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
Saffiatou Darboe,
Ruel Mirasol,
Babapelumi Adejuyigbe,
Abdul Khalie Muhammad,
Behzad Nadjm,
Annabelle De St. Maurice,
Tiffany L. Dogan,
Buntung Ceesay,
Solomon Umukoro,
Uduak Okomo,
Davis Nwakanma,
Anna Roca,
Ousman Secka,
Karen Forrest,
Omai B. Garner
Affiliations
Saffiatou Darboe
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Ruel Mirasol
Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
Babapelumi Adejuyigbe
David Geffen School of Medicine, University of California, UCLA, Los Angeles, CA 90095, USA
Abdul Khalie Muhammad
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Behzad Nadjm
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Annabelle De St. Maurice
Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
Tiffany L. Dogan
Department of Clinical Epidemiology and Infection Prevention, University of California, UCLA Health, Los Angeles, CA 90095, USA
Buntung Ceesay
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Solomon Umukoro
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Uduak Okomo
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Davis Nwakanma
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Anna Roca
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Ousman Secka
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Karen Forrest
Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
Omai B. Garner
Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
Antimicrobial resistance is a global health threat and efforts to mitigate it is warranted, thus the need for local antibiograms to improve stewardship. This study highlights the process that was used to develop an antibiogram to monitor resistance at a secondary-level health facility to aid empirical clinical decision making in a sub-Saharan African county. This retrospective cross-sectional descriptive study used 3 years of cumulative data from January 2016 to December 2018. Phenotypic data was manually imputed into WHONET and the cumulative antibiogram constructed using standardized methodologies according to CLSI M39-A4 guidelines. Pathogens were identified by standard manual microbiological methods and antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method according to CLSI M100 guidelines. A total of 14,776 non-duplicate samples were processed of which 1163 (7.9%) were positive for clinically significant pathogens. Among the 1163 pathogens, E. coli (n = 315) S. aureus (n = 232), and K. pneumoniae (n = 96) were the leading cause of disease. Overall, the susceptibility for E. coli and K. pneumoniae from all samples were: trimethoprim-sulfamethoxazole (17% and 28%), tetracycline (26% and 33%), gentamicin (72% and 46%), chloramphenicol (76 and 60%), and ciprofloxacin (69% and 59%), and amoxicillin/clavulanic (77% and 54%) respectively. Extended spectrum beta-lactamase (ESBL) resistance was present in 23% (71/315) vs. 35% (34/96) respectively. S. aureus susceptibility for methicillin was 99%. This antibiogram has shown that improvement in combination therapy is warranted in The Gambia.
