Bloodstream infections in a rural hospital in Sierra Leone: a retrospective database study

Background. The health system in Sierra Leone has limited infrastructure to provide data on the epidemiology of infectious diseases and to inform clinical decision-making. The diagnostic and research laboratory capacity at Masanga Teaching Hospital was systematically expanded with microbiology infrastructure-building as one of the centrepieces.Objective. This study aims to report the spectrum of bacterial pathogens from bloodstream infections (BSIs) in a rural hospital in Sierra Leone during the first year after the implementation of a blood culture infrastructure and characterize the detected antimicrobial resistances.Patients and methods. Patients treated at Masanga Hospital (Sierra Leone, March 2023-March 2024) were included in this database analysis if they were tested for BSI (BD BACTEC). Demographic and medical data were recorded for each patient. Antimicrobial susceptibility testing was done following EUCAST clinical guidelines.Results. Of the 340 blood cultures, 34 (10%) were positive for obligate pathogens. The three most frequent pathogens were Escherichia coli (n=8), followed by Burkholderia cepacia complex (n=7) and Salmonella enterica (n=5). Almost all Klebsiella pneumoniae (n=3/3) and E. coli (n=7/8) were resistant to third-generation cephalosporins. All four Staphylococcus aureus isolates were methicillin susceptible (mecA negative). Carbapenem resistance was detected in Acinetobacter baumannii complex (bla _NDM)Conclusion. The proportion of positive blood cultures with obligate pathogens (10%) was within the suggested benchmark (5-15%). Gram-negative bacteria dominated the pathogen spectrum of BSI with high resistance rates to third-generation cephalosporins.