SUPERBUGS: Evolving Enemies from Ghanaian Hospitals

About the Authors

Abiola Isawumi is a Postdoctoral Fellow with Dr Lydia Mosi at West African Centre for Cell Biology of Infectious Pathogens (WACCBIP). His research interests are in Antimicrobial Resistance and Hospital Acquired Infections. He has been an academic guest at Harvard and a visiting research associate at Queen’s University. He won the reputable Gordon Research fellowship in 2018 and Nature Communications Biology Early Career Award for 2019/2020.

Background of Research
The hospital should be a place of solace, where we all run to for health security and quick recovery when we fall sick. It also supposed to be clean environments assured of safety for its regular users, but it is unfortunate that what should make us stronger is now killing us. The hospital houses deadly bacteria that have the tendency to make us sicker. These bacteria take advantage of different compromising conditions in the hospital environment to evolve, and thereby becoming more dangerous. Some of these bacterial agents live on fomites (inanimate objects that can house and transmit bacteria) like door handles, chairs, tables, faucets, sinks and others are dispersed into the air where they become opportunistic and cause severe infections. Most of these opportunistic bacteria can readily adapt to changing environments as exemplified by switching from planktonic to forming a protective matrix called biofilms as a means to survive. These strains have potentials to escape all available antibiotics and specifically develop tactics to resist common and last-resort antibiotics; thereby facilitating the possible emergence of ‘superbugs’ with no option for
treatments.

Problem and why the research matters
Ghana is a population of more than 28 million people with over 300 hospitals. Salient factors unique to this region are exposure of the population to parasitic diseases (notably malaria) and high prevalence of systemic infections, sepsis and others, these conditions influence the immune system. This in turn leads to increase in hospitalization of patients with overpopulation of especially the Intensive Care Unit (ICU) and prolonged hospital stay most of the times, a situation encouraging the overuse of antibiotics and other antimicrobial agents. In Ghana, data on the diversity of bacteria and their antimicrobial (AMR) profiles in relation to environmental transmission is limited. Antimicrobial resistance is a global crisis and it is becoming increasingly important in Sub-Saharan Africa especially in the hospital, this call for an urgent research intervention. Besides, as bacteria evolve and new strains emerge, the risk of AMR in Ghanaian hospitals is unclear and the lack of the knowledge of how resistance is mediated and developed makes mitigation of spread a challenge.

Findings/Discussion of key points in research
In order to provide insights into how safe Ghanaian hospitals are, we embarked on an explorative study approved by the Ghana Health Service (GHS) in 2016-2017 and funded by World Bank ACE grant. The study was led by Dr. Lydia Mosi in collaboration with Prof. Miguel Valvano of Queen’s University UK and was conducted by Postdoctoral Fellow Abiola Isawumi of West African Centre for Cell Biology of Infectious Pathogens (WACCBIP). The overall aim was to identify the diversity and establish the AMR profiles of bacteria from air and commonly engaged fomites in ICU of Ghanaian hospitals. The outcome of the study showed the presence of bacteria that can cause infections in Ghanaian hospital environments. We identified both Gram-negative and positive bacteria described as Global Priority Pathogens by WHO that demands urgent attention. These bacteria resisted all available antibiotics commonly used to treat bacterial and hospital acquired infections in Ghana. Further, these bacteria showed high level of resistance to the ‘last-hope’ antibiotics such as carbapenems and polymyxins. The study also confirmed that the identified bacteria can cause infections that might be difficult to treat. It is even more unfortunate that most of the resistant genes identified through genomic analysis of the diverse bacteria were borne on mobile genetic elements such as ‘plasmid’ (transfer genes from one host to the other); this might make the spread of AMR in Ghanaian hospitals difficult to control. To the best of our knowledge, this is the first explorative study in the ICU indicating air and daily engaged fomites as sources of pathogens that are resistant to routinely used and last-resort antibiotics. This study provides evidence on the presence, prevalence, circulation and emergence of highly resistant ‘superbugs’ in and from Ghanaian hospitals. The pathogenicity and virulence profiles of the identified bacteria showed potential health risks posed by air and fomite to all hospital users. We highlight overuse of antibiotics in the ICUs, improper disinfection practices of medical-handy examination tools and lack of basic hygiene of most hospital users as
possible factors responsible for this emergence and consequent transmission. Also, unhygienic conditions of most hospitals breed an atmosphere for resistant bacteria to thrive. By implication, the study showed the possibility of higher prevalence of resistant bacterial pathogensthat can cause hospital acquired infections.

Intervention and Way Forward
In order to control the spread of these emerging bugs and also prevent their hospital-community transmission, there is a need for a conversation geared towards proper orientation and information sharing among health personnel, public health officials, biomedical researchers and the community. On 7th December 2019, we organized a symposium on the ‘Emergence of Superbugs in Ghanaian Hospitals’ sponsored by a Small Meeting Grant we received from The Company of Biologists UK and with supports from WACCBIP. The symposium had in attendance health personnel/Clinicians, Laboratory Scientists Public Health Officials, Pharmacists, Media Specialist/Journalists, Epidemiologists/Research Scientists, Biomedical Researchers and members of the community. The meeting highlights included ‘an urgent need for our research group to team up with GHS, different health sectors, pharmaceutical industries, ministry of health and hospital managements on how the practicality of our findings can be incorporated into public health orientations program and policy’. Also, ‘public engagements on a better approach to the use of hospital, and its facilities would go a long way in subverting infections. Proper disinfection practice and basic hand hygiene through consistent washing should be of highest priority. Periodic surveillance for diverse bacteria and consistent determination of their antimicrobial profiles will
uncover emerging bacteria and their response to new and old antibiotics’.