A groundbreaking study conducted by researchers at the Ineos Oxford Institute for Antimicrobial Research (IOI) has uncovered alarming evidence regarding the rapid spread of antimicrobial resistant bacteria among children suffering from severe acute malnutrition in a hospital setting in Niger. Published in the prestigious journal Nature Communications, this research reveals a worrisome public health issue that affects some of the world’s most vulnerable pediatric populations and sheds light on the growing threat posed by antimicrobial resistance (AMR) in resource-limited clinical environments.
Severe acute malnutrition (SAM) compromises the immune system of children, making them exceedingly susceptible to infections that would otherwise be treatable with conventional antibiotics. Globally, around 45 million children under the age of five face the ramifications of severe malnutrition, a condition intricately linked to increased morbidity and mortality through life-threatening infectious diseases such as tuberculosis and sepsis. Recognizing the critical intersection between malnutrition and infection risk, the study aimed to investigate how antimicrobial resistance genes are harbored and disseminated among malnourished children undergoing treatment.
Collaborating closely with Médecins Sans Frontières (MSF), the research team analyzed more than 3,000 rectal swab samples collected from 1,371 children admitted for nutritional rehabilitation between 2016 and 2017. Utilizing advanced genomic sequencing techniques, the scientists sought to identify the presence and genetic characteristics of bacteria harboring extended-spectrum β-lactamase (ESBL) and carbapenemase genes—two of the most clinically significant mechanisms conferring resistance to antibiotics, including those considered last-resort options.
The results were striking: over three-quarters of the children (76%) carried bacteria encoding ESBL genes, which inactivate a broad range of β-lactam antibiotics commonly used to treat infections. Even more concerning was the discovery that one in four children (25%) harbored bacteria with carbapenemase genes such as bla_NDM, which grant resistance against carbapenems—powerful antibiotics often reserved for multidrug-resistant infections. This high prevalence of carbapenemase-producing bacteria underscores the deteriorating effectiveness of vital antimicrobial agents.
Further analysis revealed dynamic changes during hospitalization. Among children who did not initially carry carbapenem-resistant bacteria, a staggering 69% had acquired such strains by the time of discharge. This highlights not only the persistence and spread of resistant organisms but also the potential role of hospital environments, overcrowding, and insufficient infection prevention and control measures in amplifying bacterial transmission. The hospital setting thus emerges as a critical nexus for the proliferation of dangerous resistance determinants.
Of particular clinical importance was the identification of Escherichia coli strains of sequence type ST167 carrying the bla_NDM gene in 11% of the children. The ST167 clone is recognized as a high-risk lineage capable of widespread dissemination and causing severe infections resistant to most available antibiotics. The plasmid-based nature of the bla_NDM gene suggests it can be transmitted horizontally across diverse bacterial species, exacerbating the challenge of containment and control.
These findings illuminate the complex interplay between malnutrition, infection, and AMR, revealing a hidden reservoir of resistant bacteria in the gut microbiota of severely malnourished children. Persisting colonization with these organisms increases the risk of subsequent infections such as pneumonia, sepsis, diarrheal diseases, and urinary tract infections, which may be unresponsive to standard antibiotic therapy. This could result in increased morbidity, prolonged hospital stays, and higher mortality rates.
Dr. Kirsty Sands, Scientific Lead at the IOI and principal investigator, emphasized the urgency of the situation, noting that malnourished children exposed to such pathogens face a grim outlook due to dwindling treatment options. While the study focused on a single nutritional treatment facility in Niger, she warned that the patterns observed likely reflect broader challenges faced by humanitarian and healthcare settings worldwide, especially in areas destabilized by conflict, climate change, and overcrowding.
The study’s co-author, Dr. Céline Langendorf of Epicentre and Médecins Sans Frontières, stressed the critical need for heightened infection prevention and control within hospitals. Resource constraints, high patient density, and limited sanitation facilitate bacterial spread, turning healthcare institutions into hotspots for resistance gene amplification. Without concerted efforts to improve hygiene practices and surveillance, vulnerable patients risk succumbing to infections previously deemed manageable.
Professor Owen B. Spiller, Head of Medical Microbiology at Cardiff University and study co-author, pointed out that the findings underscore the global scale of antimicrobial resistance exacerbated by humanitarian crises. He called for integrated international strategies combining antimicrobial stewardship, real-time genomic surveillance, and infrastructural investment in sanitation to curb the silent pandemic. Protecting the efficacy of antibiotics is particularly vital for malnourished children in resource-constrained environments where therapeutic alternatives are few.
Genomic analyses shed light on the transmission dynamics within the hospital setting. Most E. coli isolates harboring bla_NDM-5 displayed genetic homogeneity, reinforcing the hypothesis of nosocomial spread. Furthermore, the carriage of resistance genes on plasmids—extrachromosomal DNA elements capable of transferring between diverse bacteria—increases the ease with which resistance can disseminate both within an individual host’s microbiota and between patients.
The implications of this study are far-reaching. It reveals a pressing need to prioritize antimicrobial resistance as a key component of global health security, especially in the context of malnutrition and fragile healthcare infrastructures. Tackling this issue demands multidisciplinary collaboration, encompassing microbiology, clinical medicine, epidemiology, and humanitarian response, to develop robust infection control protocols and innovate new antimicrobial agents capable of overcoming emerging resistance patterns.
Ultimately, this research acts as a clarion call to the international community: unless immediate and sustained action is taken, antimicrobial resistance will continue to erode the effectiveness of life-saving antibiotics, disproportionately affecting the world’s most vulnerable children. Addressing the tangled nexus of malnutrition and AMR requires urgent commitment to research, funding, and infrastructure development to safeguard future generations.
Subject of Research: Antimicrobial resistance in bacteria colonizing malnourished children in hospital settings
Article Title: Acquisition of Escherichia coli carrying extended-spectrum ß-lactamase and carbapenemase genes by hospitalised children with severe acute malnutrition in Niger
News Publication Date: 1 August 2025
Web References: http://dx.doi.org/10.1038/s41467-025-61718-w
References: Published in Nature Communications
Image Credits: Not provided
Keywords: Antibiotic resistance; Drug resistance; Pharmacology; Health and medicine; Life sciences
