High Burden of Vaginal Infections and Multidrug Resistance With Promising Probiotic Candidates From Cervicovaginal Microbiota in North Region, Cameroon.

Vaginal infections are a major public health concern in sub-Saharan Africa, where antimicrobial resistance increasingly compromises clinical management. This study aimed to determine the prevalence of vaginal infections, describe their antimicrobial resistance profiles, and evaluate the probiotic potential of lactic acid bacteria (LAB) isolated from cervicovaginal samples of women consulting in Garoua, North Cameroon. A mixed retrospective-prospective and analytical study was conducted at three hospital facilities in Garoua (January 2023-December 2024). Microbial identification used the VITEK 2 system and API 50 CHL galleries. Antibacterial and antifungal susceptibility were interpreted per EUCAST guidelines (versions 13.1-14.0) and CLSI M60 breakpoints, respectively. LAB isolates were characterized for safety, physiological tolerance, aggregation capacity, and antimicrobial activity. Statistical analyses included chi-square tests, odds ratio, Shannon diversity index, MARI, and PCA. Among 877 records analyzed, overall prevalence was 60.55% (95% CI: 57.27%-63.73%), declining significantly from 69.60% in 2023 to 53.78% in 2024 (OR = 1.97; p < 0.0001). Women aged 15-35 years were most affected (62.55%), with a seasonal peak in August (69.31%). Gardnerella vaginalis predominated (52.02%), followed by Candida albicans (18.60%). Clotrimazole (85.50%) showed critical antifungal resistance, while econazole retained the greatest activity (82.11% sensitivity). All five bacterial species fulfilled multidrug resistance criteria, with resistance confirmed in ≥ 82% of antibiotic families tested per species. Six LAB isolates identified as Lacticaseibacillus paracasei, Lactobacillus acidophilus, Lactiplantibacillus plantarum, Lactiplantibacillus pentosus, and Lactococcus raffinolactis displayed satisfactory probiotic profiles, including absence of virulence factors, acid and bile stress tolerance, strong aggregation capacity, and antimicrobial activity against Staphylococcus aureus, Neisseria gonorrhoeae, and Escherichia coli. This study reveals a high burden of vaginal infections with alarming multidrug resistance in Garoua. The identified LAB isolates represent promising locally sourced candidates for vaginal probiotic development. Institutionalized antimicrobial surveillance, revised antifungal prescribing practices, and targeted prevention campaigns are urgently needed.