Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé, Cameroon
Michel Kengne, Marlise Beatrice Bidzogo Lebogo, Julius Mbekem Nwobegahay, Bienvenue Etogo Ondigui
The Pan African Medical Journal. 2018;31:16. doi:10.11604/pamj.2018.31.16.11195

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Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé, Cameroon

Cite this: The Pan African Medical Journal. 2018;31:16. doi:10.11604/pamj.2018.31.16.11195

Received: 17/11/2016 - Accepted: 06/08/2018 - Published: 05/09/2018

Key words: Antibiotic susceptibility, Streptococcus pneumoniae, lower respiratory tract infections, HIV patients

© Michel Kengne et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Corresponding author: Michel Kengne, Department of Medical Microbiology and Immunology, School of Health Sciences-Catholic University of Central Africa, Yaoundé, Cameroon (

Antibiotics susceptibility pattern of Streptococcus pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé, Cameroon

Michel Kengne1,&, Marlise Beatrice Bidzogo Lebogo1, Julius Mbekem Nwobegahay1,2, Bienvenue Etogo Ondigui3


1School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon, 2Yaoundé Military Hospital, Cameroon, 3Yaoundé Central Hospital, Cameroon



&Corresponding author
Michel Kengne, Department of Medical Microbiology and Immunology, School of Health Sciences-Catholic University of Central Africa, Yaoundé, Cameroon




Introduction: the susceptibility of Streptococcus pneumoniae to commonly used antibiotics is threatened by the emergence of resistance of S. pneumonia strains. So, to improve the management of lower respiratory tract infections (LRTIs) in human immunodeficiency virus infected patients, we assessed the antibiotic susceptibility of Streptococcus pneumoniae which is the most common bacterial cause of LRTIs in patients.


Methods: a cross sectional study was carried out from May to October 2014. HIV infected patients suspected of LRTIs attending the Center Medical laboratory and those followed up at the authorized treatment center of Yaounde Military Hospital in Cameroon were enrolled. Sputum was collected from each patient and cultured; identification of microorganisms was performed following standard methods. The disk diffusion method was used for antibacterial susceptibility testing according to the Antibiogram Committee of French Society for Microbiology guidelines.


Results: a total of 51 (25.5%) isolates of S. pneumoniae were recovered from sputum samples obtained from 200 HIV infected patients aged 19-66 years old (mean age: 36±10.087 years old); 144 (72%) of them were female (sex ratio M/F: 1/3). S. pneumoniae carriage was not age dependent (P = 0.384) and was significantly higher in male compared to female (P = 0.008). S. pneumoniae isolates were susceptible to amoxicillin-clavulinic acid (100%), pristinamycin (100%), erythromycin (100%) and cefixime (98.04 %). Highest resistance rates were recorded with fusidic acid (100%), fosfomycin (100%) and tetracyclin (100%).


Conclusion: S. pneumoniae is still susceptible to some agents in our study area however; ongoing surveillance for antimicrobial susceptibility remains essential to identify emerging resistance and attempt to limit its spread.



Introduction    Down

Studies have shown that bacterial infections represent an important cause of morbidity and mortality in HIV infected patients [1-3]. The most causative organisms are Streptococcus pneumoniae and Haemophilus influenza [4, 5]. S. pneumoniae has been reported to be the most common bacterial cause of lower respiratory tract infections [6]. In countries where HIV epidemic remains entrenched, the dominance of LRTIs as the most common cause of hospitalization and mortality in HIV infected patients has been described [6]. These high-risk patients have reduced ability to eliminate microbial pathogens, and so outgrowth of resistant mutants during antibiotic treatment is more likely to occur [7-9]. Moreover it has been described elsewhere that widespread antibiotic resistance is common and seems higher in immune-compromised subjects than in immune-competent individuals [10]. The steady increase of bacteria resistance to antibiotics is a cause of global concern. Infections caused by resistant microorganisms often fail to respond to empiric treatment resulting in prolonged illness and greater risk of death [11]. Available studies from sub-Saharan countries in Africa have highlighted unexpected high rates of resistance of bacteria to common antibiotics [12-18]. In Cameroon, health institutions have little to none antibiotic policy. In addition, published data on LRTIs pathogens and their antibiotic resistance profiles in patients infected with HIV are lacking.



Methods Up    Down

Patients: a cross sectional study was carried out from May to October 2014. A total of 200 HIV infected patients with suspected LRTIs attending the Center Medical laboratory and those followed up at the authorized treatment center of Yaounde Military Hospital in Cameroon were eligible for inclusion. Patients who had received antibiotics within the previous fifteen days were excluded.


Bacterial isolation, identification procedures and antimicrobial susceptibility testing: patients were instructed to collect deep coughed sputum into a sterile wide mouth container with a screw cap after rinsing the mouth twice with plain water. The samples were brought immediately to the laboratory and processed within 30 minutes of collection. Sputum samples were inoculated onto blood agar plate and incubated in a candle jar for 24h. S. pneumoniae was identified using gram stain, catalase and optochin tests that were performed in parallel. The antimicrobial susceptibility of the isolated bacterium was determined using the disc diffusion method as described by the Antibiogram Committee of French Society for Microbiology [19]. The following antibiotics purchased from Bio-Rad (Belgium) were used: amoxicillin/ clavulanic acid (20/10 µg), imipenem (10µg), oxacillin (5µg), cefixime (10 µg), pristinamycin (15µg), tetracyclin (30UI), ofloxacin (5 µg), erythromycin (15UI), fusidic acid (10 µg), fosfomycin (50µg) and rifampicin (30 µg). The reference strain used for quality control was S. pneumoniae CIP 104485.


Data analysis: data were entered and analyzed using SPSS version 12.0 for windows (SPSS, Inc., Chicago, IL). Discrete variables were expressed as percentages and proportions, and then compared using the Chi-square test. Statistical significance difference was considered at value of p<0.05.


Ethics: authorization to conduct this study was obtained from the Cameroon national ethical review committee. Informed consent was obtained from all participants ≥ 18 years; while assent consent was obtained from participant teenagers via a proxy.



Results Up    Down

From May to October 2014, a total of 200 sputum samples obtained from 200 HIV infected patients were processed. The mean age at presentation was 36±10.087 years (range 19-66 years). There were 144 (72%) females and 56 (28%) males. The male to female ratio was approximately 1:3. S. pneumoniae was found in 51 (25.5%) of the cases. S. pneumoniae carriage was not age dependent (P = 0.384) and was significantly higher in male compared to female (P = 0.008) as shown in Table 1. Amoxicillin/clavulanate (100%), erythromycin (100%), pristinamycin (100%) and cefixime (98.0 %) displayed satisfactory activity against the isolates. 100% of the isolates were resistant to fusidic acid, fosfomycin and tetracyclin as shown in Table 2.



Discussion Up    Down

Since local susceptibility patterns are essential for antimicrobial prescribing, this work aimed at determining the antibiotics susceptibility patterns of S. pneumoniae isolated from sputum cultures of human immunodeficiency virus infected patients in Yaoundé-Cameroon. In the current study, the rate of carriage for S. pneumoniae was 51/200 (25.5%). This result is different from that of other studies. Pemba et al. [20] obtained a prevalence of 8.8% (n=856) among HIV-infected mineworkers in South Africa whereas in the same country, Crewe-Brown et al. [21] recorded a prevalence of 15.5% (n=457) from patients with and without human immunodeficiency virus infection. This finding may indicate the advanced impairment of the immune system defense mechanism of the study population which confer them a reduced ability to eliminate microbial pathogens. However, CD4+ T-cell counts and viral load measurements of the patients were not examined. The present investigation found that male to female ratio for S. pneumoniae carriage was approximately 1.3:1. This result is in line with other published data where a male to female ratio of ~1.5-2:1 was seen in most studies of pneumococcal disease. The predominance of male for S. pneumoniae infection may be due to underlying conditions such as smoking and alcoholism which are more common among males [22]. The resistance of S. pneumoniae to β-lactam agents and other antimicrobial agents is increasing in many parts of the world [23, 24].

According to Friedland and McCracken [25], all β-lactam antibiotics act by interaction with penicillin binding proteins, and changes in these proteins result in decreased susceptibility to all antibiotics of this type. Our study showed that nearly all S. pneumoniae isolates were susceptible (> 90%) to β-lactamine agents. The high susceptibility of the isolates may be due to the appropriate use of this agent in treating S. pneumoniae-related diseases. The same conclusion may be drawn for macrolide agent (erythromycin) since all the isolates were susceptible (100%). A worldwide increase of the outbreak of macrolide resistance in S. pneumoniae among clinical isolates has been reported by Najafi Mosley et al. [26]. 88.2% of the isolates were susceptible to ofloxacin. This observation is in line with the results published by karlowsky et al. [27]. In the opposite, it has been reported that pneumococci have borderline susceptibility at the recommended dosages to the earlier generation of fluoroquinolones such as ofloxacin and therefore are not recommended for the treatment of pneumococcal infections [25, 28]. The increasing prevalence of pneumococci with reduced susceptibility to fluoroquinolones has been assigned to the selected pressure of resistant mutants due to the increased use of fluoroquinolones [29]. In the present study, all the isolates were resistant to fusidic acid, fosfomycin and tetracycline, probably as a result of the exposure of the study population to other antibiotics. According to previous studies [20, 30], many HIV-positive patients are given primary cotrimoxazole (trimethoprim/sulphamethoxazole) prophylaxis and exposure to this antibiotic might increase the risk of antibiotic resistance in a variety of bacterial pathogens that may infect this high-risk population.



Conclusion Up    Down

Amoxicillin/clavulanate, erythromycin, pristinamycin and cefixime are still active antibacterial agents and therefore the drugs of choice in treating S. pneumoniae-related diseases in our setting. More studies like this are required at regular interval, to formulate an antibiotic policy which helps in preventing mortality and morbidity due to LRTIs caused by this bacterium in immune-compromised individuals.

What is known about this topic

  • S. pneumoniae is the most important cause of morbidity and mortality in HIV infected patients;
  • Antibiotics resistance is common in immune-compromised subjects;
  • Infections caused by resistant microorganisms often fail to respond to empiric treatment.

What this study adds

  • Knowledge of S. pneumonia carriage among HIV+ patients in Cameroon;
  • Information about the antibiotics to be used in treating S. pneumoniae infection among HIV+ patients in the study area.



Competing interests Up    Down

The authors declare no competing interests.



Authors’ contributions Up    Down

Michel Kengne conceived designed and financed the study. Beatrice Marlyse Bidzogo Lebogo performed the sample collection, the laboratory assays and participated in the data analysis under the supervision of Michel Kengne. The latter produced the first draft of this manuscript. Julius Mbekem Nwobegahay corrected the protocol before the study and did a thorough review of the manuscript. Bienvenue Etogo Ondigui supervised the laboratory assays. All authors have revised the manuscript in its current form. All authors read and approved the final manuscript.



Acknowledgments Up    Down

We are grateful to the participants who provided the specimen and directors of the Yaoundé military hospital and the Yaoundé center laboratory who granted the research authorizations for this survey to be done in their institutions.



Tables Up    Down

Table 1: distribution of S. pneumoniae isolates based on patient age group and sex

Table 2: percentage of susceptibility of S. pneumoniae isolates to antibiotics tested



References Up    Down

  1. Phe T, Vlieghe E, Reid T, Harries DA, Lim K, Thai S, De Smet B, Veng CH, Kham CH, Leng S, Griensven VJ, Jacobs J. Does HIV status affect the aetiology, bacterial resistance patterns and recommended empiric antibiotic treatment in adult patients with bloodstream infection in Cambodia? Tropical Medicine and International Health. 2013;18(4):485-494. Google Scholar

  2. Berger BJ, Hussain F, Roistacher K. Bacterial infections in HIV infected patients. Infect Dis Clin N Am. 1994; 8(2): 449-465. PubMed | Google Scholar

  3. Schuster MG, Norris AH. Community-acquired Pseudomonas aeruginosa pneumonia in patients with HIV infection. AIDS. 1994; 8(10): 1437-1441. PubMed | Google Scholar

  4. Witt DJ, Craven DE, Mc Cabe, WR. Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS related complex. Am J Med. 1987; 82(5): 900-906. PubMed | Google Scholar

  5. Hidron HI, Kempker R, Moann A, Rimland D. Methicillin resistant Staphylococcus aureus in HIV-infected patients. Infection and Drug Resistance. 2010; 3: 73-86. PubMed | Google Scholar

  6. Madhi AS, Petersen K, Madhi A, Khoosal M, Klugman PK. Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus Type 1-infected children. Clin Infect Dis. 2000; 31(1): 170-17. PubMed | Google Scholar

  7. Zhao X, Drlica K. Restricting the selection of antibiotic-resistant mutants: a general strategy derived from fluoroquinones studies. Clin Infect Dis. 2001; 33(3): S147-156. PubMed | Google Scholar

  8. Ewig S, Ruiz M, Torres A, Marco F, Martinez AJ, Sanchez M, Mensa J. Pneumonia acquired in the community through drug-resistant Streptococcus pneumonia. Am J Respir Crit Care Med. 1999; 159(6): 1835-1842.

  9. Meynard JL, Barbut F, Blum L, Guiget M, Chouaid C, Meyohas MC, Picard O, Petit JC, Frottier J. Risk factors for isolation of Streptococcus pneumonia with decreased susceptibility to penicillin G from patients infected with human immunodeficiency virus. Clin Infect Dis. 1996; 22(3): 437-440.

  10. Adeyemi MF, Ako-Nai AK, Adejuyigbe E, Ebhodaghe IB, Osho OP, Oyeniyi TT, Kassim OO. Molecular characterization and antibiotic resistance profiles of bacterial isolates cultured from HIV seropositive patients. Archives of Clinical Microbiology. 2015; 6(1:2): 1-11. Google Scholar

  11. Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, Bartlett JG, Edwards J Jr. Infectious Diseases Society of America: The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis. 2008; 46(2): 155-164. PubMed | Google Scholar

  12. Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in Jimma University specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011; 21(2): 141-6. PubMed | Google Scholar

  13. Sire JM, Nabeth P, Perrier-Gros-Claude JD, Bahsoun I, Siby T, Macondo EA,Gaye-Diallo A, Guyomard S, Seck A, Breurec S, Garin B. Antimicrobial resistance in outpatient Escherichia coli urinary isolates in Dakar, Senegal. J Infect Dev Ctries. 2007; 1(3): 263-8. Google Scholar

  14. Dromigny JA, Nabeth P, Juergens-Behr A, Perrier-Gros-Claude JD. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrob Chemother. 2005; 56(1): 236-9. PubMed | Google Scholar

  15. Moyo SJ, Aboud S, Kasubi M, Lyamuya EF, Maselle SY. Antimicrobial resistance among producers and non-producers of extended spectrum beta-lactamases in urinary isolates at a tertiary Hospital in Tanzania. BMC Res Notes. 2010; 3: 348. PubMed | Google Scholar

  16. Dada-Adegbola HO, Muili KA. Antibiotic susceptibility pattern of urinary tract pathogens in Ibadan, Nigeria. Afr J Med Med Sci 2010; 39(3): 173-9. Google Scholar

  17. Bercion R, Mossoro-Kpinde D, Manirakiza A, Le Faou A. Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Bangui, Central African Republic. J Infect Dev Ctries 2009; 3(3): 187-90. Google Scholar

  18. Alabi AS, Frielinghaus L, Kaba H, Kösters K, Huson MA, Kahl BC, Peters G, Grobusch MP, Issifou S, Kremsner PG, Schaumburg F. Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa. BMC Infect Dis. 2013; 13: 455. PubMed | Google Scholar

  19. Société Française de Microbiologie. Comité de l'antibiogramme de la société française de microbiologie: recommandations. 2012. Accessed on 17 November 2016.

  20. Pemba L, Charalambous S, von Gottberg A, Magadla B, Moloi V, Seabi O, Wasas A, Klugman KP, Chaisson RE, Fielding K, Churchyard GJ, Grant AD. Impact of cotrimoxazole on non-susceptibility to antibiotics in Streptococcus pneumoniae carriage isolates among HIV-infected mineworkers in South Africa. Journal of Infection. 2008; 56(3): 171-178. PubMed | Google Scholar

  21. Crewe-Brown HH, Karstaedt SA, Saunders L, Khoosal M, Nicola GJ, Wasas A and Klugman PK. Streptococcus pneumonia blood culture isolates from patients with and without Human Immunodeficiency Virus infection: alterations in penicillin susceptibilities and in serogroups or serotypes. Clin Infect Dis. 1997; 25(5): 1165-1172. PubMed | Google Scholar

  22. Örtqvist Å, Hedlund J, Kalin M. Streptococcus pneumonia: Epidemiology, Risk Factors and Clinical Features. Semin Respir Crit Care Med. 2005; 26(6): 563-574. Google Scholar

  23. Barry AL, Pfaller MA, Fuchs PC, Packer RR. In vitro activities of 12 orally administered antimicrobial agents against four species of bacterial respiratory pathogens from US medical centers in 1992 and 1993. Antimicrob Agents Chemother. 1994; 38(10): 2419-25. PubMed | Google Scholar

  24. Doern GV, Brueggemann A, Holley HP Jr, Rauch AM. Antimicrobial resistance of Streptococcus pneumonia recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study. Antimicrob Agents Chemother. 1996; 40(5): 1208-13. PubMed | Google Scholar

  25. Friedland IR, McCracken GHJr. Management of infections caused by antibiotic-resistant Streptococcus pneumonia. The New England Journal of Medicine. 1994; 331(6): 377-382. PubMed | Google Scholar

  26. Najafi Mosleh M, Gharibi M, Alikhani MY, Saidijam M, Vakhshiteh F. Antimicrobial susceptibility and analysis of macrolide resistance genes in Streptococcus pneumonia isolated in Hamadan. Iran J Basic Med Sci. 2014; 17(8): 595-599. PubMed | Google Scholar

  27. Karlowsky JM, Jones ME, Draghi DC, Thornsberry C, Sahm DF, Volturo GA. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Annals of Clinical Microbiology and Antimicrobials. 2004;3:7. PubMed | Google Scholar

  28. Lee BL, Kimbrough RC, Jones SR, Chaisson RE, Mills J. Infectious complications with respiratory pathogens despite ciprofloxacin therapy. N Engl J Med. 1991; 325(7): 520-1. PubMed | Google Scholar

  29. Chen DK, Mcgeer A, De Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumonia to fluoroquinolones in Canada. N Engl J Med. 1999; 341(4): 233-239. PubMed | Google Scholar

  30. Gill CJ, Sabin LL, Tham J, Hamer DH. Reconsidering empiric cotrimoxazole prophylaxis for infants exposed to HIV infection. Bulletin of the World Health Organization. 2004; 82(4): 290-297. PubMed | Google Scholar






























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Antibiotic susceptibility
Streptococcus pneumoniae
Lower respiratory tract infections
HIV patients

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