Carbapenemase genes in hospital wastewater in Africa: A systematic review and meta-analysis | ||
| Microbes and Infectious Diseases | ||
| Articles in Press, Accepted Manuscript, Available Online from 20 November 2025 | ||
| Document Type: Systematic review or meta-analysis | ||
| DOI: 10.21608/mid.2025.389429.2835 | ||
| Authors | ||
| Oumou Hamidou1, 2; Abdourahamane Yacouba1, 2; Ounoussa Tapha* 1, 3; Harouna Moussa1; Ismael Illa Salifou4; Brah Souleymane5; Saidou Mamadou1, 5; Lamine Baba-Moussa2 | ||
| 1Laboratoire National de Référence sur la Résistance aux Antimicrobiens - Hôpital National Amirou Boubacar Diallo, Niamey, Niger | ||
| 2Faculté des Sciences et Techniques - Université d’Abomey-Calavi, Cotonou, Benin | ||
| 3Institut Régional de Santé Publique Comlan Alfred Quenum (IRSP) - Université d’Abomey-Calavi, Cotonou, Benin | ||
| 4Faculté des Sciences et Technique - Université Abdou Moumouni, Niamey, Niger | ||
| 5Faculté des Sciences de la Santé - Université Abdou Moumouni, Niamey, Niger | ||
| Abstract | ||
| Background: Antibiotic resistance poses a significant threat to global public health. Raw and treated hospital wastewater can serve as a significant reservoir of antibiotic-resistant genes, including those encoding carbapenemases. This review aimed to determine the prevalence and distribution of carbapenemase genes in hospital wastewater in Africa. Methods: We conducted a comprehensive search on carbapenemase genes in raw hospital wastewater and treated hospital wastewater in Africa up to November 30, 2024, using PubMed, Google Scholar, and African Journal Online (AJOL) databases. We included original studies without restrictions on time or language. The meta-analysis employed the R package “metafor” with a random-effects model, given the expected heterogeneity among studies. Heterogeneity was assessed using the I2 statistic. Results: We included 13 studies conducted in seven African countries. Among the 13 different carbapenemase genes reported, 9 (69.2%) genes were specific to the raw wastewater group, including blaIMP, blaVIM, blaOXA-181, blaOXA-69, blaOXA-1-like, blaOXA-48-like, blaGES, blaOXA-416, and blaOXA-51. They are more commonly isolated from enterobacteria (7; 58.3%). The estimated overall prevalence was 23.8% (95% CI: 15.4%–33.4%), and the heterogeneity between studies was high (I2 = 85%; p<0.01). Subgroup prevalence by sample source was 32% (95% CI: 0–74%) in treated wastewater and 24% (95% CI: 16–32%) in raw wastewater. Conclusion: This review highlights the high prevalence of carbapenemase genes in hospital wastewater in Africa. The study emphasizes the urgent need for geographically balanced AMR surveillance systems across Africa to reduce the spread of antibiotic resistance in the environment. | ||
| Keywords | ||
| Africa; Carbapenemase; Hospital effluents; Resistance genes | ||
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