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Researchers investigated the presence of third generation cephalosporin resistant Escherichia coli in wastewater entering the Korle Lagoon in Accra, Ghana. Across a twelve-month sampling programme, water was tested monthly at four key discharge points, including hospital drainage, a wastewater pumping station, and two treatment plants, as well as paired upstream and downstream lagoon locations. Laboratory testing confirmed high concentrations of these resistant bacteria entering the waterway, with the largest volumes found in overflow from the Korle Bu pumping station and effluent from the Mudor treatment facility. Bacterial counts were consistently higher downstream of discharge points than upstream, notably near the hospital mortuary drain and pumping station. These results show that effluent actively introduces clinically significant resistant bacteria into the aquatic environment, highlighting a need for improved treatment infrastructure and systematic resistance monitoring.
Discharging inadequately treated wastewater into urban lagoons exposes surrounding communities and ecosystems to dangerous pathogens. Third generation cephalosporins are essential clinical antibiotics, and the uncontrolled dissemination of resistant bacteria into waterways undermines modern medicine, limits treatment options for common infections, and elevates the broader public health threat posed by environmental antimicrobial resistance.
This research provides baseline observational data that can assist municipal utilities, environmental engineering firms, and public health agencies in identifying key contamination hotspots. While it represents early-stage environmental monitoring rather than a marketable product, the findings highlight an operational demand for improved wastewater filtration, disinfection technologies, and routine microbial surveillance systems across municipal drainage networks.
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Antimicrobial resistance in the environment is a major public health threat, particularly in low- and middle-income countries where there is inadequate wastewater treatment infrastructure. Third generation cephalosporin resistant Escherichia coli (3GCR E. coli) are of particular concern as they have clinical significance and may spread associated resistance genes in environment. This study quantified 3GCR E. coli in wastewater discharged into the Korle Lagoon in Accra, Ghana, and assessed the influence of these discharges on the lagoon. In a cross-sectional study conducted from November 2023 to October 2024, wastewater and lagoon water samples were collected monthly from four discharge points (the Korle Bu Teaching Hospital (KBTH) mortuary drain, the Korle Bu wastewater pumping station, the Mudor Wastewater Treatment Plant and the Lavender Hill Faecal Treatment Plant) and from paired upstream and downstream lagoon sites at each point. Isolates were enumerated by membrane filtration on a selective chromogenic medium, confirmed by MALDI-TOF mass spectrometry, and tested for antimicrobial susceptibility in accordance with CLSI (2024) guidelines. Counts were highest in overflow wastewater from the Korle Bu pumping station (median 3.75 × 10⁶ CFU/100 mL) and in Mudor effluent (1.24 × 10⁶ CFU/100 mL) and differed significantly across sampling sites (Kruskal-Wallis H = 19.6, p = 0.003). Paired comparisons consistently showed higher counts downstream than upstream of the discharge points, most markedly at the KBTH mortuary drain (4.03 × 10⁵ versus 2.36 × 10⁵ CFU/100 mL; p = 0.018) and the Korle Bu pumping station overflow (p = 0.012). The elevated downstream burden indicates active dissemination of resistant 3GCR E. coli along the lagoon continuum. These findings underscore the urgent need to upgrade wastewater treatment infrastructure and to integrate AMR surveillance within wastewater systems in Ghana.
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DOI: 10.31223/x5449f
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