The Antibiotic Crisis Arrives in Nigeria: Scientists Detect Gene That Defeats Last-Resort Drug
..Study finds worrying resistance mechanism in hospital bacteria, though prevalence remains low for now
Medical Research | January 22, 2026
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In a quiet laboratory in southeastern Nigeria, scientists recently confirmed what many in global health have been dreading: the arrival of a genetic mechanism that renders some of our most powerful antibiotics useless.
The gene, known as NDM-1, was discovered in bacteria taken from a patient with a urinary tract infection in Onitsha. Its presence, documented in new research published in Global Multidisciplinary Journal, marks a troubling milestone in Nigeria’s ongoing struggle with antimicrobial resistance.
Whilst the study found only one positive sample among 30 tested, giving a prevalence rate of just over 3%, infectious disease specialists warn that even this low level warrants serious attention. The gene’s ability to spread rapidly between bacteria means today’s isolated case could become tomorrow’s widespread problem without proper intervention.
UNDERSTANDING THE THREAT
NDM-1 stands for New Delhi Metallo-beta-lactamase-1, named after the city where it was first identified in 2008. The gene produces an enzyme that destroys carbapenem antibiotics, drugs that doctors rely on when everything else has failed.
Carbapenems occupy a special place in the antibiotic arsenal. They work against bacteria resistant to other beta-lactam drugs like penicillin and cephalosporins. When a patient has a severe infection that doesn’t respond to standard antibiotics, carbapenems often represent the last viable option.
Bacteria carrying NDM-1 defeat this final line of defence. They break down carbapenem molecules before the antibiotic can do its job, leaving clinicians with limited alternatives. The remaining options are often older drugs with worse side effects, lower efficacy, or both.
What makes NDM-1 particularly dangerous is its location on plasmids, small circular pieces of DNA that bacteria can share with each other. Unlike chromosomal genes that pass only from parent to offspring, plasmid genes can transfer horizontally between unrelated bacteria, even across different species.
“Think of it like a USB stick containing malicious software,” explains Dr Chinaza Maria Ozuluoha from Nnamdi Azikiwe University, who led the research. “One bacterium can pass the resistance gene to many others, spreading the problem far beyond the original host.”
HOW THE RESEARCH UNFOLDED
The study examined bacterial isolates from patients diagnosed with urinary tract infections at healthcare facilities in Onitsha Metropolis, a major commercial centre in Anambra State. Urinary tract infections are among the most common bacterial infections worldwide, affecting millions of people annually and accounting for substantial antibiotic use.
The researchers focused on two bacterial species: Klebsiella pneumoniae and Escherichia coli. These organisms cause the majority of urinary tract infections and are frequently implicated in antibiotic-resistant infections globally.
Laboratory work involved extracting DNA from each bacterial sample and testing specifically for the NDM-1 gene using polymerase chain reaction technology. This technique amplifies target DNA sequences, making them detectable even when present in small amounts.
Of the 30 isolates examined, only one carried the NDM-1 gene. At 3.33%, this prevalence is considerably lower than rates documented in some other regions. Parts of South Asia, the Middle East, and North Africa have reported NDM-1 prevalence exceeding 20% in certain hospital populations.
However, comparisons are complicated by differences in study design, sample selection, and testing methods. Some surveillance programmes test all bacterial isolates regardless of resistance phenotype, whilst others focus specifically on bacteria already showing carbapenem resistance, which would naturally yield higher NDM-1 detection rates.
WHY ONE CASE MATTERS
A single positive result from 30 samples might seem insignificant, but epidemiologists view it differently. The detection of NDM-1, even at low prevalence, signals that the gene has established a foothold in the local bacterial population.
Historical patterns from other regions show how quickly resistance can escalate once genes like NDM-1 arrive. Countries that initially reported sporadic detections saw prevalence increase substantially over subsequent years, particularly in healthcare settings with high antibiotic use and variable infection control.
Several factors accelerate spread. Antibiotic selective pressure favours bacteria carrying resistance genes. In environments where carbapenems are used, whether appropriately or not, resistant bacteria have survival advantages. They multiply whilst susceptible bacteria die off, gradually shifting the population balance.
Patient movement within and between healthcare facilities creates opportunities for transmission. A single patient harbouring NDM-1-positive bacteria can potentially infect others through direct contact or environmental contamination, particularly if hand hygiene and cleaning protocols are inadequate.
International travel and medical tourism further complicate containment. Patients who acquire resistant bacteria in one country can carry them across borders, introducing resistance mechanisms to new geographic areas.
“What we’re seeing is probably the tip of the iceberg,” suggests Dr Kennedy Oberhiri Obohwemu from PENKUP Research Institute, a co-author. “Limited surveillance capacity means many cases go undetected. The true prevalence could be higher, and without intervention, it will almost certainly increase over time.”
THE NIGERIAN HEALTHCARE
CONTEXT
Nigeria’s healthcare system faces multiple challenges that create favourable conditions for antimicrobial resistance to flourish. Many of these are structural issues common across low and middle-income countries.
Antibiotic availability without prescription remains widespread. Patients can often purchase antibiotics from pharmacies or informal vendors without seeing a doctor, leading to inappropriate use, incomplete courses, and self-medication for conditions that don’t require antibiotics at all.
Diagnostic capacity varies enormously between facilities. Major teaching hospitals may have sophisticated microbiology laboratories capable of identifying bacteria and testing antibiotic susceptibility. Smaller clinics often lack even basic culture capacity, forcing clinicians to prescribe antibiotics empirically without knowing what organism they’re treating or what it’s resistant to.
Infection prevention and control practices are inconsistent. Whilst some institutions maintain rigorous standards, others struggle with basic requirements like reliable water supply, adequate cleaning materials, or sufficient staffing to implement proper protocols.
Surveillance systems for antimicrobial resistance remain underdeveloped. Unlike countries with national monitoring networks that track resistance patterns systematically, Nigeria relies largely on scattered research studies to understand the problem. This makes it difficult to identify trends, target interventions, or measure progress.
Recent comprehensive reviews of antimicrobial resistance in Nigeria have documented concerning patterns across multiple bacterial species. Resistance to commonly used antibiotics is high and appears to be increasing. Carbapenem resistance, whilst still less prevalent than resistance to older drugs, is being detected more frequently.
GLOBAL CONTEXT AND COMPARISON
The NDM-1 gene has now been detected on every inhabited continent since its discovery in 2008, testament to how rapidly resistance mechanisms can spread in an interconnected world.
South Asia, particularly India, Pakistan, and Bangladesh, reports some of the highest prevalence rates. Studies have found NDM-1 in substantial proportions of carbapenem-resistant bacteria, and community acquisition outside healthcare settings has been documented.
The Middle East and North Africa also show significant prevalence, with several countries reporting widespread detection in hospital isolates. Europe and North America have seen increasing cases, often linked to travel or healthcare received abroad, though local transmission occurs as well.
Sub-Saharan Africa presents a mixed picture. Some countries have established surveillance finding variable but generally lower prevalence than South Asia or the Middle East. Others lack systematic monitoring, making prevalence unknown.
The Nigerian study adds important data for West Africa, a region where carbapenemase surveillance has been particularly limited. However, single-centre studies cannot provide national estimates, and extrapolating from Onitsha to other Nigerian cities or rural areas would be inappropriate.
WHAT SHOULD HAPPEN NEXT
The researchers outline several priorities for addressing the threat posed by NDM-1 and similar resistance mechanisms.
Expanded surveillance tops the list. Regular, systematic monitoring across multiple sites would track how prevalence changes over time, identify geographic hotspots, and provide data to guide intervention strategies. This requires investment in laboratory capacity, training, and coordination systems.
Antimicrobial stewardship programmes need strengthening. These initiatives promote appropriate antibiotic prescribing through education, guidelines, prescription review, and feedback to clinicians. Evidence shows that well-implemented stewardship reduces unnecessary antibiotic use without harming patient outcomes.
“We need to preserve carbapenems for situations where they’re genuinely necessary,” argues Oladipo Vincent Akinmade from University of Warwick, UK. “Every unnecessary prescription creates selective pressure favouring resistant bacteria. Better stewardship protects these critical drugs for future patients who will desperately need them.”
Infection prevention and control require sustained attention and resources. Hand hygiene, environmental cleaning, appropriate use of isolation precautions, and proper medical waste management all reduce transmission of resistant bacteria within healthcare settings.
Regulatory measures could address antibiotic availability without prescription. Whilst pharmaceutical regulation in Nigeria has improved in recent years, enforcement remains challenging. Ensuring antibiotics are dispensed only with appropriate prescriptions would reduce inappropriate use.
Public education campaigns might shift behaviours around antibiotic use. Many people hold misconceptions about when antibiotics are needed, how they should be taken, and why completing courses matters. Targeted communication addressing these knowledge gaps could support broader resistance control efforts.
RESEARCH GAPS AND QUESTIONS
The study raises as many questions as it answers, highlighting areas where further research is needed.
The sample size of 30 isolates, appropriate for initial surveillance, is too small for detailed epidemiological analysis. Larger studies examining hundreds or thousands of samples would enable investigation of risk factors associated with NDM-1 carriage and provide more precise prevalence estimates.
The research examined only urinary tract infection isolates. NDM-1 occurs in bacteria causing various infection types. Sampling across different infection sites, patient populations, and healthcare settings would give a more complete picture of resistance distribution.
Genetic characterisation beyond simple presence or absence of NDM-1 would illuminate transmission patterns. Which specific NDM-1 variants are present? What plasmids carry the gene? What other resistance genes co-occur? How do Nigerian isolates relate genetically to those from other regions? These questions require whole-genome sequencing and comparative genomic analysis.
Clinical outcomes associated with NDM-1-positive infections need examination. Do patients with resistant infections have worse outcomes? Do they require longer hospitalisation? Are mortality rates higher? Such data would quantify the clinical impact beyond microbiological detection.
Temporal trends are unknown. Is NDM-1 prevalence stable, increasing, or perhaps even decreasing in this region? Repeated surveillance over time would track changes and allow assessment of whether interventions are working.
THE TREATMENT DILEMMA
When doctors encounter infections caused by NDM-1-positive bacteria, treatment options become severely limited. Carbapenems obviously won’t work, eliminating what would normally be first-line therapy for resistant Gram-negative infections.
Remaining options include older antibiotics like colistin, an agent largely abandoned decades ago because of kidney toxicity but now experiencing resurgence as resistance exhausts alternatives. Tigecycline, a newer drug, shows activity against some carbapenem-resistant bacteria but has limitations regarding where in the body it achieves adequate concentrations.
Combination therapy, using multiple antibiotics simultaneously, sometimes proves more effective than single agents. However, combinations also mean more side effects and drug interactions.
The pharmaceutical pipeline offers limited hope. Few new antibiotics effective against Gram-negative bacteria are in development. The economic model for antibiotic development has largely failed, with pharmaceutical companies finding it more profitable to focus on drugs for chronic conditions rather than antibiotics that cure infections in days.
“We’re heading toward a post-antibiotic era for some infections,” warns Dr Jennifer Adaeze Chukwu from the World Health Organization Nigeria office, a study co-author. “That’s not hyperbole. We’re already seeing cases where we have no good treatment options. Prevention becomes critical when cure is no longer guaranteed.”
A CALL FOR ACTION
The study’s authors emphasise that low current prevalence creates an opportunity that may not last long. Intervening now, whilst NDM-1 remains uncommon, is far easier than attempting control after it becomes endemic.
Examples from other countries illustrate both possibilities. Some nations that detected emerging resistance early and responded aggressively managed to limit spread. Others that delayed action saw resistance become entrenched, requiring far more intensive and expensive interventions with less success.
“The time to act is when prevalence is low, not after it’s high,” argues Celestine Emeka Ekwuluo from Family Health International Ukraine, a team member. “We have a brief window to implement strong prevention measures. Waiting until the problem is obvious means we’ve already lost the battle.”
Whether Nigeria will seize this opportunity depends on political will, resource allocation, and sustained commitment to antimicrobial resistance as a health priority that deserves investment alongside more visible threats.
The evidence is now clear. The threat has arrived. The question is what happens next.
ABOUT THE STUDY
The research, “Low Prevalence of Carbapenemase Gene NDM-1 in Uropathogenic Klebsiella pneumoniae and Escherichia coli: A Molecular Surveillance Study,” appears in Global Multidisciplinary Journal, Volume 5, Issue 1. The study was conducted by researchers from Nnamdi Azikiwe University and other institutions from UK, USA, and Ukraine, with support from PENKUP Research Institute in Birmingham, UK.
Check it out here:
https://www.researchgate.net/publication/399833680_Low_Prevalence_of_Carbapenemase_Gene_NDM-1_in_Uropathogenic_Klebsiella_pneumoniae_and_Escherichia_coli_A_Molecular_Surveillance_Study
https://www.grpublishing.org/journals/index.php/gmj/article/view/275/
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(DEMOCRACY NEWSLINE NEWSPAPER, JANUARY 23RD 2026)
