Antimicrobial resistance in uropathogens in Nigeria: pathogen profiles, resistance burden, surveillance and stewardship considerations

Abstract

We analyzed aggregated national surveillance data to describe uropathogen resistance patterns and assess limitations in the available laboratory and surveillance information from Nigeria. In a secondary data study, we retrospectively analyzed a total of 84,548 valid culture results from 26,630 patients across 25 public laboratories who participated in the national AMR report. The World Health Organization (WHO) bacterial priority uropathogens and their AMR profiles for the key urinary tract infections (UTIs) antibiotic classes were assessed. More than 6,000 urine specimens were submitted for culture. The source report included both genus-level and species-level bacterial identifications. Escherichia coli was the most frequently reported species in each year, while Klebsiella, Proteus, Pseudomonas, Enterococcus , and Staphylococcus taxa were also recorded. Among Gram-negative bacteria, Klebsiella species and Escherichia coli showed alarming resistance to cephalosporins (80% each). Staphylococcus aureus showed the highest reported resistance burden, with methicillin and folate pathway inhibitor resistance reaching 82% and 89%, respectively. The descriptive assessment identified incomplete antimicrobial susceptibility testing for some pathogen-antimicrobial combinations and limitations in species-level and molecular resistance reporting. We created conceptual figures that summarize potential surveillance and stewardship considerations for clinical effectiveness. High reported resistance to several antimicrobial classes was observed among bacterial taxa included in the surveillance report. Our findings provide a historical descriptive summary and suggest priorities for future surveillance; to address existing national antimicrobial resistance patterns and demonstrating the effectiveness of specific clinical or policy interventions.