Bloodstream infections at a tertiary hospital in The Gambia - A one-year retrospective study

Introduction Antimicrobial resistance is a significant global health concern, particularly in western Sub-Saharan Africa. This study describes causes of bacteraemia and antimicrobial resistance at a tertiary hospital in The Gambia. Methods This retrospective analysis included all blood cultures performed at the Edward Francis Small Teaching Hospital, Banjul, The Gambia, from September 2022 to August 2023. Blood culture positivity-rates and pathogens were described. Antimicrobial susceptibility testing was performed using disk diffusion (CLSI). Results In total, 288/645 (45%) blood cultures were positive. A majority were drawn in intensive care units (63%) and in neonatal or paediatric patients (56%). The most common pathogens were Staphylococcus aureus 106/288 (37%), Klebsiella spp. 41/288 (14%), other bacteria within the Enterobacterales order 33/288 (11%), Pseudomonas spp. 22/288 (8%) and Acinetobacter spp. 19/288 (7%). 28/288 (10%) were classified as contaminants. Methicillin-resistant S. aureus (MRSA) was seen in 34/58 (59%) tested. Extended-spectrum beta-lactamases (ESBL) were seen in 36/40 (90%) of Klebsiella spp. and in 16/28 (57%) of other bacteria within the Enterobacterales order. Acquired antibiotic resistance, beyond wild-type, was reported in 17/20 (85%) of Pseudomonas spp. and 16/19 (84%) of Acinetobacter spp. Conclusion Overall, blood culture positivity rates were high, indicating restrictive testing. The presented data highlight blood culture findings primarily among critically ill and neonatal or paediatric patients, with nosocomial infections likely overrepresented. Despite probable selection bias, alarmingly high MRSA- and ESBL-rates were described. These findings highlight the urgent need of accessible microbiological diagnostics, antibiotic stewardships and infection control measures in West Africa. Importantly, generalizability of findings to community-acquired infections remains restricted.