A Review of Antimicrobial Resistance Challenges in Nigeria: The Need for a One Health Approach

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However, overreliance on antibiotics has led to a global antimicrobial resistance (AMR) crisis, jeopardizing progress made over the past decades. Antimicrobial resistance poses a critical public health challenge, affecting humans, animals, and the environment. The AMR challenge is particularly dire in Nigeria owing to the extensive antibiotic use across various sectors and ineffective antimicrobial stewardship programs. This narrative review summarizes the literature from January 2018 to December 2023, focusing on the current trends in AMR in Nigeria, including knowledge of antimicrobial usage, prescription patterns, and adherence to guidelines for humans, animals, and their shared environments. High antibiotic resistance patterns were detected in isolates recovered from healthcare settings, food supply chains, companion animals, wildlife, and the environment. Factors exacerbating the AMR crisis in Nigeria include poor regulation of antimicrobial agents, improper empirical prescriptions, inadequate infection prevention practices, arbitrary and prophylactic use of antibiotics in food-producing animals, environmental contamination, and insufficient surveillance programs. To effectively mitigate this crisis, it is essential to adopt the One Health approach, which prioritizes collaborative efforts among stakeholders, including governmental agencies, healthcare institutions, veterinary experts, farmers, and the scientific community, to address the convergence of human, animal, and environmental health. These efforts will promote transdisciplinary surveillance approaches and the establishment of policies aimed at ameliorating the impact of AMR on the Nigerian economy, the well-being of its population, and diverse ecosystems. Antimicrobial resistance healthcare system food supply chains environmental contamination One Health Nigeria Introduction The discovery of penicillin by Sir Alexander Fleming in 1928 revolutionized modern medicine, heralding the era of antibiotics and significantly enhancing our ability to combat bacterial infections [ 1 ]. Fleming reported that the misuse of antibiotics could lead to the emergence and spread of antibiotic-resistant bacterial species within a decade [ 2 ]. By the 1950s, antimicrobial resistance (AMR) emerged as a global challenge, jeopardizing much of the progress made in the past decades [ 3 ]. AMR occurs when microorganisms evolve mechanisms to resist or evade the effects of antimicrobial agents, making infections more difficult to treat [ 4 ]. The increase in antibiotic-resistant bacteria (ARB) complicates disease management, leading to increased morbidity, prolonged hospital stays, increased healthcare costs, and reduced life expectancy, particularly in low-and middle-income countries (LMICs) [ 5 ]. In 2019, AMR was linked to approximately 1.27 million deaths worldwide, attributed to multiple antibiotic-resistant bacterial infections. Should these trends persist, annual deaths from untreatable ARB infections could reach up to 10 million by 2050 [ 6 , 7 ]. Western sub-Saharan Africa bore the greatest burden of AMR in 2019, with approximately 27.3 deaths per 100,000 people directly attributed to AMR and a staggering 114.8 deaths per 100,000 people linked to AMR complications [ 6 ]. Nigeria faces developmental and resource (mis)allocation challenges that have dovetailed into widespread poverty and poor growth indices, as reflected in its limited access to potable water, poor hygiene and sanitation, and minimal infection control measures [ 8 ]. Of Nigeria's population of over 203 million people, 71 million lack access to clean water, while 130 million do not have basic sanitation [ 9 ]. Although water scarcity is a widespread challenge in Nigeria, the rural population faces the greatest impact [ 10 ]. Currently, only 61% of Nigerians have access to safe water: 41% within a 30-minute round trip from their homes, 31% directly on their premises, and just 7% with pipe-borne water inside their households [ 11 ]. However, as of 2019, the mortality rate linked to unsafe water, poor hygiene, and inadequate sanitation exceeded 70% per 100,000 people in various regions of Africa, including Lesotho, Somalia, Chad, Nigeria, Sierra Leone, and Niger, significantly higher than the global average of 18% [ 12 ]. The Nigerian AMR crisis has been linked to extensive antibiotic use and misuse across various sectors, including healthcare, veterinary medicine, food production, and environmental contamination [ 13 – 16 ]. One of the challenges in addressing the AMR crisis in LMICs is the lack of accurate information regarding the scope of the problem, particularly in areas with limited surveillance and sparse data. This makes it difficult to grasp the extent of the challenge and develop effective strategies to combat it. Further, limited access to advanced medical care and diagnostic tools hinders accurate diagnosis and treatment [ 6 ]. This underscores the need for a One Health approach to address the AMR challenge across human, animal, and environmental health sectors [ 17 ]. This narrative review summarizes the current patterns of AMR across healthcare, food supply chain, and environmental sectors, focusing on the need for a One Health approach in tackling the challenge across various sectors in Nigeria. Methods This narrative review was based on a comprehensive search of major databases, including PubMed, ScienceDirect, Google Scholar, ResearchGate, and African Journals Online for peer-reviewed research articles as well as web reports on antimicrobial resistance in Nigeria published between January 1, 2018, and December 31, 2023. The choice of the time frame (2018–2023) for reviewing the AMR crisis in Nigeria was based on the fact that Nigeria's National Action Plan on AMR was launched in 2017 in response to the WHO Global Action Plan (2015). Studies from 2018 onward reflect its impact, highlighting progress or gaps. Given the rapid evolution of AMR due to changing prescribing practices and bacterial adaptation, selecting studies from 2018–2023 ensures the inclusion of the most recent data. Additionally, the past five years have seen an increased adoption of molecular techniques (e.g., whole-genome sequencing and PCR-based resistance detection) in Nigerian AMR studies, enhancing data quality and comparability. We conducted this study following the guidelines recommended by Gregory and Denniss [ 18 ] that prescribed PRISMA for systematic review, but not a narrative review. The search utilized the Boolean operators "AND" and “OR” with keywords including “antibiotic resistance OR antimicrobial resistance”, “antibiotic stewardship” AND “One Health System” in combination with terms “healthcare system,” “agriculture” “veterinary medicine,” “environment,” “companion animals,” and “wildlife.” Specific bacterial species (that is, “ Escherichia coli ,” OR “ Staphylococcus aureus,” OR “ Klebsiella pneumoniae,” OR “ Acinetobacter baumannii,” OR “ Pseudomonas aeruginosa,” OR “Enterobacter,” OR “ Enterococcus species ” ) were included in the search terms. Qualitative and quantitative data from observational studies published in English were included, whereas review articles and encyclopedic content were excluded. Also excluded from the review are articles published by journals listed in Beall’s list of predatory journals [ 19 ]. The African Journals Online (AJOL) was selected as the primary source for identifying relevant studies because of its extensive collection of peer-reviewed African research, including a wide range of Nigerian journals covering medical, microbiological, and public health disciplines. AJOL provides access to regionally published studies that may not be widely indexed in global databases, ensuring a comprehensive and contextually relevant literature search. The results of the searches were first screened by titles before considering the abstract and reviewing the whole manuscript. As for relevant articles, we extracted data, including the authors’ names, year of publication, article title, microbial isolation source, and detected antimicrobial resistance phenotypes and genotypes into Microsoft Excel 2018. Duplicate entries were removed before proceeding with the remaining articles. Results and Discussion Antimicrobial Resistance in Healthcare Delivery Settings Several studies conducted in Nigeria between January 2018 and December 2023 reported a high prevalence of WHO-listed 'priority bacteria' in clinical samples from secondary and tertiary healthcare facilities. Between 2019 and 2021, 5,606 isolates were subjected to antimicrobial susceptibility testing as part of the national human health sentinel surveillance system. During this period, the prevalence of carbapenem-resistant Enterobacteriaceae ranged from 20 to 30%, while extended-spectrum β-lactamase (ESBL) producers accounted for 60 to 80% of cases. Amikacin-resistant Enterobacteriaceae remained at 20% or lower throughout the time frame. Methicillin-resistant Staphylococcus aureus (MRSA) exceeded 80%, and Streptococcus pneumoniae accounted for 90% of the resistance. Fluoroquinolone resistance in Salmonella was notably high (70–90%), whereas cephalosporin resistance was reported to be 20–30%. This trend is particularly concerning, as these multidrug-resistant (MDR) bacteria not only exhibit resistance to multiple antibiotics but also harbor mobile genetic elements (MGEs) that mediate the transfer of resistance traits to other bacterial species. These elements, including plasmids and integrons, facilitate the horizontal transfer of antibiotic resistance genes (ARGs), further exacerbating the challenge of antimicrobial resistance [ 20 – 22 ]. Gram-negative bacteria were the most dominant isolates recovered from the clinical samples, often harboring genes encoding ESBLs and New Delhi metallo-β-lactamases (NDM), such as bla TEM , bla CTX−M , bla SHV , bla OXA , and bla NDM . Conversely, the Gram-positive isolates carried the vanA and mecA genes, conferring resistance to glycopeptides and penicillin, respectively (Table 1 ). Alabi et al. [ 23 ] reported that MDR S. aureus was the predominant bacterium isolated from highly touched surfaces in selected hospitals in Northwest Nigeria. A study conducted in Kebbi State, Northwest Nigeria, reported a 14.6% methicillin-resistant S. aureus (MRSA) colonization rate among veterinarians, highlighting the high risk of livestock-acquired methicillin-resistant S. aureus (LA-MRSA) infection due to close contact with livestock. These MRSA isolates exhibited resistance to various classes of antibiotics, with approximately 60% harboring mecA [ 24 ]. These trends have raised concerns about the public health risks of MDR infections, particularly among immunocompromised individuals. Table 1 Antibiotic Resistance Patterns and Resistance Genes in Clinical Isolates Sources Isolates Resistance Patterns ARGs References Urine, Intra-abdominal, and blood samples E. coli AMP, SXT, CIP, CTM bla CTX−M−15 Seni et al ., 2018 [ 25 ] Urine, high vaginal swabs, ear and wound swabs S. aureus AMP, GEN, LEV, CIP, ERY, OXA, RIF, CLD, SXT, S mecA Angel et al ., 2019 [ 26 ] Stool Enterococcus sp. PEN, CIP, GEN, S, TET, NIT, LIN vanA Shettima et al ., 2019 [ 27 ] Nasal swab Methicillin-resistant S. aureus OXA, TET, GEN, VAN, PEN, ERY, NEO, SXT mecA Gaddafi et al ., 2020 [ 24 ] Stool E. coli AMP, AMC, FOX, CIP, LEV No ARG reported David et al ., 2020 [ 28 ] Urine E. coli , Klebsiella sp., Morganella sp., Providencia sp., Proteus sp., Yersinia sp., Serratia sp. CDZ, CRX, GEN, CFR, ERY, OFX, AMC No ARG reported Kayode et al ., 2020 [ 29 ] Urine Proteus sp. Klebsiella sp., E. coli , Enterobacter sp., Citrobacter sp., Providencia sp., S. aureus , Enterococcus sp., Corynebacterium sp., P. aeruginosa , and Salmonella sp. AMX, NIT, CFX, CXM No ARG reported Okwume et al ., 2021 [ 30 ] Urine, sputum, blood, swabs, aspirates, biopsies, seminal fluids and cerebrospinal fluids P. aeruginosa CIP, LEV, CDZ, GEN, CAR No ARG reported Manga et al ., 2021 [ 31 ] Urine, blood, non-blood, throat, ocular, stool and rectal swabs K. pneumoniae, K. quasipneumoniae CBM, PNC, TET, SUL, TMP, BLA bla NDM−1 , bla NDM−5 , bla CTX−M−15 , bla SHV , dfrA14, tetD, qnrS, oqxAB Afolayan et al ., 2021 [ 21 ] Blood E. coli CEF, SUL, SXT, AMP, CIP, AMG gyrA, parC, parE, aac(6’)-lb-cr5, bla TEM−1 , bla TEM−40 , bla TEM−84 , bla TEM−135 , bla OXA−2 , bla VEB−1 , bla CMY−42 Afolayan et al ., 2022 [ 22 ] Table 1. Antibiotic Resistance Patterns and Resistance Genes in Clinical Isolates Continued Sources Isolates Resistance Patterns ARGs References Urine, high vaginal swab, wound swab, stool, semen, sputum, endocervical swab, ear swab urethral swab, throat swab, and abdominal abscess E. coli , Klebsiella sp. CBM, CPS, QNL, AMG, MRD bla TEM , bla VEB , mecA, bla SHV , bla CTX−M . Chukwu et al ., 2022 [ 32 ] Infected surgical incisions, urine, skin burns, and wound pus S. aureus, P. aeruginosa, K. kristinae, P. mirabilis AMP, ERY, TET, DOX, VAN, CLD, MOX,*SHL-R, FOX, CFR, NIT, AMP/ SULBA, SXT, CIP, OXA No ARG reported Alabi et al ., 2023 [ 23 ] Stool, urine, catheter tips, wound swabs, and ear swabs E. coli AMC, AMX, CTM, CXM, FOX, CFR, CDZ, CIP, TET, SXT bla TEM , bla SHV , bla CTX−M , aac-lb-6-cr Egwu et al ., 2023 [ 33 ] Blood, urine, wound swabs E. coli, C. freundii, K. pneumoniae, E. cloacae subsp. Cloacae, S. ureilytica, K. quasipneumoniae SXT, MPM, CEFOL, TZB, COL, TGC, FOS, CDZ, AVB, CEFEP, CFR, CDZ, AKN, GEN, ARM, AMP, SBT, PIP, TZB, CTM. bla CTX−M−15 , bla OXA−1 , bla OXA−320 , bla OXA−534 , bla OXA−181 , bla NDM−1 , bla TEM−1A , bla TEM−1b , aph(3’’)-Ib, catB3, aac(3)-IIa, sul2, tet(A,), aac(6’)-Ib-cr Medugu et al ., 2023 [ 34 ] Stool and rectal swab Enterobacteriaceae Not reported CTX-M-1, CTX-M-9, bla NDM Edwards et al ., 2023 [ 35 ] Fecal samples E. faecalis , E. faecium FF, TZD, VAN optrA, poxtA, cfr, rplD, rplC, rplV Ngbede et al ., 2023 [ 36 ] Slaughtered cattle, poultry, and at-risk humans Campylobacter sp. CFR, NAL, CTM, EFL, CIP, S, GEN, ERY, AZM, CPC,TET aadE-1, aphA-3–1, tetO, cmeB, blaoxa-61 Njoga et al ., 2023 [ 37 ] Urine, blood, sputum, urethral swab, wound swabs, skin, ear swabs, high vaginal swabs, endocervical swabs, throat swabs, eye swabs, and stool samples S. aureus AMC, ERY, QD, CLD, TGC, TET, RIF, FOX, VAN, CIP, GEN No ARG reported Akpudo et al ., 2023 [ 38 ] Clinical specimens K. pneumoniae, P. aeruginosa AMC, CDZ bla TEM , bla SHV , bla CTX−M Daam et al ., 2023 [ 39 ] Urine samples, nasal and wound swabs S. aureus GEN, PEN, VAN, CIP, NFX, FOX, CFR vanA, mecA Abdulrahim et al ., 2023 [ 40 ] KEYS: CBM− Carbapenems; PNC− Phenicols; TMP−Trimethoprim; CPS− cephalosporins; AMG− aminoglycosides; CPC− chloramphenicol; TET− tetracycline; MRD− macrolides; FQL− Fluoroquinolones; QNL− Quinolone; AMP−Ampicillin; AMC−Amoxicillin−clavulanic acid; AMX−Amoxicillin; OFX− Ofloxacin; CDZ−Ceftazidime; CIP−Ciprofloxacin; GEN−Gentamicin; NIT−Nitrofurantoin; RIF−Rifampicin; CFR−Ceftriaxone; SXT−Sulphamethoxazole/trimethoprim; TET−Tetracycline; FF−florfenicol; S−streptomycin; CPC−chloramphenicol; NEO−Neomycin; CXM−Cefuroxime; CEF− ceftiofur; PIP−Piperacillin; LEV−Levofloxacin; CEFAZ− Cefazolin; FOX−Cefoxitin; CEFEP− Cefepime; MER−Meropenem; TBR−Tobramycin; IMI−imipenem; CPD−Cefpodoxime; CTM−Cefotaxime; OXA−Oxacillin; LIN−Linezolid; CAR−Carbenicillin; ERY−Erythromycin; CLD−Clindamycin; CFX−Cefixime; DOX−Doxycycline; TGC−Tigecycline; QD−Quinupristin−Dalfopristin; ERT−Ertapenem; CPZ−Cefoperazone; SBT−Sulbactam; NFX−Norfloxacin; MOX− Moxifloxacin; *SHL−R− Streptomycin High Level (synergy); PEN−Penicillin G; AKN− Amikacin; FF−Florfenicol; TZD−Tedizolid; AZM−Azithromycin; EFL−enrofloxacin; OQX − Oxyimino−cephalosporins; PNC –Phenicols, ARM−Aztreonam; TZB−Tazobactam; CEFOL− Cefolozane; AVB− Avibactam; ARGs −Antibiotic Resistance Genes. Challenges in controlling the AMR in healthcare settings Nigerian healthcare systems face several challenges in controlling AMR. The most notable driver is the lack of regulatory oversight on the sale of antibiotics, which are readily available without prescription [ 41 ]. In addition, poor antimicrobial stewardship programs [ 42 , 43 ], irrational antibiotic prescriptions [ 31 , 44 ], inadequate infection prevention and control (IPC) practices [ 23 ], low public awareness of the AMR crisis [ 45 ], insufficient clinical waste disposal management, and environmental contamination [ 8 , 22 ]. Surveys revealed that approximately 59.9% of patent medicine vendors and up to 97% of pharmacists in Nigeria dispense antibiotics without a prescription [ 46 , 47 ]. Furthermore, antibiotics from the Watch category are frequently prescribed, with third-generation cephalosporins and fluoroquinolones accounting for approximately 66% of antibiotics administered after consultation. In contrast, antibiotics from the ‘access group’, such as amoxicillin, are more commonly prescribed for outpatients [ 48 ]. Joy-Okwor and colleagues [ 49 ] assessed infection prevention and control (IPC) preparedness across 461 Nigerian healthcare facilities, comprising 350 (75.9%) private and 111 (24.1%) public institutions. Public facilities demonstrated greater IPC preparedness, with 69.7% having an IPC focal point and 59.6% having an IPC work plan, compared to 32.3% and 26.8% in private facilities, respectively. However, both sectors lacked trained staff and essential equipment [ 49 ]. Evidence in the literature also points to a gap in the utilization of advanced diagnostic technologies, such as next-generation sequencing (NGS), for the surveillance, characterization, and subtyping of clinically relevant isolates [ 21 , 22 , 34 , 36 ]. Although genomics and bioinformatics are crucial for improving public health delivery in Nigeria, expertise shortages, the high cost of whole-genome sequencing, and the lack of available resources limit the use of this technology in the region. To enhance public health responses to AMR and guide evidence-based treatment policies, affordable, user-friendly tools and interfaces to simplify genomic and bioinformatics technologies for non-experts are needed [ 50 , 51 ]. Antimicrobial Resistance in the Environment, Companion Animals, and Wildlife The interplay between humans, animals, and the environment in driving AMR is a complex and interconnected process, as evidenced by studies conducted across Nigeria. These studies collectively highlight how the interactions among these three components facilitate the spread of ARB and resistance genes, posing significant risks to public health and food safety. For instance, Nyandjou et al. [ 52 ] isolated Salmonella sp. exhibiting resistance to multiple antibiotics in waste dumps in Northwest Nigeria, while Adesoji et al. [ 53 ] reported the recovery of MDR P. aeruginosa in household sewage, highlighting the risk of water source contamination. These findings illustrate how environmental contamination, driven by improper waste disposal and inadequate sanitation, serves as a critical pathway for the dissemination of ARB into water sources used for irrigation, aquaculture, and recreational activities. Adesoji and Call [ 16 ] further emphasized this issue by detecting MDR bacteria, including Pseudomonas sp. and Proteus sp. carrying floR , in treated water distribution systems in Southwest Nigeria. This persistence of resistance genes even after water treatment highlights the resilience of ARB in the environment and their potential to enter the food supply chain. Animals, both domestic and wildlife, also play a pivotal role in this dynamic as reservoirs of ARB. Falodun et al. [ 54 ] identified ESBL-producing E. coli in fecal samples from healthy dogs in Ibadan, demonstrating that companion animals can harbor and spread ARB. Similarly, Obodoechi et al. [ 55 ] isolated MDR, ESBL-producing E. coli from frugivorous and insectivorous bats in Southeast Nigeria, revealing that wildlife also contributes to the maintenance and dissemination of ARGs. Kabantiyok et al. [ 56 ] expanded on this by reporting ARB in barn owls in North-Central Nigeria, where zoonotic bacterial pathogens, including Leptospira species, antibiotic-resistant Corynebacterium amycolatum , and E. coli were recovered (Table 2 ). These findings underscore the role of animals in bridging the gap between environmental contamination and human exposure, as ARB from animals can enter the food chain through direct contact, consumption of contaminated animal products, or environmental contamination. Human practices further exacerbate this cycle by driving the selection and spread of ARB. The extensive use of antibiotics in aquaculture and veterinary practices, such as the misuse of florfenicol, contributes to the emergence of resistant strains, as evidenced by the high minimum inhibitory concentrations (MICs) to florfenicol observed in bacterial isolates recovered from water distribution systems [ 16 ]. Additionally, inadequate waste management and poor sanitation practices allow ARB and resistance genes to persist in the environment, creating a continuous loop of contamination. The interconnectedness of humans, animals, and the environment creates a multifaceted challenge in addressing AMR within the food supply chain, as contaminated water sources, soil, and animals directly impact food safety. This complex interplay underscores the need for a holistic, One Health approach to tackle AMR. Without addressing the contributions of all three components, efforts to mitigate AMR in the Nigerian food supply chain will remain incomplete, leaving public health and food safety at continued risk. Table 2 Antimicrobial Resistance Patterns and Antibiotic Resistance Genes in the Environment, Companion Animals, and Wildlife Sources Isolates Resistance Patterns ARGs References Waste dumps Salmonella sp. AMP, AMC, OFX, SXT, CEF, TET, CIP No ARG reported Nyandjou et al ., 2019 [ 52 ] Residential sewage P. aeruginosa CDZ, CRX, GEN, CPR, OFX, AUG, NIT, AMP No ARG reported Adesoji et al. , 2023 [ 53 ] Drinking water distribution systems Pseudomonas sp., Serratia sp., Proteus sp., Acinetobacter sp., P. rettgeri FF, TET, S, GEN, KAN, CPC, CEF, SXT, AMC, floR Adesoji and Call, 2020 [ 16 ] Highly touched surfaces in selected hospital wards S. aureus, P. aeruginosa, E. gallinarum, O. anthropi, S. thoraltensis, C. violaceum, S. paucimobilis , E. cloacea subsp. dissolvens, S. haemolyticus, Pantoea sp., E. cloacea, S. vitulinus, E. faecalis, P. stuartii AMP, PIP, LEV, CIP, CFX, CEFAZ, GEN, NIT, FOX, CEFEP, CDZ, MRP, SXT, TBR No ARG reported Alabi et al ., 2023 [ 23 ] Dog fecal samples (Pets) E. coli TET, SXT, AMP, CIP, CFX, CDZ AMC, IPM, CPD bla SHV , bla TEM , bla CTX−M Falodun et al ., 2022 [ 54 ] Liver, spleen, and intestines of fruit ( Eidolon helvum ) and insect-eating ( Nycteris hispida ) bats E. coli AMP, AMC, CTX, CDZ, SXT, TET, S, GEN bla CTX−M−15 , bla TEM , aac(3)-II, tetA, tetB, int1 (Integron) Obodoechi et al ., 2021[ 55 ] Blood samples, Oropharyngeal and cloacal swabs from Barn Owls ( Tyto alba ) L. enterohaemorrhagica. L. grippotyphosa, L. mini (zoonotic bacterial pathogens), C. amycolatum, M. sciuri , and E. coli QNL, TET, CPS, SUL, PEN, BLA No ARG reported Kabantiyok et al ., 2023 [ 56 ] KEYS: QNL− Quinolone; CPS− cephalosporins; SUL−sulphonamides; BLA− β−Lactam; PEN− Penicillins; AMP−Ampicillin, AMC− Amoxicillin−clavulanic acid, OFX− Ofloxacin, CDZ, Ceftazidime; CRX, Cefuroxime; CPR, Ciprofloxacin; GEN, Gentamicin; NIT, Nitrofurantoin; CIP−Ciprofloxacin; CFX−Ceftriaxone; SXT−Sulfamethoxazole/trimethoprim; TET−Tetracycline; FF−florfenicol; S−streptomycin; CPC−chloramphenicol; N−Nalidixic acid; CEF− ceftiofur; PIP−Piperacillin; LEV−Levofloxacin; CEFAZ− Cefazolin; FOX−Cefoxitin; CEFEP− Cefepime; MRP: Meropenem; TBR−Tobramycin; IPM−imipenem; CPD− cefpodoxime; CTX−Cefotaxime; CLX− cloxacillin; KAN−Kanamycin; AUG−Augmentin; NIT−Nitrofurantoin; ARGs −Antibiotic Resistance Genes. Antimicrobial Resistance in the Food Supply Chain Antimicrobial resistance presents significant challenges in Nigeria's food supply chain because of extensive antimicrobial use (AMU) practices in food-producing animals. In the poultry industry, a knowledge gap among farmers regarding proper AMU has led to the unregulated prophylactic use of antibiotics. This non-adherence to veterinary guidelines has increased the risk of ARB in food-producing animals and public health. Chah et al. [ 57 ] reported that all poultry farmers in Enugu State, Southeast Nigeria use antibiotics for growth promotion, disease prevention, and treatment. The mean knowledge index of antibiotic use (KABU) was 0.54, indicating moderate knowledge among farmers, whereas the mean knowledge index of antibiotic resistance (KABR) was 0.65, with 70.5% of farmers demonstrating good knowledge. However, 83% of the respondents practiced inappropriate antibiotic use, highlighting the need for training to improve poultry farmers' AMR knowledge and practices. Furthermore, Alhaji et al . [ 13 ] investigated the practices and perceptions of 151 fish farmers regarding AMU and its implications for AMR and residual antibiotics in freshwater fish farms in North-Central Nigeria. The authors assessed the risk status of AMU and AMR using a traffic light model and detected antibiotic residues in fish organs and pond water samples. This study revealed that widespread antibiotic misuse and residue spread through the consumption of residual antibiotics in fish and contact with wastewater released from fish farms into the environment. Similarly, Smith et al. [ 58 ] surveyed antibiotic prescription habits among Nigerian veterinarians and their potential contribution to AMR. Most veterinarians acknowledge the over prescription and overuse of antibiotics, and a significant portion do not perform culture or antibiotic susceptibility testing (AST) before antibiotics are prescribed. The authors recommend laboratory reliance on antibiotic prescriptions [ 57 ]. Consequently, a high prevalence of MDR bacterial strains such as MRSA, MDR Campylobacter sp., extensively resistant E. coli , linezolid-resistant enterococci , and MDR non-typhoidal Salmonella serovars has been reported in poultry, underscoring the high risk of zoonotic transmission of ARB in the food supply chain and farm environment. Aworh et al. [ 59 ] reported zoonotic transmission of ESBL-producing E. coli among beef cattle, abattoir workers, and abattoir environments in Abuja and Lagos, Nigeria, and the circulation of the bla CTX-M-55 gene among abattoir workers and beef cattle via MGEs. In a similar study following the One Health approach, Olorunleke et al. [ 14 ] collected fecal and cecal samples from slaughtered cattle, abattoir environments, and abattoir workers in southeastern Nigeria. The authors also sampled livestock from farms, animal markets, environmental samples, and hand swabs from humans in contact with the animals. The findings revealed a widespread prevalence of extended-spectrum cephalosporin-resistant E. coli in livestock and humans, with a high prevalence of bla CTX-M genes , particularly bla CTX - M-15 . Notably, a plasmid harboring bla CTX-M-15 recovered from livestock showed high sequence identity with a plasmid recovered from river water in India [ 60 ], suggesting the global dissemination of this ESBL plasmid. In contrast, Ajuzieogu et al. [ 61 ] examined the bacteriological quality of ready-to-eat African salads in Enugu, Nigeria, and the antibiogram patterns of the associated bacteria. This study revealed high bacterial counts and the presence of various pathogenic bacteria, including β-lactam-resistant Vibrio sp., Salmonella sp., and E. coli . They recommended improved hygiene, regular cleaning, and disinfection of food-contact surfaces (Table 3 ). Antimicrobial resistance (AMR) in Nigeria’s food supply chain is a complex issue driven by systemic failures, including inadequate regulatory oversight, economic constraints, and a gap between knowledge and practice. Despite moderate awareness of antibiotic resistance among some farmers, irresponsible practices persist. Antibiotics are often used for growth promotion or prophylactically without proper diagnosis or adherence to dosage guidelines, highlighting the need for targeted education and training programs that promote alternatives and better farm management practices. Economic barriers further exacerbate the issue, as farmers and veterinarians frequently rely on antibiotics as a low-cost solution due to limited access to diagnostic testing and financial resources. Thus, addressing AMR in the food supply chain requires systemic changes, including the implementation and enforcement of stricter regulations, investment in affordable diagnostic tools, and financial incentives for antimicrobial stewardship programs to enhance food security. Table 3 Antimicrobial Resistance Patterns and Antibiotic Resistance Genes in Poultry, Aquaculture, and Food Supply Chains Sources Isolates Resistance Patterns ARGs References Fish and water samples Antibiotic residue in fish organs and water samples CIP, EFL, COL, ERY, AMP, NEO, PEN, TET, S, SUL No ARGs reported Alhaji et al ., 2021 [ 13 ] Beef cattle, abattoir environments, and abattoir workers E. coli TET, FPA, PEN, QNL, AMG, PNC, MRD, NTF, CBM, CPS bla TEM−1 , bla OXA−1 , bla CTX−M−14 , bla CTX−M−15 , bla CTX−M−55 , sul1, sul2, sul3, dfrA1, dfrA7, dfrA12, dfrA14, dfrA17, aadA1, aadA2, aadA5, aac(3)-Ila, aac(6)-Iaa, aac(6)- Ib3, aac(6)-Ib-cr, aph(3)-Ia, aph(3)-Ib, aph(3)-Id, aph(6)-Id Aworh et al ., 2022 [ 59 ] Livestock on farms, abattoirs, and animal markets, and in-contact humans E. coli CBM, 3rd generation CPS, AMG, TET, FPA, PEN, MBM, BLI, QNL, FQL bla CTX−M−15 , bla CTX−M−55 , bla CTX−M−64 , bla TEM−1b , bla OXA−1 , bla ACT−25 , bla SHV−28 , bla CTX−M−65 , strA, strB, qnrS1, tet(A)-v2, tet(A), tet(D), tet-AB, sul2, dfrA14 Olorunleke et al ., 2022 [ 14 ] Ready-to-eat African salad Salmonella sp., S. aureus, Klebsiella sp., E. coli, V. mimicus, V. fluvialis, V. cholerae, V. parahaemolyticus and V. hollisae BLI, BLA No ARGs reported Ajuzieogu et al ., 2022 [ 61 ] Freshly dressed chicken, Frozen/imported chicken, Processors, Consumers, Knives and Tables Methicillin-resistant S. aureus BLA, FQL, AMG, TET, FPA, MRD, mecA, dfrG, tet(38), blaZ, fosB, aacA-aphD, MSR(A), aphA3, mph(C), dfrS1, sat4 tet(K), SCCmec type IVa, V, Vc Ogundipe et al ., 2020 [ 62 ] Poultry droppings Salmonella sp. AMP, GEN, KAN, CTX, CIP, SUL, TET, CPC, TMP, NAL, MEM blaTEM, tet(R), aac(3)-II, aph (3”)-I, aph (6)-Ic sul1, sul2, sul3, tet (A), tet (M), qnrS1, qnrB19 Jibril et al ., 2021a [ 63 ] Poultry meat samples Salmonella sp. AMP, PIP, AZM, ERY, TET, CPC, TMP, SUL, CIP, KAN, S, CDZ, CFZ sul1, sul2, strA, floR, bla CTX Igbinosa et al ., 2022 [ 64 ] Broiler caecal samples E. coli FQL, FOS, SXT, AMP and CPS, AMG, CPC, TET, MRD bla TEM−106 , bla TEM−126 ., bla CTX−M−14 , bla CTX−M−55 , fosA3, qnrS1, qnrB19 tet(M), aph(3)-Ib, mef(B), qacE, sul1, sul2, sul3, catA1, qacE, sitABCD Al-Mustapha et al ., 2022 [ 65 ] Poultry Salmonella sp. CIP, GEN, NAL, SXT, TET pmrA, gyrA, parC, qnr, tem, catA1, cmlA1, floR, dfrA5-14, sul2, aac (3)-le, tetA Fagbamila et al. , 2023 [ 66 ] KEYS: FOS− fosfomycin; CPS− cephalosporins; AMG− aminoglycosides; CPC− chloramphenicol; TET− tetracycline; MRD− macrolides; FQL− Fluoroquinolones; BLA− β−Lactam; FPA− Folate pathway antagonist; BLI− β−Lactam inhibitor; QNL− Quinolone; PEN− Penicillins; CDZ−Ceftazidime; CFZ− Cefazolin; EFL−enrofloxacin; NEO−neomycin; CIP−ciprofloxacin; COL−colistin; ERY−erythromycin; S−streptomycin; SUL−sulphonamides; AMP−ampicillin; GEN−gentamicin; KAN−kanamycin; CTX−cefotaxime; SUL−sulphonamides; CPC−chloramphenicol; TMP−trimethoprim; NAL−nalidixic acid; MEM−meropenem; PIP−Piperacillin; AZM−Azithromycin; MBM− Monobactam; CBM− Carbapenems; PNC− Phenicols; NTF− Nitrofurans; ARGs −Antibiotic Resistance Genes. Nigeria's AMR crisis: A need for One Health Transdisciplinary Response Although Gram-negative bacterial infections are globally dominant [ 67 ], Nigeria’s healthcare delivery systems, food supply chains, companion animals, wildlife, and environments are threatened by the spread of MDR Gram-negative bacteria. Antimicrobial resistance poses a significant threat to global public health [ 68 ], with Nigeria being no exception. In Nigeria, AMR challenges are driven largely by weak regulatory frameworks and inadequate enforcement mechanisms [ 69 ]. Despite existing policies, the over-the-counter sale of antibiotics without prescriptions remains widespread, contributing to their misuse in both human and veterinary medicine. Additionally, the unregulated use of antibiotics in livestock, often as growth promoters or feed additives, further exacerbates the problem, leading to the emergence of resistant bacterial strains that can spread through the food chain [ 70 ]. Regulatory agencies such as the National Agency for Food and Drug Administration and Control (NAFDAC) face significant challenges in monitoring and enforcing compliance. The proliferation of substandard and counterfeit antibiotics further complicates efforts to contain resistance, highlighting the urgent need for more stringent regulatory oversight [ 71 ]. While NAFDAC has a legal mandate, the penalties for non-compliance, as well as the regulation of the importation and distribution of counterfeit antibiotics, are sometimes seen as insufficient or not strictly applied, reducing their deterrent effect. On the other hand, many farmers in Nigeria lack awareness of the risks associated with the misuse of antibiotics in aquaculture and livestock [ 13 , 57 , 70 ]. Collaborating with agricultural extension services and veterinary professionals to disseminate best practices and farmer education programs is essential to promote responsible antibiotic use and alternative practices, such as improved animal husbandry, vaccination, and biosecurity measures. In June 2017, Nigeria underwent its Joint External Evaluation (JEE) to assess its core capacities under the International Health Regulations (IHR). While strengths were noted in the One Health framework, significant gaps remain, particularly in surveillance and outbreak response. The evaluation also highlighted the absence of a well-coordinated, institutionalized long-term strategy for One Health as a critical area requiring attention. Further complicating these challenges is the limited government funding allocated to the sector, inadequate routine sharing of laboratory information or specimens related to zoonotic diseases among relevant agencies, and weak intersectoral collaboration in surveillance activities. Additionally, Rapid Response Teams (RRTs) in rural and Local Government Areas (LGAs) are underperforming, further hindering effective disease control and response efforts [ 72 ]. Thus, proactive stakeholder engagement and the formulation of a cohesive national framework aimed at strengthening antimicrobial stewardship programs (ASPs) are urgently needed. Such efforts would enhance a comprehensive, transdisciplinary One Health surveillance system capable of addressing the multifaceted challenges of AMR while mitigating its adverse effects on Nigerian society. Interconnectedness and Multi-Sectoral Collaboration: The One Health Perspective The One Health framework underscores the intricate interconnectedness of human, animal, and environmental health, particularly in the context of antimicrobial resistance (AMR). The overuse of antibiotics in livestock, for instance, not only impacts animal health but also contributes to the emergence and spread of ARB, which can be transmitted to humans through the food supply chain [ 73 , 74 ]. Furthermore, environmental contamination with residual antibiotics exacerbates this problem by promoting the proliferation of antibiotic-resistant strains, posing significant health risks to humans, wildlife, and ecosystems [ 75 – 78 ]. These complex interactions highlight the interconnected drivers of AMR, necessitating a unified approach to address the issue holistically [ 79 , 80 ]. A cornerstone of the One Health approach is its emphasis on multisectoral collaboration, which is essential for effectively managing AMR [ 81 ]. Tackling AMR requires coordinated efforts across diverse sectors, including human healthcare, veterinary medicine, agriculture, and environmental science. By integrating public health initiatives, veterinary practices, agricultural policies, and environmental management strategies, stakeholders can develop cohesive and comprehensive interventions to combat AMR [ 82 ]. This collaborative approach ensures that all potential sources of AMR are addressed, from clinical settings and livestock production to environmental reservoirs, and safeguards the health of humans, animals, and ecosystems. Addressing Antimicrobial Usage Antibiotics are often prescribed indiscriminately in Nigerian healthcare settings, and their use is imprudently prevalent in food-producing animals for growth promotion and disease prevention, leading to unchecked misuse of antibiotics because of a lack of regulatory oversight and ASPs [ 31 , 41 , 57 , 83 ]. The pharmaceutical sector faces significant challenges in regulation due to the vast number of products, practitioners, and premises (both registered and unregistered) that require oversight. Issues such as the prevalence of fake and counterfeit drugs, a disorganized distribution system, insufficient infrastructure, limited enforcement capabilities, and a lack of collaboration with other law enforcement agencies further complicate matters. Additionally, regulators struggle with inadequate human resources, insufficient funding, heavy dependence on imported pharmaceuticals, and substandard facilities for quality control, all of which hinder effective regulation and control of the sector [ 48 ]. Additional challenges in managing AMR include the absence of dedicated antimicrobial stewardship (AMS) teams in many hospitals across the country, as well as insufficient training and support for AMS initiatives from hospital management [ 84 ]. The One Health approach recognizes responsible antibiotic stewardship as a core principle [ 17 ], which involves a thorough and tailored strategy for managing antimicrobial use, considering not only the amount used but also how, why, and by whom they are used. This approach considers the diverse perspectives and practices of various stakeholders, including healthcare providers, patients, and others, as well as the specific circumstances that influence the decision to prescribe antimicrobial agents [ 85 ]. However, public awareness of ASPs in Nigeria remains alarmingly low, as evident by the routine and often inappropriate use of antibiotics. The One Health approach can target these practices by promoting the responsible use of antibiotics across various sectors. Surveillance and Monitoring Effective surveillance and monitoring are essential for understanding and controlling AMR [ 86 – 88 ]. Many initial obstacles encountered in establishing a national AMR surveillance system in Nigeria have been resolved by integrating national reference laboratory (NRL) functions backed by genomics [ 51 ]. Nonetheless, challenges persist and continue to arise when applying this approach in the Nigerian context. The NRLs face significant challenges, including understaffing and difficulty retaining skilled professionals in clinical laboratory science, sequencing, and bioinformatics [ 51 ]. Compounding these issues, Nigeria’s primary healthcare systems remain weak, and there is a notable absence of antimicrobial stewardship programs in both public and private healthcare sectors. Additionally, the lack of coordination, comprehensive data, and national reports on antibiotic consumption across human and animal health sectors continues to hinder progress. Despite these challenges, the Federal Government of Nigeria has taken steps to address AMR, such as launching the National Action Plan for Antimicrobial Resistance in 2017 [ 48 ]. However, there is a critical need for integrated, cross-sectoral monitoring and surveillance systems that enable the comprehensive collection and analysis of AMR data across human, animal, and environmental sectors in rural and urban areas across States and LGAs [ 48 ]. The One Health approach enhances these efforts by integrating human, animal, and environmental data. Implementing a unified national surveillance system can facilitate real-time monitoring of AMR patterns and inform targeted interventions. Data-driven decision-making, supported by robust surveillance frameworks, allows for timely responses to address this public health threat [ 89 , 90 ]. Education and Awareness Education and awareness are pivotal components of the One Health System [ 91 ]. During the 2020 World AMR Awareness Week, a diverse panel of experts from various sectors came together to address critical issues surrounding antibiotic use in Nigeria. The panel included representatives from national government agencies, research institutions, academia, and the World Health Organization, all operating within the Nigerian One Health framework. They identified widespread lack of awareness and a weak regulatory framework as key drivers of inappropriate antibiotic use across the country, further compounded by both technical and socio-economic challenges [ 92 ]. Raising awareness of the public health dangers of AMR and promoting the responsible use of antimicrobial agents is crucial for all stakeholders. In Nigeria, this includes educating healthcare providers about proper prescription practices, informing farmers about the risks of antibiotic overuse in livestock, and engaging the public in understanding the importance of adherence to prescribed drugs [ 13 , 31 , 58 ]. Educational campaigns and training programs can empower individuals and communities to make informed decisions on antibiotic use. Environmental Considerations Environmental contamination is often a neglected yet critical driver of AMR in Nigeria. Antibiotics can enter the environment through waste from healthcare facilities, agricultural runoff, improper clinical and farm waste disposal practices, poor sanitation, and the release of unmetabolized antibiotics or their residues into the environment through animal manure. On the other hand, releasing pharmaceutical industrial effluents into the environment has exacerbated this crisis [ 93 ]. These factors are closely linked and significantly contribute to the spread of AMR in the environment. These environmental pathways can spread ARB in the water, soil, and air [ 94 ]. The One Health approach advocates for environmental safety and management practices that minimize the release of antibiotics and their residues into the environment, thereby reducing selective pressure. Cultural Sensitivity A recent study revealed significant gaps in antimicrobial prescriptions among Nigerian tertiary hospital physicians, with 68% of respondents prescribing antibiotics on the WHO reserved list [ 95 ]. Another prevalent cultural practice that significantly contributes to the AMR challenges in Nigeria is self-medication, where individuals use antibiotics without a prescription or medical supervision, leading to the overuse of antibiotics [ 96 ]. The One Health approach emphasizes the need for culturally sensitive solutions that consider local practices and beliefs. Nigeria can mitigate these cultural drivers of AMR by addressing the root causes of inappropriate prescriptions and self-medication and by promoting alternative health-seeking behaviors. Conclusion This study revealed high resistance to β-lactam antibiotics in both clinical and food-related bacterial isolates, with MecA , AmpC β-lactamases, and ESBLs being the predominant resistance mechanisms. However, there is a paucity of data on the virulence determinants in these isolates across various sectors. To address the growing threat of AMR in Nigeria, it is imperative to strengthen antimicrobial stewardship programs across the healthcare and veterinary sectors, including livestock and aquaculture. A unified national strategy, aligned with global initiatives and supported by robust surveillance systems, is essential to mitigate AMR risks in healthcare delivery and food supply chains. Sustained efforts are needed to enhance research and data collection on antibiotic usage, resistance patterns, and virulence factors in food-producing animals, particularly in rural areas, to enable real-time monitoring of AMR patterns and guide targeted interventions. Cross-sector collaboration is critical to reducing extensive antibiotic use in humans and animals, promoting effective alternative treatment options, improving farm hygiene, and strengthening surveillance systems. 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Nigeria Sok J Vet Sci 21(3):151–154. https://doi.org/10.4314/sokjvs.v21i3.7 Chah JM, Nwankwo SC, Uddin IO et al (2022) Knowledge and practices regarding antibiotic use among small-scale poultry farmers in Enugu State, Nigeria, Heliyon. 8(4). https://doi.org/10.1016/j.heliyon.2022.e09342 Smith SI, Kwaga JK, Ngulukun SS et al (2022) Antibiotic prescription practices amongst veterinarians in Nigeria. Res Vet Sci 152:219–227. https://doi.org/10.1016/j.rvsc.2022.07.028 Aworh MK, Ekeng E, Nilsson P et al (2022) Extended-spectrum ß-Lactamase-Producing Escherichia coli among humans, beef cattle, and abattoir environments in Nigeria. Front Cell Infect Microbiol 12:869314. https://doi.org/10.3389/fcimb.2022.869314 Akiba M, Sekizuka T, Yamashita A et al (2016) Distribution and relationships of antimicrobial resistance determinants among extended spectrum-cephalosporin-resistant or carbapenem-resistant Escherichia coli isolates from rivers and sewage treatment plants in India. Antimicrob Agents Chemoth 60(5):2972–2980. https://doi.org/10.1128/aac.01950-15 Ajuzieogu CA, Dyboh IC, Nwobodo DC (2022) Culture-dependent examination of the bacteriological quality of ready-to-eat African salads in Enugu metropolis, Nigeria and antibiotic resistance profile of associated bacteria. Heliyon 8(10). https://doi.org/10.1016/j.heliyon.2022.e10782 Ogundipe FO, Ojo OE, Feßler AT et al (2020) Antimicrobial resistance and virulence of methicillin-resistant Staphylococcus aureus from human, chicken and environmental samples within live bird markets in three Nigerian cities. Antibio 9(9):588. https://doi.org/10.3390/antibiotics9090588 Jibril AH, Okeke IN, Dalsgaard A et al (2021) Genomic analysis of antimicrobial resistance and resistance plasmids in Salmonella serovars from poultry in Nigeria. Antibio 10(2):99. https://doi.org/10.3390/antibiotics10020099 Igbinosa EO, Beshiru A, Igbinosa IH et al (2022) Antimicrobial resistance and genetic characterisation of Salmonella enterica from retail poultry meats in Benin City, Nigeria, LWT, 169 114049. https://doi.org/10.1016/j.lwt.2022.114049 Al-Mustapha AI, Alada SA, Raufu IA et al (2022) Co-occurrence of antibiotic and disinfectant resistance genes in extensively drug-resistant Escherichia coli isolated from broilers in Ilorin, North Central Nigeria. J Glob Antimicrob Resist 31. https://doi.org/10.1016/j.jgar.2022.11.002 . 337 – 44 Fagbamila IO, Ramon E, Lettini AA et al (2023) Assessing the mechanisms of multi-drug resistant non-typhoidal Salmonella (NTS) serovars isolated from layer chicken farms in Nigeria. PLoS ONE 18(9):e0290754. https://doi.org/10.1371/journal.pone.0290754 Gu SL, Gong Y, Zhang J et al (2020) Effect of the short-term use of fluoroquinolone and β-lactam antibiotics on mouse gut microbiota. Infect Drug Res 4547–4558. https://doi.org/10.2147/IDR.S281274 Ferrara F, Castagna T, Pantolini B et al (2024) The challenge of antimicrobial resistance (AMR): current status and future prospects. Naunyn-Schmiedeberg's Arch Pharm 1:3. https://doi.org/10.1007/s00210-024-03318-x Ajekiigbe VO, Ogieuhi IJ, Odeniyi TA et al (2025) Understanding Nigeria’s antibiotic resistance crisis among neonates and its future implications. Dis Pub Health 22(1):28. https://doi.org/10.1186/s12982-025-00422-y Alhaji NB, Isola TO (2018) Antimicrobial usage by pastoralists in food animals in North-central Nigeria: The associated socio-cultural drivers for antimicrobials misuse and public health implications. One Health 6 41 – 7. https://doi.org/10.1016/j.onehlt.2018.11.001 Eruaga MA, Bature T, Itua EO (2024) Pharmacovigilance in Nigeria: Addressing challenges in ensuring drug safety and monitoring adverse effects. GSC Adv Res Rev 18(3):078–82. https://doi.org/10.30574/gscarr.2024.18.3.0093 Nigerian Center for Disease Control, One Health Strategic Plan (2019–2023) https://ncdc.gov.ng/themes/common/docs/protocols/93_1566785462.pdf , 2019 (Accessed 17 March 2025) Finley RL, Collignon P, Larsson DJ et al (2013) The scourge of antibiotic resistance: the important role of the environment. Clin Infect Dis 57(5). https://doi.org/10.1093/cid/cit355 . 704 – 10 Tang Q, Song P, Li J et al (2016) Control of antibiotic resistance in China must not be delayed: the current state of resistance and policy suggestions for the government, medical facilities, and patients. Biosci Trends 10(1):1–6. https://doi.org/10.5582/bst.2016.01034 Cabello FC, Godfrey HP, Buschmann AH et al (2016) Aquaculture as yet another environmental gateway to the development and globalisation of antimicrobial resistance. Lancet Infect Dis 16(7):e127–e133. https://doi.org/10.1016/S1473-3099(16)00100-6 Manyi-Loh C, Mamphweli S, Meyer E et al (2018) Antibiotic use in agriculture and its consequential resistance in environmental sources: potential public health implications. Molecules 23(4):795. https://doi.org/10.3390/molecules23040795 Thai PK, Binh VN, Nhung PH et al (2018) Occurrence of antibiotic residues and antibiotic-resistant bacteria in effluents of pharmaceutical manufacturers and other sources around Hanoi. Vietnam Sci Total Env 645:393–400. https://doi.org/10.1016/j.scitotenv.2018.07.126 Taylor P R. Reeder. Antibiotic use on crops in low and middle-income countries based on recommendations made by agricultural advisors. CABI Agric Biosci, 1(1) (2020)1. https://doi.org/10.1186/s43170-020-00001-y Collignon PJ, McEwen SA (2019) One health—its importance in helping to better control antimicrobial resistance. Trop Med Infect Dis 4(1):22. https://doi.org/10.3390/tropicalmed4010022 Velazquez-Meza ME, Galarde-López M, Carrillo-Quiróz B et al (2022) Antimicrobial resistance: one health approach. Vet World 15(3):743. https://doi.org/10.14202/vetworld.2022.743-749 Zinsstag J, Schelling E, Wyss K et al (2005) Potential of cooperation between human and animal health to strengthen health systems. Lancet 366(9503):2142–2145. https://doi.org/10.1016/S0140-6736(05)67731-8 Lucero-Prisno DE, Owhor IIIGA, Olayemi A et al (2023) Addressing one health in Nigeria; challenges and recommendations. PAMJ-One Health 10. https://doi.org/10.11604/pamj-oh.2023.10.3.38072 Emeje MO, Oloye S, Bubakari M et al (2022) Use of antibiotics in livestock in Nigeria: Curbing antimicrobial resistance and developing a national regulatory guideline towards monitoring antibiotic use in animal and animal foods. Int Res J Pub Env Health 9(2):55. https://doi.org/10.15739/irjpeh.22.007 Abubakar U, Tangiisuran B (2020) Nationwide survey of pharmacists’ involvement in antimicrobial stewardship programs in Nigerian tertiary hospitals. J Glob Antimicrob Res 21 148 – 53. https://doi.org/10.1016/j.jgar.2019.10.007 Hibbard R, Mendelson M, Page SW et al (2024) Antimicrobial stewardship: a definition with a One Health perspective. Npj Antimicrob Res 2(1):15. https://doi.org/10.1038/s44259-024-00031-w Frost I, Kapoor G, Craig J et al (2021) Status, challenges and gaps in antimicrobial resistance surveillance around the world. J Glob Antimicrob Res 25:222–226. https://doi.org/10.1016/j.jgar.2021.03.016 Dyar OJ, Huttner B, Schouten J et al (2017) J, What is antimicrobial stewardship? Clin. Microbiol. Infect, (11) 793-8. https://doi.org/10.1016/j.cmi.2017.08.026 Lloyd DH, Page SW (2018) Antimicrobial stewardship in veterinary medicine, in: Antimicrobial Resistance in bacteria from livestock and companion animals. Am Soc Microbiol 675–697. https://doi.org/10.1128/9781555819804.ch31 Sharan M, Vijay D, Yadav JP et al (2023) Surveillance and response strategies for zoonotic diseases: A comprehensive review. Sci One Health 2:100050. https://doi.org/10.1016/j.soh.2023.100050 Singh S, Sharma P, Pal N et al (2024) Holistic one health surveillance framework: synergizing environmental, animal, and human determinants for enhanced infectious disease management. ACS Infect Dis 10(3):808–826. https://doi.org/10.1021/acsinfecdis.3c00625 McEwen SA, Collignon PJ (2018) Antimicrobial resistance: A one health perspective. Microbiol Spectr 521–547. https://doi.org/10.1128/9781555819804.ch25 Achi CR, Ayobami O, Mark G et al (2021) Operationalising one health in Nigeria: reflections from a high-level expert panel discussion commemorating the 2020 World Antibiotics Awareness Week. Front Pub Healt 9:673504. https://doi.org/10.3389/fpubh.2021.673504 Ahmad I, Malak HA, Abulreesh HH (2021) Environmental antimicrobial resistance, and its drivers: a potential threat to public health. J Glob Antimicrob Res 27. https://doi.org/10.1016/j.jgar.2021.08.00 . 101 – 11 Sharda N, Kumar D, Thakur R et al (2023) Environmental antibiotic resistance: recent trends, scope, and relevance. Wat Air Soil Poll 234(11):683. https://doi.org/10.1007/s11270-023-06695-w Ogoina D, Iliyasu G, Kwaghe V et al (2021) Predictors of antibiotic prescriptions: a knowledge, attitude, and practice survey among physicians in tertiary hospitals in Nigeria. Antimicrob Res Infect Cont 10:1–7. https://doi.org/10.1186/s13756-021-00940-9 Akande-Sholabi W, Ajamu AT (2021) Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University. BMC Med Edu 21:1–8. https://doi.org/10.1186/s12909-021-02912-4 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6536427","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":448440778,"identity":"375ccf7f-5ec8-4ba1-a503-077f8f067ebb","order_by":0,"name":"Emmanuel Dayo Alabi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYFCCBBBhwWDAzHwAyJCQIVaLBFALG4glwUOCFgYeAxCLsBZ+9uRnEh9qJOTN2Xk+v7pRY8HDwH746AZ8WiR7nplJzjgmYbizmXebdc4xoMN40tJu4NNicCPBTJqHTYJxw2HebcY5bEAtEjxmeLXY30j/Js3zT8J+w2GeZ8Y5/4jQYiCRYybN2yaRCNTC/Di3jQgtEmfeFFvO7JNI3tnMZsac2yfBw0bIL/zt6RtvfPhmY7ud//Djzznf6uT42Q8fw6sFCFgkoAw2MIONgHIQYP6AzhgFo2AUjIJRgAIAZfhDKkKk3OoAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0003-0968-3143","institution":"Federal University Dutsin-Ma, Nigeria","correspondingAuthor":true,"prefix":"","firstName":"Emmanuel","middleName":"Dayo","lastName":"Alabi","suffix":""},{"id":448440779,"identity":"0703d60d-dcdc-4e4f-908a-2ae333e05e89","order_by":1,"name":"Akeem Ganiyu Rabiu","email":"","orcid":"","institution":"Federal University of Health Sciences, Ila-Orangun, Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Akeem","middleName":"Ganiyu","lastName":"Rabiu","suffix":""},{"id":448440780,"identity":"1e7cf48a-7bb4-45cb-98b9-2baaaa1433fc","order_by":2,"name":"Ayodele Timilehin Adesoji","email":"","orcid":"","institution":"Federal University Dutsin-Ma, Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Ayodele","middleName":"Timilehin","lastName":"Adesoji","suffix":""}],"badges":[],"createdAt":"2025-04-26 17:53:04","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6536427/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6536427/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81608440,"identity":"50973ba1-03b5-46d3-88ac-7b59794e15fa","added_by":"auto","created_at":"2025-04-29 06:28:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145043,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6536427/v1/79b98f9d-d930-44eb-a17d-b5839c644813.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA Review of Antimicrobial Resistance Challenges in Nigeria: The Need for a One Health Approach\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe discovery of penicillin by Sir Alexander Fleming in 1928 revolutionized modern medicine, heralding the era of antibiotics and significantly enhancing our ability to combat bacterial infections [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Fleming reported that the misuse of antibiotics could lead to the emergence and spread of antibiotic-resistant bacterial species within a decade [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. By the 1950s, antimicrobial resistance (AMR) emerged as a global challenge, jeopardizing much of the progress made in the past decades [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. AMR occurs when microorganisms evolve mechanisms to resist or evade the effects of antimicrobial agents, making infections more difficult to treat [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The increase in antibiotic-resistant bacteria (ARB) complicates disease management, leading to increased morbidity, prolonged hospital stays, increased healthcare costs, and reduced life expectancy, particularly in low-and middle-income countries (LMICs) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2019, AMR was linked to approximately 1.27\u0026nbsp;million deaths worldwide, attributed to multiple antibiotic-resistant bacterial infections. Should these trends persist, annual deaths from untreatable ARB infections could reach up to 10\u0026nbsp;million by 2050 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Western sub-Saharan Africa bore the greatest burden of AMR in 2019, with approximately 27.3 deaths per 100,000 people directly attributed to AMR and a staggering 114.8 deaths per 100,000 people linked to AMR complications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nigeria faces developmental and resource (mis)allocation challenges that have dovetailed into widespread poverty and poor growth indices, as reflected in its limited access to potable water, poor hygiene and sanitation, and minimal infection control measures [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Of Nigeria's population of over 203\u0026nbsp;million people, 71\u0026nbsp;million lack access to clean water, while 130\u0026nbsp;million do not have basic sanitation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although water scarcity is a widespread challenge in Nigeria, the rural population faces the greatest impact [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Currently, only 61% of Nigerians have access to safe water: 41% within a 30-minute round trip from their homes, 31% directly on their premises, and just 7% with pipe-borne water inside their households [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, as of 2019, the mortality rate linked to unsafe water, poor hygiene, and inadequate sanitation exceeded 70% per 100,000 people in various regions of Africa, including Lesotho, Somalia, Chad, Nigeria, Sierra Leone, and Niger, significantly higher than the global average of 18% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Nigerian AMR crisis has been linked to extensive antibiotic use and misuse across various sectors, including healthcare, veterinary medicine, food production, and environmental contamination [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. One of the challenges in addressing the AMR crisis in LMICs is the lack of accurate information regarding the scope of the problem, particularly in areas with limited surveillance and sparse data. This makes it difficult to grasp the extent of the challenge and develop effective strategies to combat it. Further, limited access to advanced medical care and diagnostic tools hinders accurate diagnosis and treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This underscores the need for a One Health approach to address the AMR challenge across human, animal, and environmental health sectors [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This narrative review summarizes the current patterns of AMR across healthcare, food supply chain, and environmental sectors, focusing on the need for a One Health approach in tackling the challenge across various sectors in Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis narrative review was based on a comprehensive search of major databases, including PubMed, ScienceDirect, Google Scholar, ResearchGate, and African Journals Online for peer-reviewed research articles as well as web reports on antimicrobial resistance in Nigeria published between January 1, 2018, and December 31, 2023. The choice of the time frame (2018\u0026ndash;2023) for reviewing the AMR crisis in Nigeria was based on the fact that Nigeria's National Action Plan on AMR was launched in 2017 in response to the WHO Global Action Plan (2015). Studies from 2018 onward reflect its impact, highlighting progress or gaps. Given the rapid evolution of AMR due to changing prescribing practices and bacterial adaptation, selecting studies from 2018\u0026ndash;2023 ensures the inclusion of the most recent data. Additionally, the past five years have seen an increased adoption of molecular techniques (e.g., whole-genome sequencing and PCR-based resistance detection) in Nigerian AMR studies, enhancing data quality and comparability. We conducted this study following the guidelines recommended by Gregory and Denniss [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] that prescribed PRISMA for systematic review, but not a narrative review. The search utilized the Boolean operators \"AND\" and \u0026ldquo;OR\u0026rdquo; with keywords including \u0026ldquo;antibiotic resistance OR antimicrobial resistance\u0026rdquo;, \u0026ldquo;antibiotic stewardship\u0026rdquo; AND \u0026ldquo;One Health System\u0026rdquo; in combination with terms \u0026ldquo;healthcare system,\u0026rdquo; \u0026ldquo;agriculture\u0026rdquo; \u0026ldquo;veterinary medicine,\u0026rdquo; \u0026ldquo;environment,\u0026rdquo; \u0026ldquo;companion animals,\u0026rdquo; and \u0026ldquo;wildlife.\u0026rdquo; Specific bacterial species (that is, \u0026ldquo;\u003cem\u003eEscherichia coli\u003c/em\u003e,\u0026rdquo; OR \u0026ldquo;\u003cem\u003eStaphylococcus aureus,\u0026rdquo;\u003c/em\u003e OR \u0026ldquo;\u003cem\u003eKlebsiella pneumoniae,\u0026rdquo;\u003c/em\u003e OR \u0026ldquo;\u003cem\u003eAcinetobacter baumannii,\u0026rdquo;\u003c/em\u003e OR \u0026ldquo;\u003cem\u003ePseudomonas aeruginosa,\u0026rdquo;\u003c/em\u003e OR \u003cem\u003e\u0026ldquo;Enterobacter,\u0026rdquo;\u003c/em\u003e OR \u0026ldquo;\u003cem\u003eEnterococcus\u003c/em\u003e species\u003cem\u003e\u0026rdquo;\u003c/em\u003e) were included in the search terms.\u003c/p\u003e \u003cp\u003eQualitative and quantitative data from observational studies published in English were included, whereas review articles and encyclopedic content were excluded. Also excluded from the review are articles published by journals listed in Beall\u0026rsquo;s list of predatory journals [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The African Journals Online (AJOL) was selected as the primary source for identifying relevant studies because of its extensive collection of peer-reviewed African research, including a wide range of Nigerian journals covering medical, microbiological, and public health disciplines. AJOL provides access to regionally published studies that may not be widely indexed in global databases, ensuring a comprehensive and contextually relevant literature search.\u003c/p\u003e \u003cp\u003eThe results of the searches were first screened by titles before considering the abstract and reviewing the whole manuscript. As for relevant articles, we extracted data, including the authors\u0026rsquo; names, year of publication, article title, microbial isolation source, and detected antimicrobial resistance phenotypes and genotypes into Microsoft Excel 2018. Duplicate entries were removed before proceeding with the remaining articles.\u003c/p\u003e"},{"header":"Results and Discussion","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eAntimicrobial Resistance in Healthcare Delivery Settings\u003c/h2\u003e\n \u003cp\u003eSeveral studies conducted in Nigeria between January 2018 and December 2023 reported a high prevalence of WHO-listed \u0026apos;priority bacteria\u0026apos; in clinical samples from secondary and tertiary healthcare facilities. Between 2019 and 2021, 5,606 isolates were subjected to antimicrobial susceptibility testing as part of the national human health sentinel surveillance system. During this period, the prevalence of carbapenem-resistant \u003cem\u003eEnterobacteriaceae\u003c/em\u003e ranged from 20 to 30%, while extended-spectrum \u0026beta;-lactamase (ESBL) producers accounted for 60 to 80% of cases. Amikacin-resistant \u003cem\u003eEnterobacteriaceae\u003c/em\u003e remained at 20% or lower throughout the time frame. Methicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) exceeded 80%, and \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e accounted for 90% of the resistance. Fluoroquinolone resistance in \u003cem\u003eSalmonella\u003c/em\u003e was notably high (70\u0026ndash;90%), whereas cephalosporin resistance was reported to be 20\u0026ndash;30%. This trend is particularly concerning, as these multidrug-resistant (MDR) bacteria not only exhibit resistance to multiple antibiotics but also harbor mobile genetic elements (MGEs) that mediate the transfer of resistance traits to other bacterial species. These elements, including plasmids and integrons, facilitate the horizontal transfer of antibiotic resistance genes (ARGs), further exacerbating the challenge of antimicrobial resistance [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eGram-negative bacteria were the most dominant isolates recovered from the clinical samples, often harboring genes encoding ESBLs and New Delhi metallo-\u0026beta;-lactamases (NDM), such as \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u003c/em\u003e,\u003c/sub\u003e \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003eand bla\u003c/em\u003e\u003csub\u003e\u003cem\u003eNDM\u003c/em\u003e\u003c/sub\u003e. Conversely, the Gram-positive isolates carried the \u003cem\u003evanA\u003c/em\u003e and \u003cem\u003emecA\u003c/em\u003e genes, conferring resistance to glycopeptides and penicillin, respectively (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Alabi et al. [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e] reported that MDR \u003cem\u003eS. aureus\u003c/em\u003e was the predominant bacterium isolated from highly touched surfaces in selected hospitals in Northwest Nigeria. A study conducted in Kebbi State, Northwest Nigeria, reported a 14.6% methicillin-resistant \u003cem\u003eS. aureus\u003c/em\u003e (MRSA) colonization rate among veterinarians, highlighting the high risk of livestock-acquired methicillin-resistant \u003cem\u003eS. aureus\u003c/em\u003e (LA-MRSA) infection due to close contact with livestock. These MRSA isolates exhibited resistance to various classes of antibiotics, with approximately 60% harboring \u003cem\u003emecA\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. These trends have raised concerns about the public health risks of MDR infections, particularly among immunocompromised individuals.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAntibiotic Resistance Patterns and Resistance Genes in Clinical Isolates\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIsolates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResistance Patterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eARGs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReferences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine, Intra-abdominal, and blood samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, SXT, CIP, CTM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;15\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeni \u003cem\u003eet al\u003c/em\u003e., 2018 [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine, high vaginal swabs, ear and wound swabs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, GEN, LEV, CIP, ERY, OXA, RIF, CLD, SXT, S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emecA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAngel \u003cem\u003eet al\u003c/em\u003e., 2019 [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eEnterococcus\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePEN, CIP, GEN, S, TET, NIT, LIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003evanA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShettima \u003cem\u003eet al\u003c/em\u003e., 2019 [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNasal swab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMethicillin-resistant \u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOXA, TET, GEN, VAN, PEN, ERY, NEO, SXT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emecA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGaddafi \u003cem\u003eet al\u003c/em\u003e., 2020 [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, AMC, FOX, CIP, LEV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDavid \u003cem\u003eet al\u003c/em\u003e., 2020 [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eKlebsiella\u003c/em\u003e sp., \u003cem\u003eMorganella\u003c/em\u003e sp., \u003cem\u003eProvidencia\u003c/em\u003e sp., \u003cem\u003eProteus\u003c/em\u003e sp., \u003cem\u003eYersinia\u003c/em\u003e sp., \u003cem\u003eSerratia\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCDZ, CRX, GEN, CFR, ERY, OFX, AMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKayode \u003cem\u003eet al\u003c/em\u003e., 2020 [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eProteus\u003c/em\u003e sp. \u003cem\u003eKlebsiella\u003c/em\u003e sp., \u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eEnterobacter\u003c/em\u003e sp., \u003cem\u003eCitrobacter\u003c/em\u003e sp., \u003cem\u003eProvidencia\u003c/em\u003e sp., \u003cem\u003eS. aureus\u003c/em\u003e, \u003cem\u003eEnterococcus\u003c/em\u003e sp., \u003cem\u003eCorynebacterium\u003c/em\u003e sp., \u003cem\u003eP. aeruginosa\u003c/em\u003e, and \u003cem\u003eSalmonella\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMX, NIT, CFX, CXM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOkwume \u003cem\u003eet al\u003c/em\u003e., 2021 [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine, sputum, blood, swabs, aspirates, biopsies, seminal fluids and cerebrospinal fluids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIP, LEV, CDZ, GEN, CAR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManga \u003cem\u003eet al\u003c/em\u003e., 2021 [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine, blood, non-blood, throat, ocular, stool and rectal swabs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eK. pneumoniae, K. quasipneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCBM, PNC, TET, SUL, TMP, BLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eNDM\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eNDM\u0026minus;5\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;15\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003edfrA14, tetD, qnrS, oqxAB\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfolayan \u003cem\u003eet al\u003c/em\u003e., 2021 [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCEF, SUL, SXT, AMP, CIP, AMG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003egyrA, parC, parE, aac(6\u0026rsquo;)-lb-cr5, bla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;40\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;84\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;135\u003c/em\u003e,\u003c/sub\u003e \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;2\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eVEB\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCMY\u0026minus;42\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfolayan \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. \u0026nbsp; Antibiotic Resistance Patterns and Resistance Genes in Clinical Isolates Continued\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSources\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIsolates\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResistance Patterns\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eARGs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReferences\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine, high vaginal swab, wound swab, stool, semen, sputum, endocervical swab, ear swab urethral swab, throat swab, and abdominal abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eKlebsiella\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCBM, CPS, QNL, AMG, MRD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eVEB\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003emecA, bla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u003c/em\u003e\u003c/sub\u003e.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChukwu \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfected surgical incisions, urine, skin burns, and wound pus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus, P. aeruginosa, K. kristinae, P. mirabilis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, ERY, TET, DOX, VAN, CLD, MOX,*SHL-R, FOX, CFR, NIT, AMP/ SULBA, SXT, CIP, OXA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlabi \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStool, urine, catheter tips, wound swabs, and ear swabs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMC, AMX, CTM, CXM, FOX, CFR, CDZ, CIP, TET, SXT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003eaac-lb-6-cr\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEgwu \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood, urine, wound swabs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli, C. freundii, K. pneumoniae, E. cloacae subsp. Cloacae, S. ureilytica, K. quasipneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSXT, MPM, CEFOL, TZB, COL, TGC, FOS, CDZ, AVB, CEFEP, CFR, CDZ, AKN, GEN, ARM, AMP, SBT, PIP, TZB, CTM.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;15\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;320\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;534\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;181\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eNDM\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;1A\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;1b\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003eaph(3\u0026rsquo;\u0026rsquo;)-Ib, catB3, aac(3)-IIa, sul2, tet(A,), aac(6\u0026rsquo;)-Ib-cr\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedugu \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStool and rectal swab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eEnterobacteriaceae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCTX-M-1, CTX-M-9, bla\u003c/em\u003e\u003csub\u003e\u003cem\u003eNDM\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEdwards \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFecal samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. faecalis\u003c/em\u003e, \u003cem\u003eE. faecium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFF, TZD, VAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eoptrA, poxtA, cfr, rplD, rplC, rplV\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNgbede \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSlaughtered cattle, poultry, and at-risk humans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCampylobacter\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCFR, NAL, CTM, EFL, CIP, S, GEN, ERY, AZM, CPC,TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eaadE-1, aphA-3\u0026ndash;1, tetO, cmeB, blaoxa-61\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNjoga \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine, blood, sputum, urethral swab, wound swabs, skin, ear swabs, high vaginal swabs, endocervical swabs, throat swabs, eye swabs, and stool samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMC, ERY, QD, CLD, TGC, TET, RIF, FOX, VAN, CIP, GEN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkpudo \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical specimens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eK. pneumoniae, P. aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMC, CDZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaam \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine samples, nasal and wound swabs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGEN, PEN, VAN, CIP, NFX, FOX, CFR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003evanA, mecA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdulrahim \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eKEYS: CBM\u0026minus; Carbapenems; PNC\u0026minus; Phenicols; TMP\u0026minus;Trimethoprim; CPS\u0026minus; cephalosporins; AMG\u0026minus; aminoglycosides; CPC\u0026minus; chloramphenicol; TET\u0026minus; tetracycline; MRD\u0026minus; macrolides; FQL\u0026minus; Fluoroquinolones; QNL\u0026minus; Quinolone; AMP\u0026minus;Ampicillin; AMC\u0026minus;Amoxicillin\u0026minus;clavulanic acid; AMX\u0026minus;Amoxicillin; OFX\u0026minus; Ofloxacin; CDZ\u0026minus;Ceftazidime; CIP\u0026minus;Ciprofloxacin; GEN\u0026minus;Gentamicin; NIT\u0026minus;Nitrofurantoin; RIF\u0026minus;Rifampicin; CFR\u0026minus;Ceftriaxone; SXT\u0026minus;Sulphamethoxazole/trimethoprim; TET\u0026minus;Tetracycline; FF\u0026minus;florfenicol; S\u0026minus;streptomycin; CPC\u0026minus;chloramphenicol; NEO\u0026minus;Neomycin; CXM\u0026minus;Cefuroxime; CEF\u0026minus; ceftiofur; PIP\u0026minus;Piperacillin; LEV\u0026minus;Levofloxacin; CEFAZ\u0026minus; Cefazolin; FOX\u0026minus;Cefoxitin; CEFEP\u0026minus; Cefepime; MER\u0026minus;Meropenem; TBR\u0026minus;Tobramycin; IMI\u0026minus;imipenem; CPD\u0026minus;Cefpodoxime; CTM\u0026minus;Cefotaxime; OXA\u0026minus;Oxacillin; LIN\u0026minus;Linezolid; CAR\u0026minus;Carbenicillin; ERY\u0026minus;Erythromycin; CLD\u0026minus;Clindamycin; CFX\u0026minus;Cefixime; DOX\u0026minus;Doxycycline; TGC\u0026minus;Tigecycline; QD\u0026minus;Quinupristin\u0026minus;Dalfopristin; ERT\u0026minus;Ertapenem; CPZ\u0026minus;Cefoperazone; SBT\u0026minus;Sulbactam; NFX\u0026minus;Norfloxacin; MOX\u0026minus; Moxifloxacin; *SHL\u0026minus;R\u0026minus; Streptomycin High Level (synergy); PEN\u0026minus;Penicillin G; AKN\u0026minus; Amikacin; FF\u0026minus;Florfenicol; TZD\u0026minus;Tedizolid; AZM\u0026minus;Azithromycin; EFL\u0026minus;enrofloxacin; OQX \u0026minus; Oxyimino\u0026minus;cephalosporins; PNC \u0026ndash;Phenicols, ARM\u0026minus;Aztreonam; TZB\u0026minus;Tazobactam; CEFOL\u0026minus; Cefolozane; AVB\u0026minus; Avibactam; ARGs \u0026minus;Antibiotic Resistance Genes.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eChallenges in controlling the AMR in healthcare settings\u003c/h3\u003e\n\u003cp\u003eNigerian healthcare systems face several challenges in controlling AMR. The most notable driver is the lack of regulatory oversight on the sale of antibiotics, which are readily available without prescription [\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e]. In addition, poor antimicrobial stewardship programs [\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e], irrational antibiotic prescriptions [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e], inadequate infection prevention and control (IPC) practices [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e], low public awareness of the AMR crisis [\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e], insufficient clinical waste disposal management, and environmental contamination [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Surveys revealed that approximately 59.9% of patent medicine vendors and up to 97% of pharmacists in Nigeria dispense antibiotics without a prescription [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]. Furthermore, antibiotics from the Watch category are frequently prescribed, with third-generation cephalosporins and fluoroquinolones accounting for approximately 66% of antibiotics administered after consultation. In contrast, antibiotics from the \u0026lsquo;access group\u0026rsquo;, such as amoxicillin, are more commonly prescribed for outpatients [\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eJoy-Okwor and colleagues [\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e] assessed infection prevention and control (IPC) preparedness across 461 Nigerian healthcare facilities, comprising 350 (75.9%) private and 111 (24.1%) public institutions. Public facilities demonstrated greater IPC preparedness, with 69.7% having an IPC focal point and 59.6% having an IPC work plan, compared to 32.3% and 26.8% in private facilities, respectively. However, both sectors lacked trained staff and essential equipment [\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e]. Evidence in the literature also points to a gap in the utilization of advanced diagnostic technologies, such as next-generation sequencing (NGS), for the surveillance, characterization, and subtyping of clinically relevant isolates [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e]. Although genomics and bioinformatics are crucial for improving public health delivery in Nigeria, expertise shortages, the high cost of whole-genome sequencing, and the lack of available resources limit the use of this technology in the region. To enhance public health responses to AMR and guide evidence-based treatment policies, affordable, user-friendly tools and interfaces to simplify genomic and bioinformatics technologies for non-experts are needed [\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eAntimicrobial Resistance in the Environment, Companion Animals, and Wildlife\u003c/h3\u003e\n\u003cp\u003eThe interplay between humans, animals, and the environment in driving AMR is a complex and interconnected process, as evidenced by studies conducted across Nigeria. These studies collectively highlight how the interactions among these three components facilitate the spread of ARB and resistance genes, posing significant risks to public health and food safety. For instance, Nyandjou et al. [\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e] isolated \u003cem\u003eSalmonella\u003c/em\u003e sp. exhibiting resistance to multiple antibiotics in waste dumps in Northwest Nigeria, while Adesoji et al. [\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e] reported the recovery of MDR \u003cem\u003eP. aeruginosa\u003c/em\u003e in household sewage, highlighting the risk of water source contamination. These findings illustrate how environmental contamination, driven by improper waste disposal and inadequate sanitation, serves as a critical pathway for the dissemination of ARB into water sources used for irrigation, aquaculture, and recreational activities. Adesoji and Call [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e] further emphasized this issue by detecting MDR bacteria, including \u003cem\u003ePseudomonas\u003c/em\u003e sp. and \u003cem\u003eProteus\u003c/em\u003e sp. carrying \u003cem\u003efloR\u003c/em\u003e, in treated water distribution systems in Southwest Nigeria. This persistence of resistance genes even after water treatment highlights the resilience of ARB in the environment and their potential to enter the food supply chain.\u003c/p\u003e\n\u003cp\u003eAnimals, both domestic and wildlife, also play a pivotal role in this dynamic as reservoirs of ARB. Falodun et al. [\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e] identified ESBL-producing \u003cem\u003eE. coli\u003c/em\u003e in fecal samples from healthy dogs in Ibadan, demonstrating that companion animals can harbor and spread ARB. Similarly, Obodoechi et al. [\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e] isolated MDR, ESBL-producing \u003cem\u003eE. coli\u003c/em\u003e from frugivorous and insectivorous bats in Southeast Nigeria, revealing that wildlife also contributes to the maintenance and dissemination of ARGs. Kabantiyok et al. [\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e] expanded on this by reporting ARB in barn owls in North-Central Nigeria, where zoonotic bacterial pathogens, including \u003cem\u003eLeptospira\u003c/em\u003e species, antibiotic-resistant \u003cem\u003eCorynebacterium amycolatum\u003c/em\u003e, and \u003cem\u003eE. coli\u003c/em\u003e were recovered (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings underscore the role of animals in bridging the gap between environmental contamination and human exposure, as ARB from animals can enter the food chain through direct contact, consumption of contaminated animal products, or environmental contamination.\u003c/p\u003e\n\u003cp\u003eHuman practices further exacerbate this cycle by driving the selection and spread of ARB. The extensive use of antibiotics in aquaculture and veterinary practices, such as the misuse of florfenicol, contributes to the emergence of resistant strains, as evidenced by the high minimum inhibitory concentrations (MICs) to florfenicol observed in bacterial isolates recovered from water distribution systems [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, inadequate waste management and poor sanitation practices allow ARB and resistance genes to persist in the environment, creating a continuous loop of contamination. The interconnectedness of humans, animals, and the environment creates a multifaceted challenge in addressing AMR within the food supply chain, as contaminated water sources, soil, and animals directly impact food safety. This complex interplay underscores the need for a holistic, One Health approach to tackle AMR. Without addressing the contributions of all three components, efforts to mitigate AMR in the Nigerian food supply chain will remain incomplete, leaving public health and food safety at continued risk.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAntimicrobial Resistance Patterns and Antibiotic Resistance Genes in the Environment, Companion Animals, and Wildlife\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSources\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIsolates\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResistance Patterns\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eARGs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReferences\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWaste dumps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, AMC, OFX, SXT, CEF, TET, CIP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNyandjou \u003cem\u003eet al\u003c/em\u003e., 2019 [\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResidential sewage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCDZ, CRX, GEN, CPR, OFX, AUG, NIT, AMP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdesoji \u003cem\u003eet al.\u003c/em\u003e, 2023 [\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrinking water distribution systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePseudomonas\u003c/em\u003e sp., \u003cem\u003eSerratia\u003c/em\u003e sp., \u003cem\u003eProteus\u003c/em\u003e sp., \u003cem\u003eAcinetobacter\u003c/em\u003e sp., \u003cem\u003eP. rettgeri\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFF, TET, S, GEN, KAN, CPC, CEF, SXT, AMC,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003efloR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdesoji and Call, 2020 [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHighly touched surfaces in selected hospital wards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus, P. aeruginosa, E. gallinarum, O. anthropi, S. thoraltensis, C. violaceum, S. paucimobilis\u003c/em\u003e, \u003cem\u003eE. cloacea\u003c/em\u003e subsp. \u003cem\u003edissolvens, S. haemolyticus, Pantoea\u003c/em\u003e sp., \u003cem\u003eE. cloacea, S. vitulinus, E. faecalis, P. stuartii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, PIP, LEV, CIP, CFX, CEFAZ, GEN, NIT, FOX, CEFEP, CDZ, MRP, SXT, TBR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlabi \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDog fecal samples (Pets)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTET, SXT, AMP, CIP, CFX, CDZ AMC, IPM, CPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFalodun \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiver, spleen, and intestines of fruit (\u003cem\u003eEidolon helvum\u003c/em\u003e) and insect-eating (\u003cem\u003eNycteris hispida\u003c/em\u003e) bats\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, AMC, CTX, CDZ, SXT, TET, S, GEN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;15\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003eaac(3)-II, tetA, tetB, int1\u003c/em\u003e(Integron)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObodoechi \u003cem\u003eet al\u003c/em\u003e., 2021[\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood samples, Oropharyngeal and cloacal swabs from Barn Owls (\u003cem\u003eTyto alba\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eL. enterohaemorrhagica. L. grippotyphosa, L. mini\u003c/em\u003e (zoonotic bacterial pathogens), \u003cem\u003eC. amycolatum, M. sciuri\u003c/em\u003e, and \u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQNL, TET, CPS, SUL, PEN, BLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARG reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKabantiyok \u003cem\u003eet al\u003c/em\u003e., 2023 [\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eKEYS: QNL\u0026minus; Quinolone; CPS\u0026minus; cephalosporins; SUL\u0026minus;sulphonamides; BLA\u0026minus; \u0026beta;\u0026minus;Lactam; PEN\u0026minus; Penicillins; AMP\u0026minus;Ampicillin, AMC\u0026minus; Amoxicillin\u0026minus;clavulanic acid, OFX\u0026minus; Ofloxacin, CDZ, Ceftazidime; CRX, Cefuroxime; CPR, Ciprofloxacin; GEN, Gentamicin; NIT, Nitrofurantoin; CIP\u0026minus;Ciprofloxacin; CFX\u0026minus;Ceftriaxone; SXT\u0026minus;Sulfamethoxazole/trimethoprim; TET\u0026minus;Tetracycline; FF\u0026minus;florfenicol; S\u0026minus;streptomycin; CPC\u0026minus;chloramphenicol; N\u0026minus;Nalidixic acid; CEF\u0026minus; ceftiofur; PIP\u0026minus;Piperacillin; LEV\u0026minus;Levofloxacin; CEFAZ\u0026minus; Cefazolin; FOX\u0026minus;Cefoxitin; CEFEP\u0026minus; Cefepime; MRP: Meropenem; TBR\u0026minus;Tobramycin; IPM\u0026minus;imipenem; CPD\u0026minus; cefpodoxime; CTX\u0026minus;Cefotaxime; CLX\u0026minus; cloxacillin; KAN\u0026minus;Kanamycin; AUG\u0026minus;Augmentin; NIT\u0026minus;Nitrofurantoin; ARGs \u0026minus;Antibiotic Resistance Genes.\u003c/p\u003e\n\u003ch3\u003eAntimicrobial Resistance in the Food Supply Chain\u003c/h3\u003e\n\u003cp\u003eAntimicrobial resistance presents significant challenges in Nigeria\u0026apos;s food supply chain because of extensive antimicrobial use (AMU) practices in food-producing animals. In the poultry industry, a knowledge gap among farmers regarding proper AMU has led to the unregulated prophylactic use of antibiotics. This non-adherence to veterinary guidelines has increased the risk of ARB in food-producing animals and public health. Chah et al. [\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e] reported that all poultry farmers in Enugu State, Southeast Nigeria use antibiotics for growth promotion, disease prevention, and treatment. The mean knowledge index of antibiotic use (KABU) was 0.54, indicating moderate knowledge among farmers, whereas the mean knowledge index of antibiotic resistance (KABR) was 0.65, with 70.5% of farmers demonstrating good knowledge. However, 83% of the respondents practiced inappropriate antibiotic use, highlighting the need for training to improve poultry farmers\u0026apos; AMR knowledge and practices.\u003c/p\u003e\n\u003cp\u003eFurthermore, Alhaji \u003cem\u003eet al\u003c/em\u003e. [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e] investigated the practices and perceptions of 151 fish farmers regarding AMU and its implications for AMR and residual antibiotics in freshwater fish farms in North-Central Nigeria. The authors assessed the risk status of AMU and AMR using a traffic light model and detected antibiotic residues in fish organs and pond water samples. This study revealed that widespread antibiotic misuse and residue spread through the consumption of residual antibiotics in fish and contact with wastewater released from fish farms into the environment. Similarly, Smith et al. [\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e] surveyed antibiotic prescription habits among Nigerian veterinarians and their potential contribution to AMR. Most veterinarians acknowledge the over prescription and overuse of antibiotics, and a significant portion do not perform culture or antibiotic susceptibility testing (AST) before antibiotics are prescribed. The authors recommend laboratory reliance on antibiotic prescriptions [\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e]. Consequently, a high prevalence of MDR bacterial strains such as MRSA, MDR \u003cem\u003eCampylobacter\u003c/em\u003e sp., extensively resistant \u003cem\u003eE. coli\u003c/em\u003e, linezolid-resistant \u003cem\u003eenterococci\u003c/em\u003e, and MDR non-typhoidal \u003cem\u003eSalmonella\u003c/em\u003e serovars has been reported in poultry, underscoring the high risk of zoonotic transmission of ARB in the food supply chain and farm environment.\u003c/p\u003e\n\u003cp\u003eAworh et al. [\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e] reported zoonotic transmission of ESBL-producing \u003cem\u003eE. coli\u003c/em\u003e among beef cattle, abattoir workers, and abattoir environments in Abuja and Lagos, Nigeria, and the circulation of the \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX-M-55\u003c/em\u003e\u003c/sub\u003e gene among abattoir workers and beef cattle via MGEs. In a similar study following the One Health approach, Olorunleke et al. [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e] collected fecal and cecal samples from slaughtered cattle, abattoir environments, and abattoir workers in southeastern Nigeria. The authors also sampled livestock from farms, animal markets, environmental samples, and hand swabs from humans in contact with the animals. The findings revealed a widespread prevalence of extended-spectrum cephalosporin-resistant \u003cem\u003eE. coli\u003c/em\u003e in livestock and humans, with a high prevalence of \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX-M\u003c/em\u003e\u003c/sub\u003e \u003cem\u003egenes\u003c/em\u003e, particularly \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e-\u003c/em\u003e\u003csub\u003e\u003cem\u003eM-15\u003c/em\u003e\u003c/sub\u003e. Notably, a plasmid harboring \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX-M-15\u003c/em\u003e\u003c/sub\u003e recovered from livestock showed high sequence identity with a plasmid recovered from river water in India [\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e], suggesting the global dissemination of this ESBL plasmid. In contrast, Ajuzieogu et al. [\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e] examined the bacteriological quality of ready-to-eat African salads in Enugu, Nigeria, and the antibiogram patterns of the associated bacteria. This study revealed high bacterial counts and the presence of various pathogenic bacteria, including \u0026beta;-lactam-resistant \u003cem\u003eVibrio\u003c/em\u003e sp., \u003cem\u003eSalmonella\u003c/em\u003e sp., and \u003cem\u003eE. coli\u003c/em\u003e. They recommended improved hygiene, regular cleaning, and disinfection of food-contact surfaces (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAntimicrobial resistance (AMR) in Nigeria\u0026rsquo;s food supply chain is a complex issue driven by systemic failures, including inadequate regulatory oversight, economic constraints, and a gap between knowledge and practice. Despite moderate awareness of antibiotic resistance among some farmers, irresponsible practices persist. Antibiotics are often used for growth promotion or prophylactically without proper diagnosis or adherence to dosage guidelines, highlighting the need for targeted education and training programs that promote alternatives and better farm management practices. Economic barriers further exacerbate the issue, as farmers and veterinarians frequently rely on antibiotics as a low-cost solution due to limited access to diagnostic testing and financial resources. Thus, addressing AMR in the food supply chain requires systemic changes, including the implementation and enforcement of stricter regulations, investment in affordable diagnostic tools, and financial incentives for antimicrobial stewardship programs to enhance food security.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntimicrobial Resistance Patterns and Antibiotic Resistance Genes in Poultry, Aquaculture, and Food Supply Chains\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSources\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIsolates\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResistance Patterns\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eARGs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReferences\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFish and water samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAntibiotic residue in fish organs and water samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIP, EFL, COL, ERY, AMP, NEO, PEN, TET, S, SUL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARGs reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlhaji \u003cem\u003eet al\u003c/em\u003e., 2021 [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBeef cattle, abattoir environments, and abattoir workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTET, FPA, PEN, QNL, AMG, PNC, MRD, NTF, CBM, CPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;14\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;15\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;55\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003esul1, sul2, sul3, dfrA1, dfrA7, dfrA12, dfrA14, dfrA17, aadA1, aadA2, aadA5, aac(3)-Ila, aac(6)-Iaa, aac(6)- Ib3, aac(6)-Ib-cr, aph(3)-Ia, aph(3)-Ib, aph(3)-Id, aph(6)-Id\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAworh \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLivestock on farms, abattoirs, and animal markets, and in-contact humans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCBM, 3rd generation CPS, AMG, TET, FPA, PEN, MBM, BLI, QNL, FQL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;15\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;55\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;64\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;1b\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eOXA\u0026minus;1\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eACT\u0026minus;25\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eSHV\u0026minus;28\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;65\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003estrA, strB, qnrS1, tet(A)-v2, tet(A), tet(D), tet-AB, sul2, dfrA14\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOlorunleke \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReady-to-eat African salad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella sp., S. aureus, Klebsiella sp., E. coli, V. mimicus, V. fluvialis, V. cholerae, V. parahaemolyticus and V. hollisae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBLI, BLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo ARGs reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAjuzieogu \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFreshly dressed chicken, Frozen/imported chicken, Processors, Consumers, Knives and Tables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMethicillin-resistant \u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBLA, FQL, AMG, TET, FPA, MRD,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emecA, dfrG, tet(38), blaZ, fosB, aacA-aphD, MSR(A), aphA3, mph(C), dfrS1, sat4 tet(K), SCCmec type IVa, V, Vc\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOgundipe \u003cem\u003eet al\u003c/em\u003e., 2020 [\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoultry droppings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, GEN, KAN, CTX, CIP, SUL, TET, CPC, TMP, NAL, MEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eblaTEM, tet(R), aac(3)-II, aph (3\u0026rdquo;)-I, aph (6)-Ic sul1, sul2, sul3, tet (A), tet (M), qnrS1, qnrB19\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJibril \u003cem\u003eet al\u003c/em\u003e., 2021a [\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoultry meat samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAMP, PIP, AZM, ERY, TET, CPC, TMP, SUL, CIP, KAN, S, CDZ, CFZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003esul1, sul2, strA, floR, bla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIgbinosa \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBroiler caecal samples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFQL, FOS, SXT, AMP and CPS, AMG, CPC, TET, MRD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;106\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eTEM\u0026minus;126\u003c/em\u003e\u003c/sub\u003e., \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;14\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003ebla\u003c/em\u003e\u003csub\u003e\u003cem\u003eCTX\u0026minus;M\u0026minus;55\u003c/em\u003e\u003c/sub\u003e, \u003cem\u003efosA3, qnrS1, qnrB19 tet(M), aph(3)-Ib, mef(B), qacE, sul1, sul2, sul3, catA1, qacE, sitABCD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAl-Mustapha \u003cem\u003eet al\u003c/em\u003e., 2022 [\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoultry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e sp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIP, GEN, NAL, SXT, TET\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003epmrA, gyrA, parC, qnr, tem, catA1, cmlA1, floR, dfrA5-14, sul2, aac (3)-le, tetA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFagbamila \u003cem\u003eet al.\u003c/em\u003e, 2023 [\u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eKEYS: FOS\u0026minus; fosfomycin; CPS\u0026minus; cephalosporins; AMG\u0026minus; aminoglycosides; CPC\u0026minus; chloramphenicol; TET\u0026minus; tetracycline; MRD\u0026minus; macrolides; FQL\u0026minus; Fluoroquinolones; BLA\u0026minus; \u0026beta;\u0026minus;Lactam; FPA\u0026minus; Folate pathway antagonist; BLI\u0026minus; \u0026beta;\u0026minus;Lactam inhibitor; QNL\u0026minus; Quinolone; PEN\u0026minus; Penicillins; CDZ\u0026minus;Ceftazidime; CFZ\u0026minus; Cefazolin; EFL\u0026minus;enrofloxacin; NEO\u0026minus;neomycin; CIP\u0026minus;ciprofloxacin; COL\u0026minus;colistin; ERY\u0026minus;erythromycin; S\u0026minus;streptomycin; SUL\u0026minus;sulphonamides; AMP\u0026minus;ampicillin; GEN\u0026minus;gentamicin; KAN\u0026minus;kanamycin; CTX\u0026minus;cefotaxime; SUL\u0026minus;sulphonamides; CPC\u0026minus;chloramphenicol; TMP\u0026minus;trimethoprim; NAL\u0026minus;nalidixic acid; MEM\u0026minus;meropenem; PIP\u0026minus;Piperacillin; AZM\u0026minus;Azithromycin; MBM\u0026minus; Monobactam; CBM\u0026minus; Carbapenems; PNC\u0026minus; Phenicols; NTF\u0026minus; Nitrofurans; ARGs \u0026minus;Antibiotic Resistance Genes.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eNigeria\u0026apos;s AMR crisis: A need for One Health Transdisciplinary Response\u003c/h2\u003e\n \u003cp\u003eAlthough Gram-negative bacterial infections are globally dominant [\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e], Nigeria\u0026rsquo;s healthcare delivery systems, food supply chains, companion animals, wildlife, and environments are threatened by the spread of MDR Gram-negative bacteria. Antimicrobial resistance poses a significant threat to global public health [\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e], with Nigeria being no exception. In Nigeria, AMR challenges are driven largely by weak regulatory frameworks and inadequate enforcement mechanisms [\u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e]. Despite existing policies, the over-the-counter sale of antibiotics without prescriptions remains widespread, contributing to their misuse in both human and veterinary medicine. Additionally, the unregulated use of antibiotics in livestock, often as growth promoters or feed additives, further exacerbates the problem, leading to the emergence of resistant bacterial strains that can spread through the food chain [\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eRegulatory agencies such as the National Agency for Food and Drug Administration and Control (NAFDAC) face significant challenges in monitoring and enforcing compliance. The proliferation of substandard and counterfeit antibiotics further complicates efforts to contain resistance, highlighting the urgent need for more stringent regulatory oversight [\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e]. While NAFDAC has a legal mandate, the penalties for non-compliance, as well as the regulation of the importation and distribution of counterfeit antibiotics, are sometimes seen as insufficient or not strictly applied, reducing their deterrent effect. On the other hand, many farmers in Nigeria lack awareness of the risks associated with the misuse of antibiotics in aquaculture and livestock [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e]. Collaborating with agricultural extension services and veterinary professionals to disseminate best practices and farmer education programs is essential to promote responsible antibiotic use and alternative practices, such as improved animal husbandry, vaccination, and biosecurity measures.\u003c/p\u003e\n \u003cp\u003eIn June 2017, Nigeria underwent its Joint External Evaluation (JEE) to assess its core capacities under the International Health Regulations (IHR). While strengths were noted in the One Health framework, significant gaps remain, particularly in surveillance and outbreak response. The evaluation also highlighted the absence of a well-coordinated, institutionalized long-term strategy for One Health as a critical area requiring attention. Further complicating these challenges is the limited government funding allocated to the sector, inadequate routine sharing of laboratory information or specimens related to zoonotic diseases among relevant agencies, and weak intersectoral collaboration in surveillance activities. Additionally, Rapid Response Teams (RRTs) in rural and Local Government Areas (LGAs) are underperforming, further hindering effective disease control and response efforts [\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eThus, proactive stakeholder engagement and the formulation of a cohesive national framework aimed at strengthening antimicrobial stewardship programs (ASPs) are urgently needed. Such efforts would enhance a comprehensive, transdisciplinary One Health surveillance system capable of addressing the multifaceted challenges of AMR while mitigating its adverse effects on Nigerian society.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInterconnectedness and Multi-Sectoral Collaboration: The One Health Perspective\u003c/h3\u003e\n\u003cp\u003eThe One Health framework underscores the intricate interconnectedness of human, animal, and environmental health, particularly in the context of antimicrobial resistance (AMR). The overuse of antibiotics in livestock, for instance, not only impacts animal health but also contributes to the emergence and spread of ARB, which can be transmitted to humans through the food supply chain [\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]. Furthermore, environmental contamination with residual antibiotics exacerbates this problem by promoting the proliferation of antibiotic-resistant strains, posing significant health risks to humans, wildlife, and ecosystems [\u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e78\u003c/span\u003e]. These complex interactions highlight the interconnected drivers of AMR, necessitating a unified approach to address the issue holistically [\u003cspan class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e80\u003c/span\u003e]. A cornerstone of the One Health approach is its emphasis on multisectoral collaboration, which is essential for effectively managing AMR [\u003cspan class=\"CitationRef\"\u003e81\u003c/span\u003e]. Tackling AMR requires coordinated efforts across diverse sectors, including human healthcare, veterinary medicine, agriculture, and environmental science. By integrating public health initiatives, veterinary practices, agricultural policies, and environmental management strategies, stakeholders can develop cohesive and comprehensive interventions to combat AMR [\u003cspan class=\"CitationRef\"\u003e82\u003c/span\u003e]. This collaborative approach ensures that all potential sources of AMR are addressed, from clinical settings and livestock production to environmental reservoirs, and safeguards the health of humans, animals, and ecosystems.\u003c/p\u003e\n\u003ch3\u003eAddressing Antimicrobial Usage\u003c/h3\u003e\n\u003cp\u003eAntibiotics are often prescribed indiscriminately in Nigerian healthcare settings, and their use is imprudently prevalent in food-producing animals for growth promotion and disease prevention, leading to unchecked misuse of antibiotics because of a lack of regulatory oversight and ASPs [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e83\u003c/span\u003e]. The pharmaceutical sector faces significant challenges in regulation due to the vast number of products, practitioners, and premises (both registered and unregistered) that require oversight. Issues such as the prevalence of fake and counterfeit drugs, a disorganized distribution system, insufficient infrastructure, limited enforcement capabilities, and a lack of collaboration with other law enforcement agencies further complicate matters. Additionally, regulators struggle with inadequate human resources, insufficient funding, heavy dependence on imported pharmaceuticals, and substandard facilities for quality control, all of which hinder effective regulation and control of the sector [\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e]. Additional challenges in managing AMR include the absence of dedicated antimicrobial stewardship (AMS) teams in many hospitals across the country, as well as insufficient training and support for AMS initiatives from hospital management [\u003cspan class=\"CitationRef\"\u003e84\u003c/span\u003e]. The One Health approach recognizes responsible antibiotic stewardship as a core principle [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e], which involves a thorough and tailored strategy for managing antimicrobial use, considering not only the amount used but also how, why, and by whom they are used. This approach considers the diverse perspectives and practices of various stakeholders, including healthcare providers, patients, and others, as well as the specific circumstances that influence the decision to prescribe antimicrobial agents [\u003cspan class=\"CitationRef\"\u003e85\u003c/span\u003e]. However, public awareness of ASPs in Nigeria remains alarmingly low, as evident by the routine and often inappropriate use of antibiotics. The One Health approach can target these practices by promoting the responsible use of antibiotics across various sectors.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSurveillance and Monitoring\u003c/h2\u003e\n \u003cp\u003eEffective surveillance and monitoring are essential for understanding and controlling AMR [\u003cspan class=\"CitationRef\"\u003e86\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e88\u003c/span\u003e]. Many initial obstacles encountered in establishing a national AMR surveillance system in Nigeria have been resolved by integrating national reference laboratory (NRL) functions backed by genomics [\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]. Nonetheless, challenges persist and continue to arise when applying this approach in the Nigerian context. The NRLs face significant challenges, including understaffing and difficulty retaining skilled professionals in clinical laboratory science, sequencing, and bioinformatics [\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]. Compounding these issues, Nigeria\u0026rsquo;s primary healthcare systems remain weak, and there is a notable absence of antimicrobial stewardship programs in both public and private healthcare sectors. Additionally, the lack of coordination, comprehensive data, and national reports on antibiotic consumption across human and animal health sectors continues to hinder progress. Despite these challenges, the Federal Government of Nigeria has taken steps to address AMR, such as launching the National Action Plan for Antimicrobial Resistance in 2017 [\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e]. However, there is a critical need for integrated, cross-sectoral monitoring and surveillance systems that enable the comprehensive collection and analysis of AMR data across human, animal, and environmental sectors in rural and urban areas across States and LGAs [\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eThe One Health approach enhances these efforts by integrating human, animal, and environmental data. Implementing a unified national surveillance system can facilitate real-time monitoring of AMR patterns and inform targeted interventions. Data-driven decision-making, supported by robust surveillance frameworks, allows for timely responses to address this public health threat [\u003cspan class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e90\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eEducation and Awareness\u003c/h2\u003e\n \u003cp\u003eEducation and awareness are pivotal components of the One Health System [\u003cspan class=\"CitationRef\"\u003e91\u003c/span\u003e]. During the 2020 World AMR Awareness Week, a diverse panel of experts from various sectors came together to address critical issues surrounding antibiotic use in Nigeria. The panel included representatives from national government agencies, research institutions, academia, and the World Health Organization, all operating within the Nigerian One Health framework. They identified widespread lack of awareness and a weak regulatory framework as key drivers of inappropriate antibiotic use across the country, further compounded by both technical and socio-economic challenges [\u003cspan class=\"CitationRef\"\u003e92\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eRaising awareness of the public health dangers of AMR and promoting the responsible use of antimicrobial agents is crucial for all stakeholders. In Nigeria, this includes educating healthcare providers about proper prescription practices, informing farmers about the risks of antibiotic overuse in livestock, and engaging the public in understanding the importance of adherence to prescribed drugs [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e]. Educational campaigns and training programs can empower individuals and communities to make informed decisions on antibiotic use.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eEnvironmental Considerations\u003c/h2\u003e\n \u003cp\u003eEnvironmental contamination is often a neglected yet critical driver of AMR in Nigeria. Antibiotics can enter the environment through waste from healthcare facilities, agricultural runoff, improper clinical and farm waste disposal practices, poor sanitation, and the release of unmetabolized antibiotics or their residues into the environment through animal manure. On the other hand, releasing pharmaceutical industrial effluents into the environment has exacerbated this crisis [\u003cspan class=\"CitationRef\"\u003e93\u003c/span\u003e]. These factors are closely linked and significantly contribute to the spread of AMR in the environment. These environmental pathways can spread ARB in the water, soil, and air [\u003cspan class=\"CitationRef\"\u003e94\u003c/span\u003e]. The One Health approach advocates for environmental safety and management practices that minimize the release of antibiotics and their residues into the environment, thereby reducing selective pressure.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eCultural Sensitivity\u003c/h2\u003e\n \u003cp\u003eA recent study revealed significant gaps in antimicrobial prescriptions among Nigerian tertiary hospital physicians, with 68% of respondents prescribing antibiotics on the WHO reserved list [\u003cspan class=\"CitationRef\"\u003e95\u003c/span\u003e]. Another prevalent cultural practice that significantly contributes to the AMR challenges in Nigeria is self-medication, where individuals use antibiotics without a prescription or medical supervision, leading to the overuse of antibiotics [\u003cspan class=\"CitationRef\"\u003e96\u003c/span\u003e]. The One Health approach emphasizes the need for culturally sensitive solutions that consider local practices and beliefs. Nigeria can mitigate these cultural drivers of AMR by addressing the root causes of inappropriate prescriptions and self-medication and by promoting alternative health-seeking behaviors.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed high resistance to β-lactam antibiotics in both clinical and food-related bacterial isolates, with \u003cem\u003eMecA\u003c/em\u003e, \u003cem\u003eAmpC\u003c/em\u003e β-lactamases, and ESBLs being the predominant resistance mechanisms. However, there is a paucity of data on the virulence determinants in these isolates across various sectors. To address the growing threat of AMR in Nigeria, it is imperative to strengthen antimicrobial stewardship programs across the healthcare and veterinary sectors, including livestock and aquaculture. A unified national strategy, aligned with global initiatives and supported by robust surveillance systems, is essential to mitigate AMR risks in healthcare delivery and food supply chains. Sustained efforts are needed to enhance research and data collection on antibiotic usage, resistance patterns, and virulence factors in food-producing animals, particularly in rural areas, to enable real-time monitoring of AMR patterns and guide targeted interventions. Cross-sector collaboration is critical to reducing extensive antibiotic use in humans and animals, promoting effective alternative treatment options, improving farm hygiene, and strengthening surveillance systems. Embracing a One Health approach will foster transdisciplinary research and partnerships across human, veterinary, and environmental health sectors, address the root causes of AMR, safeguard public health, and protect Nigeria\u0026rsquo;s ecosystems.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSengupta S, Chattopadhyay MK, Grossart HP (2013) The multifaceted roles of antibiotics and antibiotic resistance in nature. Front Microbiol 4:38490. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fmicb.2013.00047\u003c/span\u003e\u003cspan address=\"10.3389/fmicb.2013.00047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenblatt-Farrell N (2009) The landscape of antibiotic resistance. 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BMC Med Edu 21:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12909-021-02912-4\u003c/span\u003e\u003cspan address=\"10.1186/s12909-021-02912-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Federal University Dutsin-Ma, Katsina State, Nigeria","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antimicrobial resistance, healthcare system, food supply chains, environmental contamination, One Health, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-6536427/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6536427/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe discovery of penicillin and other antibiotics has revolutionized modern medicine. However, overreliance on antibiotics has led to a global antimicrobial resistance (AMR) crisis, jeopardizing progress made over the past decades. Antimicrobial resistance poses a critical public health challenge, affecting humans, animals, and the environment. The AMR challenge is particularly dire in Nigeria owing to the extensive antibiotic use across various sectors and ineffective antimicrobial stewardship programs. This narrative review summarizes the literature from January 2018 to December 2023, focusing on the current trends in AMR in Nigeria, including knowledge of antimicrobial usage, prescription patterns, and adherence to guidelines for humans, animals, and their shared environments. High antibiotic resistance patterns were detected in isolates recovered from healthcare settings, food supply chains, companion animals, wildlife, and the environment. Factors exacerbating the AMR crisis in Nigeria include poor regulation of antimicrobial agents, improper empirical prescriptions, inadequate infection prevention practices, arbitrary and prophylactic use of antibiotics in food-producing animals, environmental contamination, and insufficient surveillance programs. To effectively mitigate this crisis, it is essential to adopt the One Health approach, which prioritizes collaborative efforts among stakeholders, including governmental agencies, healthcare institutions, veterinary experts, farmers, and the scientific community, to address the convergence of human, animal, and environmental health. These efforts will promote transdisciplinary surveillance approaches and the establishment of policies aimed at ameliorating the impact of AMR on the Nigerian economy, the well-being of its population, and diverse ecosystems.\u003c/p\u003e","manuscriptTitle":"A Review of Antimicrobial Resistance Challenges in Nigeria: The Need for a One Health Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 06:20:07","doi":"10.21203/rs.3.rs-6536427/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"76c2539e-a849-454b-9580-af3b4fa09eb2","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-29T06:20:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 06:20:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6536427","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6536427","identity":"rs-6536427","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}