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Meta-Analysis
. 2025 Apr 11;25(1):1364.
doi: 10.1186/s12889-025-22513-w.

Antibiotic resistance in hospital wastewater in West Africa: a systematic review and meta-analysis

Prince Hotor  1 , Fleischer C N Kotey  2 , Eric S Donkor  3
Affiliations
Meta-Analysis

Antibiotic resistance in hospital wastewater in West Africa: a systematic review and meta-analysis

Prince Hotor et al. BMC Public Health. .

Abstract

Background: The occurrence of antibiotic-resistant bacteria (ARB) has become a global menace and therefore increases morbidity, mortality and healthcare costs. Globally, hospital wastewater (HWW) has been identified as a significant source of antibiotic-resistant elements.

Objectives: This review aims to systematically review and to perform meta-analyses from evidence on antibiotic resistance studies in HWW in West Africa.

Methods: The review was conducted in compliance with PRISMA and included studies published between 1990 and 2024 in West Africa from the Scopus, PubMed, and Web of Science databases. Eligible studies that characterized resistant bacteria, genes, or antibiotic residues in HWW were included. Meta-analyses for resistant bacteria and genes as well risk of bias using the Newcastle-Ottawa scale were conducted.

Results: Out of 23 studies reviewed, resistant bacteria were reported in 39% (E. coli), 26% (K. pneumoniae), and 17% (P. aeruginosa), while 17 studies reported ARGs, with blaTEM (29%), blaOXA- 48 (18%), blaSHV (18%), and mecA (18%) being the most common. Only 4% and 9% of studies focused on toxin genes and antibiotic residues, respectively. Meta-analysis showed pooled prevalence rates for resistant bacteria: E. coli 42.6% (95% CI: 26.7%-60.3%) and K. pneumoniae 32.1% (95% Cl: 28.8%- 36.5%), and ARGs: blaTEM 76.0% (95% CI = 64.6%-84.6%) and blaSHV 59.3% (95% CI = 19.5%-89.8%).

Conclusion: This systematic review highlights significant findings of high levels of ARGs and ARBs of public health concern in HWW in West Africa. This highlights the need to improve upon the monitoring of antibiotic resistance and treatment of HWW in West Africa.

Keywords: Antibiotic residues; Antibiotic resistance; Antibiotic resistance genes; Antibiotic-resistant bacteria; Horizontal gene transfer; Hospital wastewater; Wastewater treatment; West Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic representation of the search strategy for records and articles using the PRISMA criteria
Fig. 2
Fig. 2
West African countries that have several studies on antimicrobial resistance in HWW
See this image and copyright information in PMC

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