International Journal of Public Health Science (IJPHS)

International Journal of Public Health Science (IJPHS) Vol. 14, No. 4, December 2025, pp. 1666~1674 ISSN: 2252-8806, DOI: 10.11591/ijphs.v14i4.26835  1666 Journal homepage: http://ijphs.iaescore.com Antimicrobial resistance profiles of methicillin resistant coagulase negative Staphylococcus at a reference laboratory in Sierra Leone: implications for infection control Abraham Bwalhuma Muhindo1,2, Adamu Almustapha Aliero3, Darlinda F. Jiba4, Festo Mwebaze Syalhasha5 1Department of Medical Laboratory Sciences, Uganda Christian University, Kagando University College, Kisinga, Uganda 2Department of Microbiology, Premium Medical Services, Freetown, Sierra Leone 3Department of Microbiology, Faculty of Life Sciences, Kebbi State Univers ity of Science and Technology, Aliero, Nigeria 4College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 5Institute of Public Health and Management, Clarke International University, Kampala, Uganda Article Info ABSTRACT Article history: Received Aug 15, 2025 Revised Sep 20, 2025 Accepted Nov 3, 2025 Methicillin-resistant CoNS (MR-CoNS) are increasingly recognized as significant nosocomial pathogens. Sierra Leone lacks data on the prevalence and antibiotic-resistance patterns of these bacteria, which hinders a crosssectoral approach to tackling antimicrobial resistance as well as regional and global health surveillance. We report on clinical multidrug-resistant MRCoNS from Freetown, Sierra Leone, West Africa, as emerging pathogens. This study aimed to explore the prevalence and antimicrobial resistance profiles of MR-CoNS isolated from clinical samples in Freetown, Sierra Leone. A cross-sectional study was conducted at the reference laboratory from January 2025 to June 2025. Clinical samples submitted to the microbiology department were screened for Staphylococcus species, and isolates identified as coagulase-negative Staphylococci (CoNS) using standard microbiological techniques. Methicillin resistance in all isolates was tested with a 30 μg cefoxitin disc and further confirmed through an automated Scenker XK Microbial ID and AST system by measuring the minimum inhibitory concentration (MIC) with oxacillin. Antibiotic susceptibility profiles were determined using the Scenker XK Microbial ID/AST system following the Clinical and Laboratory Standards Institute (CLSI) guidelines, and data were analysed using SPSS ver 16. Findings from our study show a prevalence of 18.2% of MR-CoNS with Staphylococcus schleiferi, (26.9%) predominant. Linezolid, vancomycin, and teicoplanin exhibited 100% activity against all the MR-CoNS isolated. However, there was co-and multidrug resistance exhibited to commonly known antibiotics gentamycin (75-100%), levofloxacin (80-100%), clarithromycin (87-100%), including resistance to newer antibiotics as daptomycin (33-50%). Keywords: Antibiotics Coagulase negative Staphylococcus Methicilin resistance Oxacillin Sierra Leone Susceptibility profiles This is an open access article under the CC BY-SA license. Corresponding Author: Abraham Bwalhuma Muhindo Department of Medical Laboratory Sciences, Uganda Christian University, Kagando University College Kisinga, Kasese, Uganda Email: amu[email protected].ug 1. INTRODUCTION Over the past decade, coagulase-negative staphylococci (CoNS) have gained recognition as significant pathogens, with their pathogenic potential and role in various diseases increasingly Int J Public Health Sci ISSN: 2252-8806  Antimicrobial resistance profiles of methicillin resistant coagulase … (Abraham Bwalhuma Muhindo) 1667 highlighted [1]. Although CoNS are part of the normal flora of human and animal skin and mucous membranes, they act as opportunistic pathogens, frequently causing infections in immunocompromised individuals [2]. These infections include skin and soft tissue infections [3], [4], bacteremia [5], ocular infections [6], urinary tract infections [7], [8], and implant-associated hospital-acquired infections. The growing resistance of methicillin-resistant CoNS (MRCoNS) to multiple antibiotics complicates treatment strategies and underscores the need for continuous surveillance and monitoring of antibiotic susceptibility patterns [9], [10]. The rise in antibiotic-resistant CoNS in both human and non-human environments has been linked to selective pressure from healthcare practices, widespread antibiotic use in animal husbandry, and environmental exposure. Resistance to β-lactam antibiotics—particularly methicillin—poses a major concern, as it confers resistance to nearly all drugs in this class, except for two anti-methicillin-resistant Staphylococcus aureus (MRSA) cephalosporins [11]. This resistance is mediated by an alternative penicillin-binding protein (PBP2a) with reduced affinity for β-lactams, encoded by the mec genes (mecA, mecB, and mecC) [12]–[14]. These genes are carried on the staphylococcal cassette chromosome mec (SCCmec), a mobile genetic element (MGE) ranging from 20 to 70 kb in size, found in staphylococci. In 2019, Sierra Leone recorded an estimated 9,700 deaths attributable to antimicrobial resistance (AMR). Among 19 countries in the African region, it ranked fifth in age-standardized AMR-related mortality, with deaths exceeding those caused by cardiovascular diseases (9,000), maternal and neonatal disorders (8,000), and neoplasms or other non-communicable diseases (7,500) [15]. A nationwide point prevalence survey (PPS) conducted in 2021 revealed extensive antibiotic use, with 73.7% of hospitalized patients across 26 facilities receiving antibiotics, the highest prevalence observed in pediatric wards [16]. Currently, Connaught Hospital—primarily serving adult medical and surgical patientsis the only institution in Sierra Leone with an established antimicrobial stewardship (AMS) program [17]. The lack of sufficient bacteriology capacity, limited AMS initiatives, and widespread antibiotic use in public hospitals are expected to exacerbate the country’s AMR burden. Methicillin-resistant Staphylococcus (MRS) surveillance data are sparse. Importantly, data on methicillin-resistant coagulase-negative Staphylococci (MRCoNS) are nonexistent, and yet these have been reported as significant nosocomial pathogens. Identifying the local prevalence and determining susceptibility patterns of these MR-CoNS is essential for addressing local antimicrobial knowledge gaps and providing data that can aid in developing targeted antimicrobial stewardship programs as well as instituting infection prevention and control strategies. 2. METHOD This laboratory-based cross-sectional study was carried out at the Premium Medical Services Microbiology Laboratory, a facility that delivers essential diagnostic support to a diverse patient population and serves as a critical interface between healthcare-associated and community-acquired infections. The regional setting is characterized by notable variations in antimicrobial resistance, particularly methicillinresistant coagulase-negative staphylococci (MRCoNS), driven by extensive antimicrobial use. As a central laboratory hub with high patient volume and widespread reliance on antimicrobial therapies, Premium provides an optimal environment for evaluating the prevalence and resistance patterns of MRCoNS. 2.1. Study population The study included all patients' clinical samples sent to the microbiology department at Premium Medical Services Laboratory for microbial analyses. These samples were from consenting patients from different medical units, encompassing all age groups and sexes. 2.2. Sampling and sample size We used a non-probability purposive sampling technique to focus only on the information-rich cases for the purposes of this study. The research, spanning a 6-month duration, included 143 distinct clinical samples. 2.3. Bacterial identification and antimicrobial susceptibility testing Pure bacterial colonies were selected from well-isolated areas on culture plates and emulsified in the sample diluent (common) to prepare a suspension matching the 0.5 McFarland standard. This standardization ensured the correct inoculum density for accurate identification and susceptibility testing. The prepared suspension was inoculated into specialized micro-well panels (ID/AST cards) compatible with the Scenker XK-Microbial identification system. The Staphylococcus ID/ASTcard, with each card containing a series of wells embedded with dried biochemical substrates for identification and predefined concentrations of antibiotics for susceptibility testing, was used [18].  ISSN: 2252-8806 Int J Public Health Sci, Vol. 14, No. 4, December 2025: 1666-1674 1668 After inoculation, the kits were incubated for 18-24 hours, after which they were loaded into the XK-11 instrument chamber, and the test was initiated through the system's software interface. The instrument automatically incubated the cards and monitored the reactions using optical sensors. Bacterial identification was based on the colorimetric changes that occurred as the organisms metabolized specific substrates. These reactions generated a metabolic profile that was interpreted by the system’s software and compared against a built-in database of known bacterial species. Simultaneously, the antimicrobial susceptibility testing was carried out by measuring bacterial growth (via turbidity changes) in the presence of different antibiotics, with the system determining minimum inhibitory concentrations (MICs) for oxacillin (OXA), gentamicin (GEN), levofloxacin (LEV), erythromycin (ERY), clindamycin (CLI), linezolid (LNZ), daptomycin (DAP), teicoplanin (TEC), vancomycin (VAN), tetracycline (TET), tigecycline (TIG), fosfomycin (FOS), fusidic acid (FUS), rifampicin (RIF), trimethoprim/sulfamethoxazole (TMP-SMX), Moxiflaxacin (MOX), Penicillin (PEN), Nitrofurantoin, Tigecycline and Doxycycline according to the CLSI standards. The final output included organism identification and interpreted AST results according to Clinical and Laboratory Standards Institute (CLSI) breakpoints. The system also flagged resistance mechanisms methicillin resistance (MRS), where applicable. All results were reviewed and validated using internal software quality control checks, and any inconsistencies were resolved manually before finalization. 2.4. Phenotypic confirmation of MRCoNS isolates Phenotypic identification of methicillin-resistant coagulase-negative staphylococci (MRCoNS) was carried out using the cefoxitin disk diffusion assay in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines (2020) [19]. Colonies of CoNS obtained from overnight cultures were inoculated into nutrient broth. The suspensions were adjusted to a 0.5 McFarland standard and spread onto Mueller– Hinton agar (Lab M, Lancashire, UK) plates in duplicate, with cefoxitin (30 µg) and oxacillin (1 µg) discs (Mast Diagnostics, UK). Plates were incubated at 37 °C for 24 hours. Isolates exhibiting cefoxitin resistance, defined as a zone diameter of ≤ 21 mm, were classified as MRCoNS. 2.5. Quality control To ensure the accuracy of bacterial identification and susceptibility testing, standard quality control (QC) strains were tested alongside samples. These included Staphylococcus aureus ATCC 25923. QC results were compared against expected performance ranges recommended by CLSI [19]. Deviations beyond acceptable limits would have required repeating the tests. 2.6. Data processing and analysis All data collected from microbial cultures and antimicrobial susceptibility testing were entered into Microsoft Excel for organization and adequate cleaning. Data were checked for completeness, consistency, and accuracy prior to analysis. Statistical analyses were done using SPSS version 16/frequencies and percentages were computed to summarize the distribution of bacterial isolates, as well as their antimicrobial resistance patterns. Results were presented in tables and graphs to facilitate clear interpretation. 3. RESULTS AND DISCUSSION 3.1. Results 3.1.1. Prevalence of Methicillin Resistance Coagulase-Negative Staphylococcus (MR-CoNS) This study found an 18.2% (26/143) prevalence of MR-CoNS. Of the 26 MR-CoNS isolated, 9/26 (34.6%) were identified as Staphylococcus schleiferi. Others included 6/26 (23.0%) Staphylococcus xylosus, 4/26 (15.3%) Staphylococcus cohnii, 3/26 (11.5%) Staphylococcus capitis, 2/26 (7.6%) Staphylococcus lugdunensis, and 2/26 (7.6%) Staphylococcus saprophiticus as presented in Figure 1. Staphylococcus schleiferi was the most prevalent coagulase-negative Staphylococcus organism. 3.1.2. Distribution of MR-CoNS by clinical samples analysed MR-CoNS were isolated mainly from wound/pus swabs as they are a normal part of the skin's microbiome, making them readily available to contaminate or infect wounds, as presented in Table 1. The majority of the MR-CoNS were isolated from wound/Pus swabs. 3.1.3. Antimicrobial susceptibility patterns of the isolated MR-CoNS All MR-CoNS isolated were 100% sensitive to linezolid, vancomycin, and teicoplanin. S cohnii and S schleiferi showed >90% sensitivity to Moxifloxacin, Monocycline, and Trimethoprim/Sulfamethoxazole. There was notable resistance to daptomycin, which is one of the new antibiotics for the treatment of severe Staphylococcus infection. The resistance to gentamycin was 75-100% for all isolates (Table 2). Int J Public Health Sci ISSN: 2252-8806  Antimicrobial resistance profiles of methicillin resistant coagulase … (Abraham Bwalhuma Muhindo) 1669 Figure 1. The graph of prevalence of MR-CoNS strains recovered from various clinical samples Table 1. Distribution of MR-CoNS from clinical samples that were analysed Sample type Clinical significance No of MR-CoNS MR-CoNS spps Wound/Pus swabs Infection 4 Staphylococcus cohnii 1 Staphylococcus lugdunensis 2 Staphylococcus xylosus 2 Staphylococcus capitis 3 Staphylococcus schlefferi Urine Infection 2 Staphylococcus xylosus 1 Staphylococcus lugdunensis 3 Staphylococcus schlefferi 1 Staphylococcus saprophyticus High vaginal swab Infection 2 Staphylococcus schlefferi 1 Staphylococcus saprophyticus 2 Staphylococcus xylosus Blood Infection 1 staphylococcus capitis Semen Infection 1 Staphylococcus schlefferi Table 2. The antimicrobial sensitivity profile of MR-CoNS isolated Antibiotics S. Cohnii n = 4 S. Schleifferi n = 9 S. xylosus n = 6 S. saprophyticus n = 2 S. Capitis n = 3 S. lugdunensis n = 2 S(%) R(%) S(%) R(%) S(%) R(%) S(%) R(%) S(%) R(%) S(%) R(%) Penicillin 25 75 0 100 0 100 0 100 0 100 0 100 Oxacillin 0 100 0 100 0 100 0 100 0 100 0 100 Trimethoprim/Sulf 100 0 90 10 66.7 33.3 100 0 66.7 33.3 0 100 Clindamycin 100 0 87.5 12.5 33.3 66.7 100 0 66.7 33.3 0 100 Erythromycin 0 100 12.5 87.5 0 100 0 100 0 100 0 100 Gentamicin 25 75 10 90 0 100 0 100 0 100 0 100 Nitrofurantoin 100 0 90 10 33.3 66.7 100 0 66.7 33.3 0 100 Levofloxacin 0 100 20 80 16.7 83.3 0 100 0 100 0 100 Moxifloxacin 100 0 90 10 50 50 100 0 66.7 33.3 0 100 Doxycycline 100 0 90 10 66.7 33.3 100 0 66.7 33.3 50 50 Minocycline 100 0 87.5 0 33.3 66 100 0 100 0 0 100 Vancomycin 100 0 100 0 100 0 100 0 100 0 100 100 Teicoplanin 100 0 100 0 100 0 100 0 100 0 100 100 Tigecycline 50 50 30 70 33.3 66.7 50 50 33.3 66.7 0 100 Linezolid 100 0 100 100 0 0 100 0 100 0 100 100 Rifampicin 50 50 30 70 16.7 83.3 0 100 33.3 66.7 0 100 Daptomycin 100 0 90 10 66.7 33.3 100 0 66.7 33.3 50 50 Clarithromycin 0 100 12.5 87.5 0 100 0 100 0 100 0 100 3.2. Discussion Antimicrobial resistance (AMR) in bacterial pathogens poses a significant challenge to infection control and prevention efforts. CoNS, which are common commensals of the skin and mucous membranes, share the ecological niche of the anterior nares with Staphylococcus aureus and other bacteria [20]–[22]. This proximity facilitates horizontal gene transfer and the exchange of resistance determinants [21]. The situation is further complicated by the emergence of methicillin-resistant CoNS (MR-CoNS). CoNS are increasingly  ISSN: 2252-8806 Int J Public Health Sci, Vol. 14, No. 4, December 2025: 1666-1674 1670 recognized as reservoirs of resistance traits that can be disseminated across the Staphylococcaceae family [23], including genes conferring resistance to last-resort antibiotics such as linezolid and daptomycin [24], [25]. In staphylococci, methicillin/oxacillin resistance is of particular concern. It is primarily mediated by the mecA gene, which encodes an alternative penicillin-binding protein (PBP2a) with reduced affinity for βlactams. This gene is located on transferable SCCmec genomic elements, mobile genetic structures whose origins have been traced to Staphylococcus sciuri (recently reclassified as Mammaliicoccus sciuri) [26]–[29] and macrococcal species [30]. 3.2.1. Prevalence of methicillin resistant coagulase negative Staphylococcus From the clinical samples analyzed, methicillin-resistant coagulase-negative staphylococci (MRCoNS) were detected at a prevalence of 18.2%. To the best of our knowledge, no published data currently exist on MR-CoNS in Freetown, Sierra Leone. It is also noteworthy that CoNS are often regarded as contaminants in both clinical and non-clinical contexts, a perception that may be widespread across many African countries [31]. Nevertheless, comparable studies conducted in Africa have documented MR-CoNS in human populations [32]–[36], with a pooled prevalence estimated at 36% across the continent [37]. Our study found 9/26(26.9%) Staphylococcus schleiferi as the predominant MR-CoNS. Others included, 6/26 (23.0%) Staphylococcusxylosus, 4/26 (15.3%) Staphylococcuscohnii, 3/26 (11.5%) Staphylococcus capitis, 2/26 (7.6%) Staphylococcus lugdunensis and 2/26 (7.6%) Staphylococcus saprophiticus. Unlike our study, most studies have found S epidermidis to be the most prevalent MR-CoNS. However, majority if these studies were about colonization and not necessarily infection [38]–[41] as illustrated in Figure 1 and Table 1. Staphylococcus schleiferi was recognized in the late 1980s as a new species of CoNS. Some studies have revealed S. schleiferi infections to be more common with more than half of the patients with evidence of immunosuppression. The majority of our isolates were from HIV/AIDs MPox coinfected individuals. Therefore, our study is an agreement with similar studies that found S. schleiferi infection in humans, having a possible association with immunosuppression [42], [43]. Schleiferi has been shown to be more virulent than, for instance, Staphylococcus warneri or Staphylococcus hominis. However, a recent review of CoNS and MR-CoNS did not cite S. schleiferi among the CoNS that have been isolated. This can be owed to limited diagnostic capacity, but also the notion that all CoNS are contaminants which is a perception prevalent among most clinicians and microbiologists [37]. 3.2.2. Antibiotic resistance patterns of the isolated MR-CoNS Fortunately, we did not find any resistance to newer antibiotics such as linezolid in our sample. Equally vancomycin and teicoplanin exhibited 100% activity against all the MR-CoNS isolated. All isolates showed 50-100% sensitivity to Daptomycin and a 90-100% sensitivity exhibited by S. cohnii and S. schleiferi to Moxifloxacin, Monocycline, and trimethoprim/sulfamethoxazole, as presented in Table 2. S. cohnii showed sensitivity to most antibiotics, while S. lugdunesis showed resistance to most of the antibiotics tested. We found a 10%, 33.3%, 33.3%, and 50% resistance to daptomycin by S. schleiferi, S. xylosus, S. capitis, and lugdunensis, respectively. Daptomycin is one of the newer antibiotics against staphylococcal infections. Our results are consistent with previous studies that have documented co-resistance and multidrug resistance in CoNS, not only among human isolates but also in samples from animals and environmental sources [44]–[49]. These findings serve as a warning signal, indicating the ongoing introduction and dissemination of multidrug-resistant CoNS (MR-CoNS) into both the hospital and the community settings. At present, the management of CoNS infections is challenging due to widespread resistance to β‑lactams and several other antibiotic classes. Newer agents such as linezolid, daptomycin, and tigecycline may serve as alternative treatment options, provided they are accessible and considered cost‑effective. Some MR-CoNS in our study exhibited resistance to the reserve antibiotics such as daptomycin. Whilst this resistance could be intrinsic, it represents a worrying trend as these antibiotics are not currently in use in SierraLeone. However, their uncontrolled use and natural resistance can accelerate the spread of mobile resistance genes, reinforcing the need for safeguarding these antibiotics. Our study has several limitations. First, being a single-site purposive study, the findings cannot be readily generalized, as antibiotic resistance and bacterial profiles were characterized only at one location in Sierra Leone. To better understand the burden and resistance patterns of MR-CoNS infections, further investigations across multiple tertiary health facilities are warranted, particularly in the context of hospitalacquired infections. Additionally, MR-CoNS detection in this study was limited to phenotypic characterization. Future research should incorporate molecular and proteomic approaches (e.g., whole genome sequencing, MALDI-TOF) to provide deeper insights into species diversity, SCCmec types, and potential clonal distributions within Sierra Leone. Such data would be valuable for policymakers, infection Int J Public Health Sci ISSN: 2252-8806  Antimicrobial resistance profiles of methicillin resistant coagulase … (Abraham Bwalhuma Muhindo) 1671 prevention and control specialists, and microbiologists in developing effective strategies to mitigate the public health impact of MR-CoNS. Despite these constraints, our study offers the first evidence of MR-CoNS resistant pathogens isolated from clinical samples in Sierra Leone. 4. CONCLUSION This study highlights the concerning prevalence of resistant MR-CoNS to commonly used antibiotics in the local context of Sierra Leone. The emergence of such resistance patterns poses a significant and growing threat, potentially rendering multiple antimicrobial therapies ineffective for treating MR-CoNS infections. Therefore, practical approaches like standardizing the diagnosis of these infections, improving infection prevention and control practices, enhancing the diagnostic capacity, and instituting antimicrobial stewardship programs will ultimately combat the spread of antibiotic resistance among the MR-CoNS. However, the success of these initiatives relies on sustained resource allocations, capacity building of resourceful personnel, and a good diagnostic bacteriological quality control system. ACKNOWLEDGMENTS We express gratitude to those who contributed to this study, especially those whose samples were included in the study, and to the management of Premium Medical Laboratory and its staff. FUNDING INFORMATION This research received no specific grant from any funding agency in the public, commercial or notfor-profit sectors. AUTHOR CONTRIBUTIONS STATEMENT This journal uses the Contributor Roles Taxonomy (CRediT) to recognize individual author contributions, reduce authorship disputes, and facilitate collaboration. Name of Author C M So Va Fo I R D O E Vi Su P Fu Abraham Bwalhuma Muhindo ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Adamu Almustapha Aliero ✓ ✓ ✓ ✓ ✓ ✓ ✓ Darlinda Jibba ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Festo Mwebaze Syalhasha ✓ ✓ ✓ ✓ ✓ ✓ C : Conceptualization M : Methodology So : Software Va : Validation Fo : Formal analysis I : Investigation R : Resources D : Data Curation O : Writing - Original Draft E : Writing - Review & Editing Vi : Visualization Su : Supervision P : Project administration Fu : Funding acquisition CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. INFORMED CONSENT Informed consent was sought from each patient before their sample was included in the study. ETHICAL APPROVAL Ethical approval was obtained from the scientific research board of Premium Medical Services, and permission sought from the management of Premium Microbiology Laboratory. Confidentiality was ensured with strict storage of data and use of unique identification numbers. All procedures involved  ISSN: 2252-8806 Int J Public Health Sci, Vol. 14, No. 4, December 2025: 1666-1674 1672 were performed in accordance with the ethical standards and the 1964 Helsinki declarations and their current amendments. DATA AVAILABILITY The data supporting this study’s findings can be obtained from the corresponding author, [ABM], upon reasonable request. REFERENCES [1] J. Asante et al., “Review of clinically and epidemiologically relevant coagulase-negative staphylococci in Africa,” Microbial Drug Resistance, vol. 26, no. 8, pp. 951–970, 2020, doi: 10.1089/mdr.2019.0381. [2] K. Becker, A. Both, S. Weißelberg, C. Heilmann, and H. Rohde, “Emergence of coagulase-negative staphylococci,” Expert Review of Anti-Infective Therapy, vol. 18, no. 4, pp. 349–366, 2020, doi: 10.1080/14787210.2020.1730813. [3] P. A. 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Cutler, “Antibiotic resistance and mecA characterization of coagulase-negative staphylococci isolated from three hotels in London, UK,” Frontiers in Microbiology, vol. 6, p. 947, Sep. 2015, doi: 10.3389/fmicb.2015.00947. [49] S. He et al., “Insights into the epidemiology of methicillin-resistant coagulase-negative staphylococci carriage in communitybased drug users,” Journal of Infection and Public Health, vol. 13, no. 11, pp. 1742–1748, Nov. 2020, doi: 10.1016/j.jiph.2020.09.011.  ISSN: 2252-8806 Int J Public Health Sci, Vol. 14, No. 4, December 2025: 1666-1674 1674 BIOGRAPHIES OF AUTHORS Abraham Bwalhuma Muhindo is a diagnostic and medical microbiology specialist. He is a lecturer of microbiology at the Department of Medical Laboratory Sciences of Kagando University College-Uganda Christian University in Uganda, and a Microbiologist with Premium Medical Services in Sierra Leone. His research interests are in the areas of hospital-acquired infections’ organisms (HCAIs) and their associated antimicrobial resistance profiles. He has published 4 peer-reviewed articles on the subject of antibiotic and antifungal resistance. He is enthusiastic about training, research, and diagnosis, and always puts a premium on initiative, with a strong disease and laboratory surveillance. He can be contacted at email: [email protected]. Adamu Almustapha Aliero Ph.D., is a senior lecturer of microbiology and mycology at the Department of Microbiology, Faculty of Life Sciences, Kebbi State University of Science and Technology, Aliero, Nigeria. Adamu has published over 50 peerreviewed articles in mycology and microbiology. He can be contacted at email: [email protected]. Darlinda F. Jiba is a young female Sierra Leonean doctor and an early-career researcher. She graduated with an M.B., Ch.B. from the College of Medicine and Allied Health Sciences, University of Sierra Leone is currently doing a residency training in Internal Medicine (with keen interest in Infectious Diseases) at the University of Sierra Leone Teaching Hospitals Complex. She has over five (5) years of experience in clinical medicine and research and has co-authored over twenty (21) research papers, eighteen (18) of which are published in peer-reviewed journals, with publications on HIV/AIDS used in updating the national HIV/AIDS guidelines. She is the former national case management pillar research coordinator at the National COVID-19 Emergency Response Center, Sierra Leone. She also offers voluntary STI services to some NGOs dealing with key populations in Sierra Leone. She can be contacted at email: [email protected]. Festo Mwebaze Syalhasha is a Chartered Marketer and Public Health Specialist with over 14 years of experience in the pharmaceutical and health systems sector. He holds a Bachelor of Science in Technology (Biology) from Kyambogo University, a Chartered Postgraduate Diploma in Marketing from the Chartered Institute of Marketing (UK), and an MSc in Public Health from Clarke International University. He has previously served as Project Lead for HIV Self-Testing (SHIPs) at PSI and held senior roles at GSK Pharmaceuticals and Roche, focusing on market access for oncology, HIV, and noncommunicable diseases. Currently, he is Marketing Manager at Quality Chemical Industries Limited (QCIL), leading private sector expansion and brand launches to improve access to medicines in Uganda and across Africa. He can be contacted at email: [email protected].