Speaking during the institute’s February Media Chat, senior research scientist Emelda Chukwu said drug-resistant infections are no longer a distant threat but an unfolding reality within Lagos healthcare facilities. According to her, resistance patterns observed in recent surveillance efforts are eroding decades of medical progress, as medicines once considered reliably effective are increasingly failing.
Reserve Antibiotics Losing Effectiveness
NIMR’s surveillance across four major hospitals in Lagos revealed alarmingly high resistance to third-generation cephalosporins — broad-spectrum antibiotics typically reserved for severe infections that do not respond to first-line treatments.
“These are reserve drugs, but we are now seeing that even these third-generation medicines are losing their effectiveness. That is a major red flag,” Ms Chukwu warned.
She noted that the growing resistance is limiting treatment options, prolonging hospital stays, increasing complications, and raising mortality risks.
“When our reserve antibiotics begin to fail, patient safety is at serious risk,” she added.
AMR Burden in Nigeria
Antimicrobial resistance occurs when microorganisms — including bacteria, viruses, fungi, and parasites — evolve to survive exposure to medicines designed to eliminate them. As resistance spreads, antibiotics and other antimicrobial drugs become less effective, making infections significantly harder and more expensive to treat.
AMR often develops gradually, driven by misuse and overuse of medications, poor infection prevention practices, and the spread of resistant strains through communities, healthcare facilities, food systems, and the environment.
The World Health Organization (WHO) has described AMR as a silent but escalating global crisis. In Nigeria alone, the agency estimates that drug-resistant infections claim more than 60,000 lives annually — a burden the country has faced consistently since 1990.
In 2021, Nigeria recorded an estimated 50,500 deaths directly attributable to AMR and 227,000 associated deaths, with children under five disproportionately affected.
Global Implications
Globally, WHO estimates that AMR was associated with 4.71 million deaths in 2021, including 1.14 million deaths directly caused by drug-resistant infections. Sub-Saharan Africa accounted for roughly 250,000 of those deaths.
Beyond mortality, the crisis carries enormous economic and social costs. The world is estimated to lose about 178 million disability-adjusted life years (DALYs) to AMR, and projections suggest the global economy could face nearly $1 trillion in annual losses if resistance continues unchecked. Recent modelling indicates that AMR could claim up to 39 million lives by 2050.
Human Behaviour Driving Resistance
Tracing the roots of the crisis, Ms Chukwu identified antibiotic misuse and over-prescription as key contributors. She noted that resistant organisms spread easily across communities and borders, regardless of whether individuals personally use antibiotics responsibly.
Her team has developed facility-specific antibiograms — data tools that map local resistance patterns to guide doctors in selecting effective treatments. However, she said that approximately 80 percent of hospital prescriptions remain empirical, meaning they are issued without laboratory confirmation.
“If doctors are guided by data from their own facilities, it can significantly improve outcomes,” she explained.
Wastewater Findings Raise Further Concern
The institute’s findings extend beyond hospital settings. Environmental surveillance conducted across all 20 local government areas in Lagos detected antimicrobial-resistant bacteria in wastewater canals, alongside cholera-causing Vibrio cholerae O1.
“Out of the 20 LGAs surveyed, nine had Vibrio cholerae O1 incubating in their wastewater canals. That was extremely alarming,” Ms Chukwu said.
She disclosed that the findings prompted a policy advisory to Lagos authorities ahead of the 2024 cholera outbreak, which later spread across 36 states. The approach, known as wastewater-based epidemiology, enables early detection of infectious threats before they escalate into full-scale outbreaks.
Risky practices such as illegal dumping and open defecation, she added, are compounding the problem. Overflowing canals can carry pathogens back into homes, creating a cycle of reinfection.
Call for Coordinated Action
Despite ongoing surveillance efforts, Ms Chukwu stressed that monitoring alone will not curb AMR. Research conducted by her team highlights persistent pressure on doctors to prescribe antibiotics and widespread public misconceptions that antibiotics are cure-alls.
“Even prescribers are under pressure to prescribe. The public believes antibiotics are cure-alls. These practices are fueling resistance,” she said.
She called for sustained public awareness campaigns, stronger antimicrobial stewardship programmes, and coordinated “One Health” interventions that integrate human, animal, and environmental health strategies.
“Antimicrobial resistance is not a future threat. It is here with us. If we do not act decisively, we risk losing the gains made since the discovery of antibiotics in the 1920s. The time to strengthen surveillance and change behaviour is now,” she warned.