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Abstract
Nigeria carries a documented burden of community- and hospital-onset urinary tract infection, driven by uropathogenic Escherichia coli and Klebsiella pneumoniae that now display high rates of extended-spectrum beta-lactamase production, fluoroquinolone resistance, and multidrug resistance. Treatment failure and recurrence remain common, yet most Nigerian surveillance still characterises only the urinary isolate and leaves the intestinal reservoir unexamined. This study assessed whether published clinical, rectal-carriage, and metagenomic datasets are sufficient to establish a mechanistic role for gut microbiome dysbiosis in the antimicrobial resistance patterns of recurrent urinary tract infection in Nigerian patients. A desk-based comparative resource assessment compiled Nigerian uropathogen antibiograms, One Health resistome surveys, rectal colonisation studies, and international shotgun metagenomic cohorts of recurrent infection, and appraised them against a six-criterion rubric covering reservoir plausibility, resistome congruence, taxonomic dysbiosis signal, mobile genetic element linkage, population accessibility of evidence, and translational actionability. Rectal ESBL-Enterobacterales carriage and high-risk extra-intestinal E. coli clones obtained the highest weighted congruence indices (4.20 and 4.05 of 5.00). Pooled Nigerian gene frequencies for blaCTX-M, blaSHV, blaTEM, qnr, tet, and sul map closely onto the phenotypic gaps recorded in urine, while international paired metagenomes show that the gut of patients with recurrent infection is an antimicrobial-resistance-gene-enriched reservoir from which uropathogenic lineages bloom after treatment and reseed the urinary tract. The principal constraint is the absence of a Nigerian paired stool–urine shotgun dataset. The study concludes that Nigeria possesses a genuine and internally consistent evidence base linking intestinal dysbiosis and resistome enrichment to recurrent, drug-resistant urinary infection, and recommends a staged paired-metagenomic verification programme at tertiary centres with high recurrence caseloads.