A Complex Adaptive Systems Approach to Understanding Antimicrobial Resistance Dynamics in Nigerian Hospital Environments

Antimicrobial resistance in Nigerian hospital environments is a dynamic phenomenon shaped by non-linear interactions between antibiotic prescribing, microbial evolution, patient flow, environmental contamination, and policy interventions that conventional linear pharmacological models cannot adequately capture. This study applied a complex adaptive systems theoretical framework to understanding and modelling antimicrobial resistance dynamics in Nigerian hospital environments. A multi-method investigation was conducted at four teaching hospitals across Lagos, Kano, Enugu, and Abuja. Data collection encompassed 24-month antibiotic prescription surveillance, quarterly microbiological resistance profiling from clinical samples, hospital environmental microbiome sampling, patient movement data analysis, and infection control event records. A system dynamics model was constructed using Vensim software, incorporating feedback loops between antibiotic use intensity, resistance selection pressure, environmental reservoir dynamics, and patient acquisition risk. Agent-based modelling was used to simulate cross-infection transmission pathways incorporating stochastic variability in patient and microorganism behaviours. Model validation was conducted against observed resistance trend data. The complex adaptive systems model identified four critical leverage points for resistance intervention: antibiotic approval workflows, environmental decontamination scheduling, infection control training frequency, and antibiogram-guided empiric prescribing. Simulated interventions targeting all four leverage points simultaneously generated a predicted 38 percent reduction in carbapenem-resistant Enterobacteriaceae rates over three years. This study provides an original theoretical and methodological contribution to antimicrobial resistance systems science in Nigerian teaching hospitals.

Keywords: antimicrobial resistance, complex adaptive systems, system dynamics, Nigerian hospitals, infection control