Streptococcus pneumoniae is a leading cause of pneumonia, a type of respiratory tract infection, particularly among the elderly population, who are often immunocompromised. Pneumococcal bacteremia occurs in about 25%–30% of patients with pneumococcal pneumonia which is as a result of infection with Streptococcus pneumoniae. The World Health Organization (WHO) has identified pneumococcal antimicrobial resistance (AMR) as a major public health concern, with an emerging number of pneumococcal strains showing resistance to multiple antibiotics.
In low and middle-income countries, such as Ghana, there has been a concern of AMR in Streptococcus pneumoniae infection treatment among the elderly population. In 2022, the PARSTREP1 team set out to combat the gap of difficulty in obtaining information about the prevalence of AMR in Ghana especially among the elderly. The team participated in three health screening events at different locations in Accra, Ghana. During these health screenings the team members educated the attendees on the impact of AMR. Furthermore, the PARSTREP team set up a collaboration with the Nutrition department at the University of Ghana to open a new research line about the correlation between nutrition, infection and AMR.
The PARSTREP team conducted a research project titled “Genomics of host-pathogen interactions underlying Streptococcus pneumoniae infection in the Ghanaian elderly population” to study the influence of AMR on Streptococcus pneumoniae within the Ghanaian elderly population. A total of 98 elderly participants were enrolled in the project, with 62 nasopharyngeal samples successfully collected from the participating elderly. Of these samples, 82 bacteria were identified, indicating that multiple different bacteria were present in the nasopharynx of some participants. The project also collected data on the self-reported frequency of antibiotic use among the Ghanaian elderly population. The data revealed that 38% of the elderly population indicated that they never used antibiotics, 19% said they take antibiotics every month, 9% reported taking antibiotics three to six times per year, 7% taking antibiotics one to two times per year and 27% less than 1 time per year.
Another component of the research project is a literature review. “The PARSTREP team has concluded a systematic review and meta-analysis on Streptococcus pneumoniae carriage and AMR in Africa. This revealed high percentages of non-susceptibility to certain antibiotics, especially Penicillin, Tetracycline, and Co-trimoxazole.” – Augustina Frimpong.
A literature search on PubMed using the search terms “antimicrobial resistance Ghana” revealed 132 hits. From these 132, 54 studies describe bacterial strains and AMR patterns in samples obtained in Ghana. Furthermore, there were 24 studies on antimicrobial stewardship/policy/treatment guidelines and seven studies describing the fundamental mechanisms of AMR.
Misuse, overuse, and underuse of antibiotics are major causes of AMR. The findings from the PARSTREP project were relayed to collaborators and partners who also work in the field of AMR prevention and control and healthcare providers. Results of the research were disseminated at the 37 Military Hospital, Accra, Ghana at beginning 2023. Doctors at the hospital’s Department of Internal Medicine acknowledged the data obtained. They were interested in the different types of bacteria detected by the PARSTREP team in patients. “The doctors were shocked at the increased frequency of self-reported antibiotic use among patients and suggested further investigation into the types of antibiotics employed.” the PARSTREP team
The PARSTREP team also participated in a workshop themed “Introduction to Bacterial Genomics Bioinformatics Workshop,” where they presented findings from the project. The workshop was organized by scientists from NMIMR and the bioinformatics unit of the University of Cambridge, and sponsored by AREF and CAMBRIDGE-AFRICA ALBORADA research funds.
“From the workshop, our team is now working on a proposal to use a systems biology approach (omics) to understand infection outcome in the elderly, given the understudied nature of the Ghanaian elderly population’s health-related issues”, said Augustina Frimpong
According to Augustina Frimpong and the PARSTREP team, bacterial infection, including pneumonia, and AMR among Ghana’s elderly population is an issue that needs attention in Ghana as shown by the findings of the research and report of advocacy.
1- Streptococcus pneumonia Resistance to Antibiotics in Ghanaian Elderly Population (PARSTREP)