A retrospective assessment of antimicrobial resistance patterns in WHO-access, watch, and reserve-classified antibiotics across two large hospitals in a resource-limited setting

This retrospective analysis of 14,423 culture tests from two large hospitals in Abuja (2023) shows a high burden of antimicrobial resistance within the WHO AWaRe framework, with 27.6% of samples yielding pathogens and an overall AMR rate of 42%. Urine was the most common sample type and Escherichia coli the most frequent isolate, while all identified microbes were resistant to multiple antibiotics. Resistance was substantial across all AWaRe categories—highest in Watch (46.7%) and Access (44.3%), but also notable in Reserve (35.0%)—with extreme resistance to commonly used agents such as doxycycline (100%) and cefuroxime (85.7%), and unexpectedly high resistance to limited-availability drugs like aztreonam and ertapenem. Over 70% multidrug resistance was observed in frequently used antibiotics, and the most resistant organisms included Staphylococcus aureus, Klebsiella spp., Streptococcus spp., and E. coli, with higher positivity rates in women than men. Overall, these real-world data underscore the urgent need to institutionalize the AWaRe framework alongside strengthened antimicrobial stewardship, supply-chain management, and national AMR surveillance in Nigeria.