Antibiotic Resistance: Prevalence and Determinants in Yaounde Gynaecology Obstetric and Paediatric Hospital, Cameroon

In hospitals around the world, doctors rely on antibiotics to fight bacterial infections, saving countless lives from pneumonia, surgical complications, and severe illnesses. These medicines work by targeting specific weaknesses in bacteria, stopping them from multiplying or killing them outright. However, bacteria are remarkably adaptable. Over time, they can change their biology to survive the very drugs designed to destroy them, a phenomenon known as antibiotic resistance. When this happens, standard treatments fail, infections linger longer, and patients face higher risks of severe complications or death. This is not just a theoretical threat; it is a growing reality that strains healthcare systems and endangers public health, particularly in regions where resources are limited and infections are common. Understanding how and why these resistant bacteria emerge in specific hospitals is the first step toward stopping their spread.

In Yaoundé, the capital of Cameroon, researchers turned their attention to the Yaoundé Gynaecology, Obstetrics and Paediatric Hospital, a major medical center that treats critically ill women and children. The team set out to map the landscape of antibiotic resistance within the facility, looking not only at which bacteria were becoming resistant but also at the human behaviors and system gaps that drive the problem. They conducted a four-month study between February and May 2025, examining the medical records of nearly 370 patients who were receiving antibiotics. To understand the "why" behind the numbers, the researchers also sat down for interviews with twenty-five doctors who prescribe these medicines and sixteen patients who had developed resistant infections. Their goal was to uncover the full picture: how often resistance occurs, which drugs are being used most, and what barriers prevent doctors and patients from using antibiotics more wisely.

The study revealed that antibiotic resistance is a present and significant concern within the hospital, affecting a small but critical portion of patients. Among those tested, about 5.7 percent carried bacteria that were resistant to the antibiotics prescribed to treat them. The problem was not evenly distributed; the highest rates of resistance appeared in the general pediatric ward and the gynecology-obstetrics ward. The bacteria causing the most trouble were two common types: Escherichia coli and Klebsiella pneumoniae. These organisms were most frequently resistant to a specific class of drugs called third-generation cephalosporins, which are powerful antibiotics often used for serious infections. The researchers found that Klebsiella pneumoniae was particularly stubborn, showing resistance to these drugs in more than a third of the cases where it was found.

A closer look at how antibiotics were being used showed a pattern of heavy reliance on these medicines. Nearly three out of every four patients in the hospital were receiving antibiotic therapy. The vast majority of these prescriptions, more than 96 percent, were given without waiting for lab results to confirm exactly which bacteria were causing the infection. Doctors were prescribing based on their best guess, a practice known as empirical prescribing. The most commonly prescribed drug was ceftriaxone, a powerful antibiotic that belongs to a category the World Health Organization calls "Watch," meaning it has a higher potential for driving resistance if overused. While most antibiotics used in the hospital fell into the "Access" category—drugs that are generally safer and less likely to cause resistance—the pediatric ward was an exception, where nearly half of the prescriptions were for the more risky "Watch" drugs.

The interviews with doctors and patients painted a clear picture of the obstacles standing in the way of better antibiotic use. The doctors expressed a strong desire to prescribe correctly but cited major systemic hurdles. They reported a lack of up-to-date local guidelines to follow and a severe shortage of rapid, affordable diagnostic tests. Without quick lab results to tell them exactly which bacteria a patient has, doctors feel forced to guess and often choose broader, stronger antibiotics to be safe. They also noted that government enforcement of rules restricting over-the-counter antibiotic sales is weak, making it easy for people to buy powerful medicines without a prescription.

On the patient side, the interviews uncovered deep-seated habits that fuel resistance. Many patients admitted to buying and taking antibiotics on their own for common symptoms like fever or cough, often without a doctor's advice. There was a widespread misunderstanding that antibiotics are a cure-all for any illness, including viral infections like the flu, which they cannot treat. Even when patients did receive a prescription, many stopped taking the medicine as soon as they felt better, rather than finishing the full course, or they saved the leftover pills to use later. These behaviors, combined with a lack of awareness about how misuse leads to resistance, create a perfect environment for bacteria to evolve and survive.

The researchers concluded that the rise of antibiotic resistance in this hospital is driven by a combination of factors: a lack of diagnostic tools that forces doctors to guess, a shortage of clear local guidelines, and patient behaviors rooted in misconceptions and convenience. The study suggests that solving this problem requires more than just telling doctors to prescribe less. It demands a coordinated effort to improve access to rapid lab tests, enforce stricter rules on how antibiotics are sold, and launch public education campaigns to change how people view these life-saving medicines. Without these changes, the cycle of overuse and resistance is likely to continue, threatening the effectiveness of treatments for the most vulnerable patients in Cameroon.