INAUGURAL LECTURE NARRATIVE REPORT
Professor Nicholas T.K.D. Dayie
Department of Medical Microbiology
University of Ghana Medical School
ntkddayie@ug.edu.gh; nicholasdayie@yahoo.com; +233208449415
TITLE: When Microbes Speak and Data Appear Inconsistent, Are We Witnessing Falsehood or Truth?
On a quiet evening at the University of Ghana, Professor Nicholas T.K.D. Dayie stood before an audience and posed a question that seemed simple, yet carried profound implications:
When microbes speak and data appear inconsistent, are we witnessing falsehood or truth?
It is a question that reaches far beyond the laboratory. It speaks to the heart of modern medicine, to the reliability of science, and ultimately, to the lives of patients.
We live in a world teeming with microbes, organisms too small to be seen with the naked eye, yet powerful enough to determine health and disease. Many are beneficial. Others are not. Among the most concerning are bacteria that have developed the ability to survive the very drugs designed to kill them. This phenomenon, known as antimicrobial resistance, is no longer a distant scientific concern. It is a present and growing crisis. Across the world, millions of infections are becoming harder to treat, and thousands of lives are lost each year because medicines that once worked no longer do.
Ghana is not spared. Behind national statistics are real patients, those who do not respond to treatment as expected, infections that persist longer than they should, and clinicians forced to make decisions under uncertainty. But beyond the microbes themselves lies another, less visible challenge: the systems we rely on to detect and understand them.
Professor Dayie’s journey into this realization did not happen overnight. It began in Ghana, where he first encountered bacteriology not merely as a laboratory discipline, but as a clinical reality, one that directly influences patient outcomes. His work later took him to the University of Copenhagen, where he studied the molecular mechanisms of bacterial resistance. Yet it was at the London School of Hygiene and Tropical Medicine that a defining shift occurred. There, the focus moved from individual pathogens to the systems that detect them. And with that shift came a powerful insight:
The challenge is not only the microbes. It is also the systems we use to measure them.
Because in science, data are only as reliable as the systems that produce them.
In the context of antimicrobial resistance, this raises a critical distinction between what Professor Dayie describes as “truth” and “falsehood.” Truth reflects the genuine biological behaviour of microbes, their evolution, their spread, and their resistance patterns. Falsehood, however, is not about dishonesty. It is about distortion, data shaped by weak laboratory practices, poor-quality reagents, inconsistent methodologies, or gaps in quality assurance.
This distinction matters. Clinical decisions, treatment outcomes, and national health policies all depend on the assumption that laboratory data reflect reality. But what if that assumption does not always hold?
Consider a situation where a laboratory report indicates that a bacterium is susceptible to a particular antibiotic. The clinician prescribes the drug with confidence. Yet the patient does not improve. In some cases, the explanation lies not in the drug or the clinician’s judgment, but in the biology of the organism itself. The bacterium may carry a resistance mechanism that is not expressed under routine laboratory conditions but becomes active during treatment.
The result is a dangerous illusion: a test that appears correct but does not tell the whole story.
Such realities are not theoretical. At the Korle Bu Teaching Hospital, evidence has emerged of highly resistant bacterial strains carrying some of the most concerning resistance genes known globally. These organisms are capable of surviving last-line antibiotics and spreading within hospital environments, posing a serious threat to patient safety.
Yet even as these biological threats evolve, another challenge persists, the structure of the surveillance system itself. Ghana has approximately 4,841 laboratories, but only about 93 have the capacity to perform bacteriology testing. This means that the national picture of antimicrobial resistance is constructed from a very limited subset of data.
It raises an uncomfortable but necessary question: Are we seeing the full truth or only fragments of it?
Part of the answer lies in understanding why antimicrobial resistance data sometimes appear inconsistent. According to Professor Dayie, variability in such data arises from three distinct sources. The first is genuine biological change (microbes evolving, spreading, and adapting in response to selective pressure). The second is methodological variability introduced by laboratory systems (differences in procedures, reagents, or quality control). The third is test-condition–dependent expression, where resistance may be present but not detected depending on how laboratory tests are performed.
Distinguishing between these sources is not merely an academic exercise. It is fundamental to patient care. If variability is misinterpreted, treatment decisions may be misguided. And when treatment is misguided, lives are at risk.
For this reason, Professor Dayie argues that truth in antimicrobial resistance surveillance must be deliberately constructed. It cannot be assumed. It must be engineered through strong laboratory systems, rigorous quality assurance, and coordinated national efforts.
He outlines five essential pillars for achieving this: accurate detection, robust validation, integration across sectors through a One Health approach, governance that translates data into action, and sustainable financing. Together, these pillars form the foundation of a system capable of generating reliable, actionable evidence.
Ghana has already made important strides in this direction, developing guidelines, strengthening laboratory practices, and building surveillance frameworks. But progress alone is not enough. Sustaining and expanding these gains will require investment, coordination, and long-term commitment.
As the lecture drew to a close, the question that opened the evening lingered, no longer rhetorical, but deeply practical.
When antimicrobial resistance data appear inconsistent, what are we truly observing?
Perhaps it is the natural evolution of microbes.
Perhaps it is the limitation of our systems.
More often than not, it is both.
What remains clear, however, is the responsibility that follows.
When microbes speak, they do so truthfully.
The task before us is to ensure that our systems hear them clearly, interpret them correctly, and respond with wisdom.
Because in the end, antimicrobial resistance is not only about bacteria.
It is about the integrity of science, the strength of systems, and the value we place on human life.
