+\u0026thinsp;Tazobactam\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCephalosporins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCefoxitin (2nd gen), Cefotaxime, Ceftriaxone, Cefixime, Ceftazidime (3rd gen), Cefepime (4th gen)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMonobactams\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAztreonam\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCarbapenems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eErtapenem, Meropenem\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhenicols\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eChloramphenicol\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eQuinolones\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1st gen quinolone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNalidixic acid\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFluoroquinolones\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNorfloxacin, Ciprofloxacin, Levofloxacin\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAminoglycosides\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGentamicin, Tobramycin, Amikacin\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSulfonamides\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCotrimoxazole (Sulfamethoxazole\u0026thinsp;+\u0026thinsp;Trimethoprim)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhosphonic acid derivative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFosfomycin\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eQuality Control\u003c/h3\u003e\n\u003cp\u003eQuality control of antibiograms performed on Gram-negative bacilli was carried out according to CA-SFM/EUCAST (2024) recommendations [21].\u003c/p\u003e\u003cp\u003eTwo standardized reference strains were used to validate technical performance:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e ATCC\u0026reg; 25922 - reference for antibiotic-sensitive Enterobacteriaceae.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e ATCC\u0026reg; 27853 - reference for testing antipseudomonal agents, including third-generation cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThese strains were used to control the quality of culture media (Mueller-Hinton agar), antibiotic disk concentrations, and accuracy of inhibition zone measurements. The results obtained were within the expected ranges defined by CA-SFM/EUCAST, confirming the reliability and reproducibility of the susceptibility tests performed during the study.\u003c/p\u003e\n\u003ch3\u003eOperational Definitions\u003c/h3\u003e\n\u003cp\u003eA bacterial strain was classified as multidrug-resistant (MDR) if it exhibited resistance to at least one agent in three different antibiotic classes, and as pan-resistant if it was resistant to all tested antibiotics, according to the criteria of Magiorakos et al. [22].\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were entered and analyzed using Excel 2016 and EPI Info 7.2.6.0. Results were expressed as absolute and relative frequencies. Proportion comparisons were made using Chi-squared or Fisher\u0026rsquo;s exact test, depending on conditions. The threshold for statistical significance was set at 5%.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eGeneral Characteristics of Environmental Samples\u003c/h2\u003e\u003cp\u003eA total of 588 environmental samples were collected and analyzed from six university hospitals (CHUs) in Benin (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below). The CNHU-HKM was the most represented with 141 samples (23.98%), followed by CHU-MEL (20.07%), CHUD-B/A (19.90%), CHUD-OP (19.56%), CHUZ Sourou-L\u0026eacute;r\u0026eacute; (9.52%), and CHUZ-AC (6.97%).\u003c/p\u003e\u003cp\u003eSamples were collected from a variety of clinical units, including: surgical operating room (21.77%), neonatology (21.26%), intensive care unit (20.92%), pediatric intensive care (18.37%), maternal intensive care (10.20%), and maternity operating room (7.48%).\u003c/p\u003e\u003cp\u003eIn terms of relative abundance of the sample types, the distribution was as follows: inert surfaces (43.54%), medical devices (18.03%), healthcare workers\u0026rsquo; hands (11.73%) and gowns (5.78%), disinfectants/detergents (5.95%), water (5.78%), ambient air (5.10%), faucets (2.38%), and sinks (1.70%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Environmental Samples Collected (n\u0026thinsp;=\u0026thinsp;588)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eName of CHU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHU-MEL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHUD-OP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHUD-B/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHUZ-AC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHUZ Sourou-L\u0026eacute;r\u0026eacute;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCNHU-HKM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClinical Units\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical operating room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternity operating room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntensive care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal intensive care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePediatric intensive care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAir\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntiseptic/disinfectant/detergent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare worker gown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical device\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWater\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSink\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare worker hand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFaucet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInert surface\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eOverall Positivity Rate for Gram-Negative Bacilli Isolation\u003c/h2\u003e\u003cp\u003eOut of the 588 samples, 318 (54.08%) yielded positive cultures for Gram-negative bacilli (GNB). The sample types most frequently found to be positive included: sinks (90%), gowns (76.47%), faucets (71.43%), exposed inert surfaces (61.33%), and medical devices (49.06%) (see Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eDiversity of Isolated Bacterial Species\u003c/h2\u003e\u003cp\u003eA total of 426 Gram-negative bacilli (GNB) strains were isolated. Enterobacteriaceae were predominant (257 strains; 60.33%), followed by non-fermenting Gram-negative bacteria (169 strains; 39.67%).\u003c/p\u003e\u003cp\u003eThe most frequently identified species included: \u003cem\u003ePseudomonas spp.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;101; 23.7%), \u003cem\u003eKlebsiella spp.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;78; 18.3%), \u003cem\u003eEnterobacter spp.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;54; 12.7%), \u003cem\u003eEscherichia spp.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;40; 9.4%), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;34; 8.0%), \u003cem\u003eSerratia spp.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;29; 6.8%), and \u003cem\u003ePantoea spp.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;24; 5.6%) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRare or emerging species were also identified, such as: \u003cem\u003eBurkholderia cepacia\u003c/em\u003e, \u003cem\u003eRaoultella spp.\u003c/em\u003e, \u003cem\u003eChromobacterium violaceum\u003c/em\u003e, \u003cem\u003eStenotrophomonas maltophilia\u003c/em\u003e, \u003cem\u003eYersinia pestis\u003c/em\u003e, \u003cem\u003ePhotobacterium damselae\u003c/em\u003e, and \u003cem\u003eChryseobacterium indologenes\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eDistribution of Isolated Species by Hospital Center\u003c/h2\u003e\u003cp\u003eAmong the 426 isolated GNB strains from environmental samples collected in the six university hospitals (CHUs) included in the study, CNHU-HKM alone accounted for 33.3% of the isolates (n\u0026thinsp;=\u0026thinsp;142), followed by CHUD-Ou\u0026eacute;m\u0026eacute; (22.3%, n\u0026thinsp;=\u0026thinsp;95) and CHU-MEL (18.1%, n\u0026thinsp;=\u0026thinsp;77). The lowest proportions were observed at CHUZ Abomey-Calavi (4.7%) and CHUZ Sourou-L\u0026eacute;r\u0026eacute; (14.6%).\u003c/p\u003e\u003cp\u003eOverall, \u003cem\u003ePseudomonas spp.\u003c/em\u003e (23.7%), \u003cem\u003eKlebsiella spp.\u003c/em\u003e (18.3%), and \u003cem\u003eEnterobacter spp.\u003c/em\u003e (12.7%) were the three most frequently isolated species across all six CHUs (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Isolated Gram-Negative Bacilli Species by Hospital (n\u0026thinsp;=\u0026thinsp;426)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHospital Centers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"12\" nameend=\"c13\" namest=\"c2\"\u003e\u003cp\u003eBacterial species\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eA. baumannii\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eB. cepacia\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eCitrobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eEnterobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eEscherichia spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eKlebsiella spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003ePantoea spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ePseudomonas spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eRaoultella spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cem\u003eSalmonella spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cem\u003eSerratia spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003eOther GNB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUD-OUEME\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(7.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(11.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e(15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e28\u003c/p\u003e\u003cp\u003e(29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(2.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(2.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e95 (22.30)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUD-PARAKOU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(36.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(36.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.04)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHU-MEL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e29\u003c/p\u003e\u003cp\u003e(37.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e77\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(18.08)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUZ-ABOMEY CALAVI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(4.69)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUZ-SOUROU LERE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(4.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003cp\u003e(22.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(11.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e(19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(9.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(14.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e62\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.55)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCNHU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e17\u003c/p\u003e\u003cp\u003e(12.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e26\u003c/p\u003e\u003cp\u003e(18.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e30\u003c/p\u003e\u003cp\u003e(21.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(2.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e(10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e19\u003c/p\u003e\u003cp\u003e(13.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e142\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(33.33)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(8.0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.1%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.9%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e54\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(12.7%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(9.4%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e78\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(18.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e24\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(5.6%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e101\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(23.7%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.6%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.8%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(6.8%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.0%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e426\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eDistribution of Isolated Strains by Clinical Department\u003c/h2\u003e\u003cp\u003eThe departments most affected by the isolated GNB strains were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePediatric intensive care: 113 isolates (26.53%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNeonatology: 103 isolates (24.18%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSurgical operating room: 80 isolates (18.78%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIntensive care unit: 59 isolates (13.85%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMaternity operating room: 41 isolates (9.62%)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMaternal intensive care: 30 isolates (7.04%)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePseudomonas spp.\u003c/em\u003e were dominant in neonatology (n\u0026thinsp;=\u0026thinsp;24), pediatric intensive care (n\u0026thinsp;=\u0026thinsp;23), intensive care (n\u0026thinsp;=\u0026thinsp;20), and the surgical operating room (n\u0026thinsp;=\u0026thinsp;18).\u003c/p\u003e\u003cp\u003e\u003cem\u003eKlebsiella spp.\u003c/em\u003e were primarily found in neonatology and intensive care units, while \u003cem\u003eEnterobacter spp.\u003c/em\u003e and \u003cem\u003eA. baumannii\u003c/em\u003e were isolated in nearly all departments (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of Isolates by Hospital Department in Benin CHUs (n\u0026thinsp;=\u0026thinsp;426)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBacteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eHospital Departments\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal n\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical Operating Room\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaternity Operating Room\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeonatology\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMaternal ICU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePediatric ICU\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePseudomonas spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(22.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(26.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(23.30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(33.90%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(16.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23\u003c/p\u003e\u003cp\u003e(20.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e101\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(23.71%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKlebsiella spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(31.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003cp\u003e(20.39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(18.64%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(16.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(17.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e78\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(18.31%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEnterobacter spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003cp\u003e(17.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(9.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(10.68%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(10.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(13.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e(13.27%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e54\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(12.68%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEscherichia spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(16.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(8.74%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(6.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(16.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(7.96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(9.39%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcinetobacter baumannii\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(6.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(7.32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(8.74%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(10.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(7.08%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.98%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerratia spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(6.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(9.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(5.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(11.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(6.81%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePantoea spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(5.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(7.32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(5.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(6.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(7.96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e24\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(5.63%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSalmonella spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(4.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(3.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(3.39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.82%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBurkholderia cepacia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(2.91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(3.39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(2.65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.11%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCitrobacter spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(5.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(1.94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.69%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(0.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.88%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRaoultella spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(2.91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(2.65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.64%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther GNB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(8.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(4.85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(11.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(6.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(7.96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.04%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e80\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(18.78%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e51\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(11.97%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e103\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(24.18%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e59\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(13.85%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.04%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e113\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(26.53%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e426\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(100.00%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eDistribution of Isolated Strains by Sample Type\u003c/h2\u003e\u003cp\u003eThe most frequently isolated species from inert surfaces were: \u003cem\u003ePseudomonas spp.\u003c/em\u003e (18.18%), \u003cem\u003eKlebsiella spp.\u003c/em\u003e (17.70%), \u003cem\u003eEnterobacter spp.\u003c/em\u003e (13.88%), and \u003cem\u003eEscherichia spp.\u003c/em\u003e (10.05%).\u003c/p\u003e\u003cp\u003eMedical devices were mainly colonized by \u003cem\u003ePseudomonas spp.\u003c/em\u003e (29.85%) and \u003cem\u003eKlebsiella spp.\u003c/em\u003e (19.4%). Similarly, healthcare workers\u0026rsquo; hands and gowns were colonized by \u003cem\u003ePseudomonas spp.\u003c/em\u003e, \u003cem\u003eEnterobacter spp.\u003c/em\u003e, \u003cem\u003eA. baumannii\u003c/em\u003e, and \u003cem\u003eKlebsiella spp.\u003c/em\u003e (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of Isolates by Hospital Environmental Sampling Site in CHUs (n\u0026thinsp;=\u0026thinsp;426)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBacteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u003cp\u003eMaterial\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal n\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAir\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAntiseptic/ Detergent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStaff Gown\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedical Device\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWater\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSink\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eStaff Hands\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFaucet\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eSurface\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePseudomonas spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(29.41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(30.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(13.89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(29.85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(39.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(22.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(35.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e38\u003c/p\u003e\u003cp\u003e(18.18%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e101\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(23.71%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKlebsiella spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(50.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(16.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(19.40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(13.04%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(28.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(13.89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(28.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e37\u003c/p\u003e\u003cp\u003e(17.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e78\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(18.31%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEnterobacter spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(11.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(16.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(7.46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(13.04%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(22.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e29\u003c/p\u003e\u003cp\u003e(13.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e54\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(12.68%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEscherichia spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(16.42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(13.04%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e21\u003c/p\u003e\u003cp\u003e(10.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(9.39%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcinetobacter baumannii\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(11.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(22.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(5.97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(4.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(11.11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e(7.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.98%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerratia spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(4.48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(8.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(21.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e17\u003c/p\u003e\u003cp\u003e(8.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(6.81%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePantoea spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(11.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(1.49%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(8.61%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e24\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(5.63%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSalmonella spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(2.99%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(4.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(8.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(1.44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.82%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBurkholderia cepacia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(11.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(2.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(8.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(0.96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.11%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCitrobacter spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(2.99%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(2.87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.88%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRaoultella spp.\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(57.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(3.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1.64%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther GNB\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(5.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(8.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(8.96%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(4.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(5.56%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e16\u003c/p\u003e\u003cp\u003e(7.66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.04%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(4.00%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(2.35%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e36\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(8.45%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e67\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(15.73%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e23\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(5.40%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(3.29%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e36\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(8.45%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(3.29%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e209\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(49.06%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e426\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(100.00%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePhenotypic Resistance to Antibiotics\u003c/h2\u003e\u003cp\u003eAntimicrobial susceptibility profiles revealed high levels of resistance to cephalosporins, carbapenems, and aminoglycosides (see Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e):\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResistance Rates (%) of Isolated Gram-Negative Bacilli to Various Antibiotics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAntibiotics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"12\" nameend=\"c13\" namest=\"c2\"\u003e\u003cp\u003eBacteria (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eA. baumannii\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eB. cepacia\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eCitrobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eEnterobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eEscherichia spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eKlebsiella spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003ePantoea spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ePseudomonas spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eRaoultella spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cem\u003eSalmonella spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cem\u003eSerratia spp.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eOther GNB\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAmpicillin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e92.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e76.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e82.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAmoxicillin\u0026ndash;Clavulanic Acid\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e72.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e75.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e53.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePiperacillin\u0026ndash;Tazobactam\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e39.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e33.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e62.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e26.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTicarcillin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e93.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e75.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e82.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e63.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTicarcillin\u0026ndash;Clavulanic Acid\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e85.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e72.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e83.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e82.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e56.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCefoxitin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e77.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e72.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e63.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCefotaxime\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e59.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e83.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e62.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCeftriaxone\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e79.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e71.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e58.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e63.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCefixime\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCeftazidime\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e76.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e60.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e41.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e68.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e43.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCefepime\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAztreonam\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e73.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e89.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e73.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eErtapenem\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e54.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e78.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e83.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e68.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMeropenem\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e35.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e24.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChloramphenicol\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e34.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e54.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e70.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e83.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e41.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e36.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNalidixic Acid\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e45.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e50.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e58.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e51.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNorfloxacin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e64.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e35.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e58.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e55.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e33.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCiprofloxacin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e37.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e55.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e6.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevofloxacin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e67.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e54.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e36.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e55.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGentamicin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e73.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e58.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e58.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e23.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTobramycin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e74.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e43.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e58.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAmikacin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e21.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e51.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e23.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCotrimoxazole\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e66.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e53.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e33.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e55.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFosfomycin\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e61.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e54.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e16.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e58.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e63.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCeftriaxone\u003c/b\u003e: 100% resistance in \u003cem\u003eCitrobacter spp.\u003c/em\u003e, 88.24% in \u003cem\u003eA. baumannii\u003c/em\u003e, 77.5% in \u003cem\u003eEscherichia spp.\u003c/em\u003e, 71.79% in \u003cem\u003eKlebsiella spp.\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eErtapenem\u003c/b\u003e: 91.18% resistance in \u003cem\u003eA. baumannii\u003c/em\u003e, 87.5% in \u003cem\u003eCitrobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eMeropenem\u003c/b\u003e: 88.89% resistance in \u003cem\u003eB. cepacia\u003c/em\u003e, 55.88% in \u003cem\u003eA. baumannii\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGentamicin \u0026amp; Tobramycin\u003c/b\u003e: \u0026gt;70% resistance in \u003cem\u003eKlebsiella spp.\u003c/em\u003e, \u003cem\u003eEscherichia spp.\u003c/em\u003e, and \u003cem\u003eA. baumannii\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eAmikacin\u003c/b\u003e: showed the best efficacy, with only 21.78% resistance in \u003cem\u003ePseudomonas spp.\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFluoroquinolones\u003c/b\u003e: \u0026gt;60% resistance in \u003cem\u003eA. baumannii\u003c/em\u003e and \u003cem\u003eKlebsiella spp.\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFosfomycin\u003c/b\u003e: 61.76% resistance in \u003cem\u003eA. baumannii\u003c/em\u003e, only 20% in \u003cem\u003eEscherichia spp.\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of Multidrug Resistance (MDR)\u003c/h2\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, among the 426 isolated strains, 389 (91.31%) were classified as multidrug-resistant (MDR). The highest MDR rates were observed in maternal intensive care (96.67%), maternity operating room (95.12%), and neonatology (94.17%), indicating strong selective pressure in these critical care units. In contrast, the lowest MDR rates were recorded in intensive care (88.14%) and pediatric intensive care (87.61%) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eDistribution of MDR Strains by CHU and Clinical Department\u003c/h2\u003e\u003cp\u003e The distribution of MDR strains across CHUs and hospital units revealed notable concentrations in neonatology (24.94%), pediatric intensive care (25.45%), and intensive care (13.37%). The CNHU and CHUZ-Sourou L\u0026eacute;r\u0026eacute; recorded the highest proportions of MDR isolates, with 32.64% and 14.4% respectively of the total isolates (see Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Multidrug-Resistant Strains by CHU and Clinical Departments (n\u0026thinsp;=\u0026thinsp;389)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCHU Name\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eDepartments\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical Operating Room\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaternity Operating Room\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeonatology\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMaternal ICU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePediatric ICU\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUD-OUEME\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(13.10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e(14.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(28.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(15.48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24\u003c/p\u003e\u003cp\u003e(28.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e84\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(21.59%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUD-PARAKOU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(17.24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(3.45%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(24.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(10.34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(13.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(31.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.45%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHU-MEL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(24.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(24.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(5.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(24.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17\u003c/p\u003e\u003cp\u003e(22.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e75\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(19.28%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUZ-ABOMEY CALAVI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(22.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(27.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(22.22%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(27.78%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e18\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(4.63%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUZ-SOUROU LERE\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003cp\u003e(39.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003cp\u003e(26.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e(21.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(12.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e56\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.40%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCNHU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(10.24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(8.66%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003cp\u003e(24.41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28\u003c/p\u003e\u003cp\u003e(22.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(1.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42\u003c/p\u003e\u003cp\u003e(33.07%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e127\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(32.64%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e73\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(18.77%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e39\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(10.03%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e97\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(24.94%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e52\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(13.37%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.46%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e99\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(25.45%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e389\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(100.00%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eDistribution of MDR Strains by Bacterial Species\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows the proportions of MDR strains among the main Gram-negative species isolated from the hospital environment. The highest MDR prevalence rates were observed in \u003cem\u003eSalmonella spp.\u003c/em\u003e and \u003cem\u003eRaoultella spp.\u003c/em\u003e (100%), followed by \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (97.5%) and \u003cem\u003eKlebsiella spp.\u003c/em\u003e (97.44%). The lowest rates were found in \u003cem\u003eBurkholderia cepacia\u003c/em\u003e (88.89%) and \u003cem\u003ePantoea spp.\u003c/em\u003e (83.33%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003ePan-Resistant Strains\u003c/h2\u003e\u003cp\u003eThe overall proportion of pan-resistant strains identified in the study was 3.3% (n\u0026thinsp;=\u0026thinsp;14/426). However, this extreme resistance was not evenly distributed among the bacterial species. \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e exhibited the highest pan-resistance rate (14.7%), followed by \u003cem\u003ePantoea spp.\u003c/em\u003e (12.5%) and \u003cem\u003eKlebsiella spp.\u003c/em\u003e (5.13%). \u003cem\u003eEnterobacter cloacae\u003c/em\u003e and \u003cem\u003ePseudomonas spp.\u003c/em\u003e showed lower rates of 1.85% and 1%, respectively (see Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePan-Resistance Rates by Bacterial Species\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBacterial Species\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-Pan-Resistant n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePan-Resistant n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAcinetobacter baumannii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (85.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (8.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther GNB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (7.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBurkholderia cepacia\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCitrobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEnterobacter spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53 (98.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (12.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEscherichia spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eKlebsiella spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74 (94.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (18.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePantoea spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePseudomonas spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100 (99.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101 (23.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eRaoultella spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSalmonella spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSerratia spp.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (6.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e412 (96.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e426 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eDistribution of Pan-Resistant Strains by Department and Hospital Center\u003c/h2\u003e\u003cp\u003eAmong the 14 pan-resistant strains identified, the highest proportions were observed in pediatric intensive care units (28.6%) and neonatology units (21.4%). CHUD-Ou\u0026eacute;m\u0026eacute; alone accounted for more than one-third (35.7%) of the cases (see Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e). The most frequently affected supports included exposed surfaces (8 strains), healthcare workers\u0026rsquo; hands (4 strains), followed by staff gowns and ambient air (1 strain each).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Pan-Resistant Strains by Hospital and Department\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003ePan-resistance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHU / Department\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgical Operating Room\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaternity Operating Room\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeonatology\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMaternal ICU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePediatric ICU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n, %)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUD-OU\u0026Eacute;M\u0026Eacute;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(35.7%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUD-PARAKOU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHU-MEL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUZ-ABOMEY CALAVI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.1%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCHUZ-SOUROU L\u0026Eacute;R\u0026Eacute;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCNHU\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal (n, %)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(7.1%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(21.4%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(14.3%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(28.6%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(100%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eAssociation Between Equipment Disinfection and Pathogen Isolation\u003c/h2\u003e\u003cp\u003eThe analysis showed that among 550 disinfectable sites, 56.7% tested positive for bacterial isolation. Among the equipment disinfected prior to sampling, 178 (56.15%) yielded GNB, compared to 134 (57.5%) from non-disinfected equipment.\u003c/p\u003e\u003cp\u003eNo statistically significant association was found between prior disinfection and bacterial isolation (p\u0026thinsp;=\u0026thinsp;0.79; two-tailed Fisher\u0026rsquo;s exact test).\u003c/p\u003e\u003cp\u003eThe rate of contamination remained high whether the equipment had been disinfected (56.2%) or not (57.5%), with a non-significant odds ratio (OR\u0026thinsp;=\u0026thinsp;0.95; 95% CI: 0.67\u0026ndash;1.33) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights a concerning level of environmental contamination by multidrug-resistant Gram-negative bacilli (MDR-GNB) in university hospitals (CHUs) in Benin. These findings underscore the urgent need to strengthen infection prevention and control (IPC) measures, particularly in critical care units where patients are most vulnerable.\u003c/p\u003e\u003cp\u003eThe hospital environment is recognized as a significant reservoir of pathogenic microorganisms, especially Gram-negative bacilli (GNB), which are frequently isolated in high-risk clinical settings such as operating rooms, intensive care units, and neonatal wards [23, 24].\u003c/p\u003e\u003cp\u003eMoreover, the ability of GNB to form biofilms increases their resistance to disinfection and extends their survival on surfaces. Abdallah et al. (2014) demonstrated that these biofilms develop on inert surfaces and in moist areas, often involving species such as \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, and may persist despite routine cleaning procedures [25]. In addition, Bouhrour et al. (2024) reported biofilm formation on multidrug-resistant medical devices such as catheters, contributing to up to 70% of all healthcare-associated infections [26].\u003c/p\u003e\u003cp\u003eThe overall positivity rate (54.08%) observed in this study exceeds levels reported in several African hospitals (43\u0026ndash;47%), including a Tunisian study that recorded 52.6% contaminated surfaces [27]. This situation reflects the active circulation of resistant pathogens in critical units such as neonatology, intensive care, and operating theatres. These elevated rates could be attributed to inadequate disinfection, as evidenced by the minimal difference in contamination between disinfected and non-disinfected sites. This finding reinforces conclusions by WHO and Africa CDC, which emphasize that environmental hygiene remains a weak link in the fight against AMR [28, 29].\u003c/p\u003e\u003cp\u003e Globally, antimicrobial resistance (AMR) is recognized as one of the top ten public health threats, according to the World Health Organization (WHO). Balasubramanian et al. (2023) estimate that 136\u0026nbsp;million hospital-acquired resistant infections occur annually across 195 countries, with a disproportionate burden in middle-income countries [10]. In contrast, Zublenko et al. (2025) reported a positivity rate below 2% in a European hospital with stringent hygiene protocols, highlighting the direct impact of rigorous infection control measures [30].\u003c/p\u003e\u003cp\u003eThe bacterial diversity observed in this study, characterized by the predominance of \u003cem\u003ePseudomonas spp\u003c/em\u003e., \u003cem\u003eKlebsiella spp\u003c/em\u003e., \u003cem\u003eEnterobacter spp\u003c/em\u003e., and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, mirrors profiles identified in several African hospital settings. Studies from Ghana [31] and Ethiopia [32] confirm the significant role of these pathogens in nosocomial infections, driven by their multidrug resistance and biofilm-forming capabilities. These traits confer high persistence on exposed surfaces, rendering standard disinfection less effective when poorly executed. These findings align with data from international surveillance systems, such as the WHO\u0026rsquo;s GLASS and the Africa CDC network, which emphasize the ability of these pathogens to survive in hospital environments, colonize healthcare workers\u0026rsquo; hands, and facilitate cross-transmission in the absence of rigorous hygiene and prevention measures [33,20].\u003c/p\u003e\u003cp\u003eThe antibiotic resistance profiles observed reveal concerning resistance to third- and fourth-generation cephalosporins, carbapenems, and aminoglycosides, particularly in \u003cem\u003eCitrobacter spp.\u003c/em\u003e, \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, \u003cem\u003eKlebsiella spp.\u003c/em\u003e, \u003cem\u003eEscherichia spp.\u003c/em\u003e, and \u003cem\u003ePseudomonas spp.\u003c/em\u003e Complete resistance to ceftriaxone in \u003cem\u003eCitrobacter spp.\u003c/em\u003e and high rates in other enterobacteria corroborate trends reported in African and international studies, notably in Nigeria, where a high prevalence of multidrug-resistant Gram-negative bacilli was documented [34]. These resistances are often linked to the production of extended-spectrum β-lactamases (ESBLs) and carbapenemases, as highlighted by Nordmann and Poirel (2014) [35].\u003c/p\u003e\u003cp\u003eFrom an environmental perspective, the high resistance rates identified in this study are consistent with the observed biosafety conditions in Benin\u0026rsquo;s CHUs. Soulaymani et al. (2021) reported high microbial density on hospital surfaces in Morocco, predominantly multidrug-resistant enterobacteria, recommending enhanced routine microbiological monitoring to curb pathogen spread [36]. Similarly, data from CPIAS Normandie in France underscore that environmental contamination is a significant vector for cross-transmission, particularly when sampling, cleaning, and disinfection protocols are not rigorously applied [37]. These findings support the notion that combating AMR relies heavily on strict hospital hygiene and environmental microbiological surveillance.\u003c/p\u003e\u003cp\u003eIn this study, over 91% of isolates were multidrug-resistant (MDR), and 3.29% were pan-resistant, surpassing the African average of 72% reported by Tadesse et al. [11] and aligning with trends observed in the United States, Asia, and the Middle East [31,38]. These strains, identified on surfaces, medical devices, and healthcare workers\u0026rsquo; hands, pose a direct threat to patient safety.\u003c/p\u003e\u003cp\u003eA notable finding is the identification of overlooked but critical reservoirs: 10 contaminated disinfectant samples, alongside positive samples from hospital water and ambient air. These results corroborate Lompo et al. (2023), who found Gram-negative bacilli (GNB) in 75% of hygiene products tested in Benin and Burkina Faso [39], and Gwenzi et al. (2023), who documented airborne contamination in African intensive care units [40].\u003c/p\u003e\u003cp\u003eDespite high GNB isolation rates on disinfected (56.2%) and non-disinfected (57.5%) materials, statistical analysis showed no significant association (OR\u0026thinsp;=\u0026thinsp;0.95; 95% CI: 0.67\u0026ndash;1.33; p\u0026thinsp;=\u0026thinsp;0.79), raising concerns about the effectiveness of applied disinfection practices.\u003c/p\u003e\u003cp\u003eThese findings are supported by studies in resource-limited hospital settings. In The Gambia, a quasi-experimental study reported sustained or increased surface contamination after training and supervision interventions, attributed to structural and material deficiencies (water, supplies, staffing) [41]. This highlights the limitations of cleaning strategies focused solely on training without improving operational conditions.\u003c/p\u003e\u003cp\u003eAt the Universit\u0026eacute; des Montagnes in Cameroon, a laboratory study demonstrated the efficacy of 0.12% sodium hypochlorite in eliminating bacterial loads on work surfaces, confirming that scientifically validated disinfectants are critical for success [42]. Similarly, an Egyptian study showed that an enhanced cleaning protocol (training, standardized methods, and audits) significantly reduced Gram-negative bacteria on critical surfaces (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), underscoring the impact of structured approaches [43].\u003c/p\u003e\u003cp\u003eFurthermore, research in Burkina Faso illustrated that locally produced sodium hypochlorite with adequate concentrations (\u0026gt;\u0026thinsp;5 g/L), combined with awareness sessions, sustainably improved adherence to hospital hygiene practices [44]. These studies support our findings, suggesting that appropriate, scientifically validated disinfectants and operational supervision are essential for effective disinfection in our hospitals. These observations align with the African Union\u0026rsquo;s Landmark Report, which notes that over 70% of African hospitals lack verifiable disinfection protocols [45].\u003c/p\u003e\u003cp\u003eBeyond their microbiological significance, these results serve as a strategic wake-up call for policymakers. Preventing healthcare-associated infections through hand hygiene, rigorous disinfection, and environmental surveillance represents the first line of defense against antimicrobial resistance (AMR), as emphasized by the WHO, CDC, and American Society for Microbiology. According to the WHO\u0026rsquo;s 2024 global report, up to 70% of nosocomial infections could be prevented through simple hygiene and control measures. Each infection prevented reduces the need for antibiotic treatment, thereby lowering selection pressure. Conversely, every lapse in hospital hygiene fuels the AMR spiral. This positions hospital hygiene as a critical lever in combating AMR.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eThe absence of genotypic evaluation of isolates limited a detailed characterization of antibiotic resistance mechanisms.\u003c/p\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eDespite the relevant findings, this study has limitations that warrant mention. Its single cross-sectional design precludes assessment of contamination trends over time or the impact of potential corrective interventions. Environmental contamination is subject to seasonal or organizational variations (e.g., staff shortages, disinfectant stockouts). The study could not establish clonal links between environmental and clinical isolates from patients. The absence of molecular typing techniques limits the ability to confirm direct nosocomial transmission or epidemic spread and to provide a detailed characterization of antibiotic resistance mechanisms. Additionally, the lack of a before/after comparison of improved hygiene practices prevents evaluation of corrective actions\u0026rsquo; efficacy. Finally, the six CHUs included differ significantly in human, technical, and organizational resources, which may influence infection prevention quality and the circulation of multidrug-resistant bacteria, complicating comparisons.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights persistent, multifactorial environmental contamination by multidrug-resistant Gram-negative bacilli (MDR-GNB) in Benin\u0026rsquo;s University Hospitals (CHUs). It reveals not only a diversity of isolated bacteria and high antimicrobial resistance rates but also the presence of overlooked reservoirs (disinfectants, air, water) and human vectors (hands, gowns) often neglected in conventional prevention strategies.\u003c/p\u003e\u003cp\u003eThese findings confirm that, in their current configuration, Benin CHU environments facilitate antimicrobial resistance (AMR) dissemination despite existing disinfection practices, suggesting deficiencies in procedure implementation, disinfectant quality, or efficacy monitoring. They align with epidemiological trends reported in Africa, Asia, Europe, and the Americas, underscoring the global and systemic nature of the threat. Given these observations, fully integrating the hospital environment into AMR control policies is essential. This requires strengthening infection prevention and control (IPC) programs in healthcare facilities, emphasizing standardized and validated disinfection procedures, regular environmental microbiological surveillance, continuous training for healthcare and cleaning staff, and quality control of disinfectants within a coherent, operational, and verifiable One Health framework.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eAMR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntimicrobial Resistance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eGNB\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGram-Negative Bacilli\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eIPC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInfection Prevention and Control\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eUSD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States Dollar\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eOECD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOrganization for Economic Co-operation and Development\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eKPC, NDM, VIM, OXA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTypes of Carbapenemases:Klebsiella pneumoniae Carbapenemase (KPC), New Delhi Metallo-β-lactamase (NDM), Verona Integron-encoded Metallo-β-lactamase (VIM), Oxacillinase (OXA)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eTrACSS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTracking Antimicrobial Resistance Country Self-Assessment Survey\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eICARS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Centre for Antimicrobial Resistance Solutions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMUSTPIC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultisectoral Approach to Strengthen Surveillance and Prevention of Infections and AMR in West Africa\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCDC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCenters for Disease Control and Prevention\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHU\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre Hospitalier Universitaire (University Teaching Hospital)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCNHU-HKM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre National Hospitalier Universitaire Hubert Koutoukou Maga (National University Hospital Center Hubert Koutoukou Maga)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHU-MEL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre Hospitalier Universitaire de la M\u0026egrave;re et de l\u0026rsquo;Enfant Lagune (Mother and Child Lagoon University Hospital)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHUD-Ou\u0026eacute;m\u0026eacute;\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre Hospitalier Universitaire D\u0026eacute;partemental de l\u0026rsquo;Ou\u0026eacute;m\u0026eacute; (Departmental University Hospital of Ou\u0026eacute;m\u0026eacute;)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHUD-Borgou\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre Hospitalier Universitaire D\u0026eacute;partemental du Borgou (Departmental University Hospital of Borgou)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHUZ-AC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre Hospitalier Universitaire de Zone d\u0026rsquo;Abomey-Calavi (University Zone Hospital of Abomey-Calavi)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCHUZ-SL\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre Hospitalier Universitaire de Zone Sourou-L\u0026eacute;r\u0026eacute; (University Zone Hospital of Sourou-L\u0026eacute;r\u0026eacute;)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCA-SFM\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e Comit\u0026eacute; de l\u0026rsquo;Antibiogramme de la Soci\u0026eacute;t\u0026eacute; Fran\u0026ccedil;aise de Microbiologie (French Society for Microbiology Antibiogram Committee)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCA-SFM/EUCAST\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e Joint Standard by CA-SFM and the European Committee on Antimicrobial Susceptibility Testing\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eATCC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAmerican Type Culture Collection\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMDR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultidrug Resistant\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eEPI Info\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEpidemiological Information Software (developed by the CDC)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eWHO\u0026rsquo;s GLASS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWHO\u0026rsquo;s Global Antimicrobial Resistance Surveillance System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eESBLs\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eExtended-Spectrum Beta-Lactamases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eCPIAS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre d\u0026rsquo;appui pour la Pr\u0026eacute;vention des Infections Associ\u0026eacute;es aux Soins (French National Support Center for Healthcare-Associated Infection Prevention)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMDR-GNB\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultidrug-Resistant Gram-Negative Bacilli\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003e The research protocol was approved by the Local Ethics Committee for Biomedical Research of the University of Parakou (CLERB-UP). Reference number: 564/2024/CLERB-UP/P/SP/R/SA.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research was self-funded by the authors and no external funding was\u003c/p\u003e\u003cp\u003eprovided.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: SESD, CCD, and HSB; Methodology: SESD, CCD, and HSB; Validation: CCD and HSB; Investigation and data collection: SESD, DAA, OT, JBY; Laboratory sample analysis: SESD, CCD, and DAA; Statistical analyses: SESD and CCD; Data curation: SESD and CCD; Writing of the original version: SESD; Coursework and validation: CCD, DAA, OT, JBY, and HSB. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to express their sincere gratitude to the Clinical Director and staff of the Public Health Laboratory Unit of the University Hospital Hygiene Clinic of the National University Hospital Center - Hubert Koutoukou MAGA in Cotonou for providing laboratory facilities and their contributions to sample analyses during the study. They are also grateful to the various administrations of the six University Hospital Centers of Benin involved in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMurray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al.\u003cbr\u003eGlobal burden of bacterial antimicrobial resistance in 2019: a systematic analysis. \u003cem\u003eLancet\u003c/em\u003e. 2022;399(10325):629-655. https://doi.org/10.1016/S0140-6736(21)02724-0\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO).\u003cbr\u003e TrACSS 2023 - Tracking Antimicrobial Resistance Country Self-Assessment Survey [Internet]. Geneva: WHO; 2023. 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Available from: https://www.cell.com/heliyon/abstract/S2405-8440(24)01678-5\u003c/li\u003e\n\u003cli\u003eHamed, NM, Deif, OA, El-Zoka, AH \u003cem\u003eet al.\u003c/em\u003e Impact d\u0026apos;un nettoyage renforc\u0026eacute; sur la contamination bact\u0026eacute;rienne des surfaces environnementales hospitali\u0026egrave;res : essai clinique en unit\u0026eacute; de soins intensifs d\u0026apos;un h\u0026ocirc;pital \u0026eacute;gyptien. \u003cem\u003eAntimicrob Resist Infect Control \u003c/em\u003e\u003cstrong\u003e13\u003c/strong\u003e , 138 (2024). https://doi.org/10.1186/s13756-024-01489-z\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"44\"\u003e\n\u003cli\u003e\u003cstrong\u003eDuvernay PG, de Laguiche E, Campos Nogueira R, Graz B, Nana L, Ou\u0026eacute;draogo W, Sauter Y, Sauvageat E.\u003c/strong\u003e Preventing nosocomial infections in resource-limited settings: An interventional approach in healthcare facilities in Burkina Faso. \u003cem\u003eInfect Dis Health\u003c/em\u003e. 2020 Aug;25(3):186-93. https://doi.org/10.1016/j.idh.2020.04.003\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"45\"\u003e\n\u003cli\u003eAfrica Centres for Disease Control and Prevention (Africa CDC). African Union AMR Landmark Report: Voicing African priorities on the active pandemic [Internet]. Addis Ababa: Africa CDC; 2024. Available from: https://africacdc.org/wp-content/uploads/2024/08/African-Union-AMR-Landmark-Report-.pdf [Accessed 4 Jul 2025].\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gram-negative bacilli, Multidrug resistance, Hospital environment, Mapping, University Hospitals of Benin","lastPublishedDoi":"10.21203/rs.3.rs-7255149/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7255149/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAntimicrobial resistance (AMR) represents a major global health threat, one that is exacerbated in sub-Saharan Africa by systemic shortcomings in hospital hygiene. This cross-sectional descriptive study was conducted in six University Teaching Hospitals in Benin, with the aim of mapping multidrug-resistant Gram-negative bacilli (GNB) present in the clinical environment and assessing the vectors of their spread.\u003c/p\u003e\u003cp\u003eA total of 588 samples were collected from various environmental and clinical surfaces. More than half (54.08%) yielded GNB isolates, with a predominance of \u003cem\u003ePseudomonas spp.\u003c/em\u003e (23.7%) and \u003cem\u003eKlebsiella spp.\u003c/em\u003e (18.3%). Multidrug resistance rates reached 91.3%, with a pan-resistance rate of 3.29%. High levels of resistance were observed against third-generation cephalosporins (100%), carbapenems (\u0026gt;\u0026thinsp;90%), and aminoglycosides (\u0026gt;\u0026thinsp;70%). The most contaminated surfaces included sinks (90%), staff gowns (76.47%), and surfaces (61.33%).\u003c/p\u003e\u003cp\u003eDisinfection procedures proved largely ineffective, with similar positivity rates between disinfected sites (56.15%) and non-disinfected ones (57.51%).\u003c/p\u003e\u003cp\u003eThese findings highlight the massive presence of multidrug-resistant strains in the hospital environment in Benin and the urgent need to strengthen infection prevention and control (IPC) practices, particularly in critical care units. The study also reveals serious shortcomings in cleaning protocols and calls for a revision of disinfection strategies within a One Health framework.\u003c/p\u003e","manuscriptTitle":"Bacterial ecology and antimicrobial resistance profiles of Gram-negative bacilli from the hospital environment of the University Hospital Centers of Benin","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 11:45:11","doi":"10.21203/rs.3.rs-7255149/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-15T17:27:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T15:32:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T19:00:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66656007770117841715251102741757744759","date":"2025-12-06T15:51:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-06T08:16:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253727325181390814037034444578497602051","date":"2025-12-05T19:08:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21853359095430205557323518152610910088","date":"2025-12-05T12:55:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T08:04:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-22T11:36:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-05T08:27:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T08:26:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Microbiology","date":"2025-07-30T16:44:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"911670d5-b1d9-4b93-bbf4-57f32c253fc5","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-25T20:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 11:45:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7255149","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7255149","identity":"rs-7255149","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}