Transmission dynamics of antimicrobial resistant Streptococcus pneumoniae: a scoping review

Introduction: Antimicrobial resistance (AMR) in Streptococcus pneumoniae remains a substantial public health challenge, yet the transmission dynamics of resistant strains are inadequately understood. Materials and methods: This scoping review mapped existing evidence on the biological, ecological, and behavioural determinants of pneumococcal AMR transmission across healthcare, community, and environmental contexts. Results: Evidence identified associations between resistance and bacterial fitness, serotype-specific traits, and co-colonisation in sustaining resistance. Transmission patterns were shaped by inappropriate antibiotic usage, structural inequities, and the convergence of clinical and community interfaces. Emerging evidence also implicated environmental reservoirs and wastewater pathways, although these remain underexplored. Policy interventions, including vaccination, stewardship and surveillance programmes, and antibiotic access regulation, demonstrate variable impact, underscoring the need for integrated, multisectoral strategies. Conclusions: This review consolidates a fragmented evidence base and provides a conceptual framework to inform future studies, transmission models, and coordinated policy responses aimed at curbing the spread of resistant S. pneumoniae.