Background: There is relatively little data on the aetiology of bacterial infections in patients with sickle cell anaemia (SCA) in West Africa, and no data from countries that have implemented conjugate vaccines against both Streptococcus pneumoniae and Haemophilus influenzae type b (Hib).

Methods: We conducted a retrospective analysis of SCA patients admitted to the Medical Research Council Unit, The Gambia during a five-year period when there was high coverage of Hib and Pneumococcal conjugate vaccination. We evaluated 161 admissions of 126 patients between April 2010 and April 2015.

Results: Pathogenic bacteria were identified in blood cultures from 11 of the 131 admissions that had cultures taken (8.4%, 95% CI 4.5-14.1%). The most frequent isolate was Salmonella Typhimurium (6/11; 54.5%), followed by Staphylococcus aureus (2/11; 18.2%) and other enteric Gram-negative pathogens (2/11; 18.2%) and there was one case of H. influenzae non-type b bacteraemia (1/11; 9.1%). There were no episodes of bacteraemia caused by S. pneumoniae or Hib.

Conclusions: The low prevalence of S. pneumoniae and Hib, and the predominance of non-typhoidal Salmonella as a cause of bacteraemia suggest the need to reconsider optimal antimicrobial prophylaxis and the empirical treatment regimens for patients with SCA.