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Abstract


Background. Antimicrobial resistance (AMR) is a major and growing public health threat worldwide, with a disproportionate burden in low- and middle-income countries. While hospitals are recognized hotspots for the emergence and amplification of resistant bacteria, hospital effluents represent an underexplored pathway for the dissemination of antimicrobial resistance into the environment. Evidence from African settings remains scarce, limiting integration of environmental reservoirs into AMR surveillance and One Health strategies. Methods. We conducted a descriptive and analytical cross-sectional study between March and June 2025 at the Yaoundé University Hospital Centre (CHUY), Cameroon. Twelve liquid effluent samples were collected from four strategic points within the hospital wastewater system: (i) runoff from clinical wards, (ii) effluents from emgency services, (iii) sludge at the entrance of the wastewater treatment station, and (iv) treated water at the outlet of the station. Bacterial enumeration, isolation, and identification were performed using standard microbiological techniques. Antimicrobial susceptibility testing (AST) was conducted by disk diffusion and interpreted according to EUCAST–CASFM 2024 guidelines. Resistance profiles from effluent isolates were compared with those of clinical isolates processed at the same hospital during the same period. Results.
The mean total bacterial load of hospital effluents was 5.7×10⁷ CFU/mL. Identified species included Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus spp., Staphylococcus aureus, Citrobacter spp., Enterobacter spp., and Acinetobacter baumannii. Most isolates were multidrug resistant (resistant to ≥3 antibtic classes), notably to beta-lactams, aminoglycosides, and fluoroquinolones. ESBL-producing and carbapenemase-producing Enterobacterales, methicillin- and vancomycin-resistant S. aureus, vancomycin-resistant enterococci, and ceftazidime-resistant P. aeruginosa were detected. Bacterial populations differed between effluent and clinical isolates (p = 0.0107), while resistance profiles were comparable(p=0.438). Conclusion. Hospital effluents at CHUY constitute a substantial environmental reservoir of multidrug-resistant bacteria, reflecting resistance patterns observed in clinical settings. Hospital wastewater management should be integrated into AMR surveillance and One Health strategies in Cameroon and similar contexts.


Résumé


Contexte. La résistance aux antimicrobiens (RAM) représente une mence majeure pour la santé publique mondiale, avec une charge disproportionnée dans les pays à revenu faible et intermédiaire. Si les hôpitaux sont reconnus comme des foyers critiques d’émergence de bactéries multirésistantes, le rôle des effluents hospitaliers dans la dissémination environnementale de la RAM reste insuffisamment documenté en Afrique, limitant leur intégration dans les stratégies de surveillance et les approches One Health. Méthodes. Une étude transversale descriptive et analytique a été menée entre mars et juin 2025 au Centre Hospitalier Universitaire de Yaoundé (CHUY), au Cameroun. Douze échantillons d’effluents liquides ont été collectés à quatre points stratégiques du système d’eaux usées hospitalières, incluant les services cliniques, les urgences, l’entrée et la sortie de la station de traitement. Les analyses microbiologiques ont porté sur l’isolement, l’identification bactérienne et les tests de sensibilité aux antibioques par diffusion en milieu gélosé, interprétés selon les recommandations EUCAST–CASFM 2024. Les profils de réstance des isolats environnementaux ont été comparés à ceux des isolats cliniques du même établissement sur la même période. Résultats. La charge bactérienne moyenne des effluents était de 5,7 × 10⁷ UFC/mL. Les espèces isolées comprenaient notamment Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus spp., Staphylococcus aureus et Acinetobacter baumannii. La majorité des isolats présentaient une multirésistance, incluant des phénotypes BLSE, des entérobactéries productrices de carbapénémases, ainsi que des souches résistantes à la méthicilline et à la vancomycine. Bien que la composition bactérienne différât entre isolats cliniques et environnementaux (p = 0,0107), les profils de résistance étaient similaires (p = 0,438). Conclusion. Les effluents hospitaliers constituent un réservoir environnemental majeur de bactéries multirésistantes reflétant les profils observés en milieu clinique. Leur intégration dans les systèmes de surveillance de la RAM et les stratégies One Health apparaît essentielle pour renforcer la lutte contre la résistance aux antimicrobiens au Cameroun et dans des contextes similaires

Keywords

Resistance Antimicrobials, Effluents, Multidrug-resistant bacteria Résistance, Antimicrobiens, Effluents, Bactéries multirésistantes

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Yap Boum, Ritchnel Goufack, Linda Esso, & Hortense Gonsu. (2026). Multidrug-Resistant Bacteria in Hospital Effluents: Evidence from a Tertiary Hospital in Cameroon and implications for One Health Antimicrobial Resistance Control: Bactéries Multirésistantes dans les Effluents Hospitaliers : Preuves d’un Hôpital Tertiaire au Cameroun et Implications pour le Contrôle de la Résistance aux Antimicrobiens dans le Cadre de la Santé Unique. HEALTH SCIENCES AND DISEASE, 27(Suppl 1). https://doi.org/10.5281/zenodo.18314940
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