Antimicrobial Resistance Gap Analysis for Uropathogens in Nigeria: Pathogen Profiles, Resistance Burden, and Translational Microbiological Action Plans

Abstract Background We investigated laboratory culture results for uropathogens with existing antimicrobial resistance (AMR) patterns to leverage novel microbiological gaps in Nigeria. Methods In a retrospective study, we analysed a total of 84,548 valid culture results from 26,630 patients across 25 public laboratories participated in the national AMR report. The WHO priority bacteria uropathogens with their AMR patterns for the key urinary tract infections (UTIs) antibiotic classes were assessed. A p-value of <0.05 was considered statistically significant. Results Urine contributed 6426 samples collected for culture. A total of 16 uropathogens were identified, Escherichia coli was the most frequently isolated organism each year. Among Gram-negatives, Klebsiella species and Escherichia coli showed alarming resistance to cephalosporins (80% each). Staphylococcus aureus demonstrated the highest resistance burden, with methicillin and folate pathway inhibitor resistance reaching 89% and 82%, respectively. In the gap analysis, cephalosporin susceptibility testing remained incomplete and in the mapping of six uropathogens and their recommended stewardship responses, E.coli was recommended to alert the monitoring of tetracycline and folate inhibitors. Conclusion High AMR across key drug classes for uropathogens like Klebsiella, Escherichia and Staphylococcus species suggests a narrowing window for effective treatment of UTIs in Nigeria. Graphical Abstract