preprint · Research Square
Abstract Background Antibiotic resistance represents a critical public health challenge in Cameroon, particularly in tertiary care hospitals with high infection burdens and suboptimal infection prevention measures. This study aimed to determine the prevalence and determinants of antibiotic resistance to improve prescription practices. Methods A prospective mixed methods study was conducted at Yaoundé Gynaecological and Paediatric Hospital over four months (February- May 2025). Census sampling was used following the WHO Point Prevalence Survey methodology for quantitative data collection from medical records of all eligible inpatients receiving antibiotic therapy (n = 368; 73.9% of total inpatients). Purposive sampling was used for qualitative data collection, with semi-structured interviews conducted among all resident prescribing clinicians (n = 25) and patients with resistant infections (n = 16). Results The prevalence of antibiotic resistance was 5.7%. Klebsiella pneumoniae and Escherichia coli were the most resistant organisms, primarily against third-generation cephalosporins. Antibiotic utilisation was high (73.9%), with ceftriaxone being the most prescribed. Paediatrics had 49.5% of the WHO Access group. Overall compliance with international guidelines was 68.4%, while empirical prescribing occurred in 96.3% of cases. As determinants of prescription, clinicians’ interviews revealed barriers, including a lack of local guidelines, the inaccessibility of rapid diagnostic tests, and insufficient affordable diagnostic tools. Factors of the patient that contributed to resistance included self-medication, misconceptions about antibiotics, incomplete treatment courses, and poor awareness of antibiotic resistance. Conclusion Antibiotic resistance in YGOPH is a significant concern driven by systemic (guideline gaps, diagnostic limitations) and patient behaviour (self-medication, incomplete treatment). Stewardship programmes customised for hospitals and communities, supported by improved diagnostic capacity and regulatory enforcement, are urgently needed.
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DOI: 10.21203/rs.3.rs-10723821/v1
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