Clinical Scorecard: Trends in Antimicrobial Resistance and Epidemiology of Invasive Bacterial Pathogens in The Gambia: A Retrospective Study from 2019 to 2024
At a Glance
Category | Detail |
|---|
Condition | Invasive bacterial infections |
Key Mechanisms | Antimicrobial resistance, pathogen distribution, and demographic and seasonal variation |
Target Population | Patients represented by invasive clinical specimens submitted to the study laboratory |
Care Setting | Clinical Microbiology Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine |
Key Highlights
Among 423 invasive isolates, Staphylococcus aureus was the most common pathogen at 32.9%, followed by Escherichia coli at 17.5%, Streptococcus pyogenes at 9.9%, Streptococcus pneumoniae at 9.7%, and Klebsiella pneumoniae at 8.5%.
S. aureus showed approximately 92% resistance to penicillin, and methicillin-resistant S. aureus accounted for 10.0% of isolates.
E. coli showed 92.0% resistance to ampicillin and 44.2% resistance to ciprofloxacin, while S. pneumoniae showed approximately 97% resistance to cotrimoxazole.
S. pneumoniae was more common during the dry season, whereas K. pneumoniae was more common during the wet season.
Whole-genome sequencing of 40 S. aureus isolates showed mecA-positive isolates across multiple phylogenetic clades, supporting polyclonal rather than single-strain MRSA emergence.
Guideline-Based Recommendations
Diagnosis
Bacterial identification and antimicrobial susceptibility testing in the study were performed according to Clinical and Laboratory Standards Institute guidelines.
Phenotypic assays were used to identify resistance mechanisms, including extended-spectrum beta-lactamase and carbapenemase production.
Management
Use institution-level antimicrobial resistance surveillance and updated antibiograms to inform empirical treatment and antimicrobial stewardship.
The authors recommend coordinated multisite national surveillance to support development of national empirical treatment guidance.
Monitoring & Follow-up
Maintain surveillance of invasive bacterial pathogen distribution and antimicrobial resistance patterns.
The authors state that polyclonal mecA carriage warrants enhanced infection-control strategies and ongoing molecular surveillance.
Risks
High resistance was observed to several antibiotics among major invasive bacterial pathogens.
Findings from this single research-affiliated diagnostic laboratory should not be generalized to national invasive bacterial pathogen epidemiology in The Gambia.
Patient & Prescribing Data
The analysis included 423 invasive bacterial isolates from 7,496 clinical specimens processed from 2019 through 2024 after noninvasive specimens, duplicate isolates, contaminated samples, and incomplete records were excluded. Blood accounted for 81.1% of invasive specimens, aspirates for 18.0%, and cerebrospinal fluid for 0.9%.
Multidrug resistance was observed among major pathogens, including S. aureus, Streptococcus species, E. coli, K. pneumoniae, and Salmonella species. Resistance levels to key antibiotics were higher in the current study than in the comparator study cited by the authors.
Clinical Best Practices
In the study, antimicrobial susceptibility testing and interpretation followed Clinical and Laboratory Standards Institute standards.
Laboratory quality control was maintained using reference strains recommended by the Clinical and Laboratory Standards Institute.
Use local antimicrobial resistance data and regularly updated antibiograms to inform empirical prescribing and antimicrobial stewardship.
Interpret these findings as institution-level evidence rather than as nationally representative estimates for The Gambia.
Related Resources & Content
Epidemiology and antimicrobial resistance trends of invasive bacterial pathogens in the Gambia: a retrospective analysis, 2019-2024 — Abdulrahman Yakubu Mohammed, Mustapha Dibbasey, Buntung Ceesay, Morrow Minteh, Solomon E. Umukoro, Ousman Secka, and Abdoulie Bojang — International Journal of Infectious Diseases — Publication year: 2026; accepted September 14, 2026.
Community-acquired invasive bacterial disease in Urban Gambia, 2005-2015: a hospital-based surveillance — Darboe S, Okomo U, Muhammad A-K, Ceesay B, Jallow M, Usuf E, et al. — Clinical Infectious Diseases — 2019.
Bloodstream infections at a tertiary hospital in the Gambia – a one-year retrospective study — Rahden P, Barrow E, Bah H, Bittaye SO, Nygren D, Badjan A — BMC Infectious Diseases — 2025.
Using an antibiogram profile to improve infection control and rational antimicrobial therapy in an urban hospital in the Gambia, strategies and lessons for low- and Middle-income countries — Darboe S, Mirasol R, Adejuyigbe B, Muhammad A, Nadjm B, De St Maurice A, et al. — Antibiotics — 2023.
