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PERSPECTIVE article

Front. Public Health
Sec. Environmental Health and Exposome
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1525873
This article is part of the Research Topic Wastewater-Based Epidemiology: Emerging Substance Use and Chemical Exposure Monitoring View all articles

Mitigating Antimicrobial Resistance through Effective Hospital Wastewater Management in Low-and Middle-Income Countries

Provisionally accepted
Yaovi Mahuton Gildas Hounmanou Yaovi Mahuton Gildas Hounmanou 1*Adonias Houefonde Adonias Houefonde 2Tram Thuy Nguyen Tram Thuy Nguyen 3Anders Dalsgaard Anders Dalsgaard 1
  • 1 University of Copenhagen, Copenhagen, Denmark
  • 2 Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
  • 3 National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

The final, formatted version of the article will be published soon.

    Hospital wastewater (HWW) is a significant environmental and public health threat, containing high levels of pollutants such as antibiotic-resistant bacteria (ARB), antibiotic-resistant genes (ARGs), antibiotics, disinfectants, and heavy metals. This threat is of particular concern in low- and middle-income countries (LMICs), where untreated effluents are often used for irrigating vegetables crops, leading to direct and indirect human exposure. Despite being a potential hotspot for the spread of antimicrobial resistance (AMR), existing HWW treatment systems in LMICs primarily target conventional pollutants and lack effective standards for monitoring the removal of ARB and ARGs. Consequently, untreated or inadequately treated HWW continues to disseminate ARB and ARGs, exacerbating the risk of AMR profiferation. Addressing this requires targeted interventions, including cost-effective treatment solutions, robust AMR monitoring protocols, and policy-driven strategies tailored to LMICs. This perspective calls for a paradigm shift in HWW management in LMIC, emphasizing the broader implementation of onsite treatment systems, which are currently rare. Key recommendations include developing affordable and contextually adaptable technologies for eliminating ARB and ARGs and enforcing local regulations for AMR monitoring and control in wastewater. Addressing these challenges is essential for protecting public health, preventing the environmental spread of resistance, and contributing to a global effort to preserve the efficacy of antibiotics. Recommendations include integrating scalable onsite technologies, leveraging local knowledge, and implementing comprehensive AMR-focused regulatory frameworks.

    Keywords: Hospital wastewater, antimicrobial resistance, antibiotic-resistant genes, Antibioticresistant bacteria, Hospital wastewater management

    Received: 10 Nov 2024; Accepted: 26 Dec 2024.

    Copyright: © 2024 Hounmanou, Houefonde, Nguyen and Dalsgaard. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yaovi Mahuton Gildas Hounmanou, University of Copenhagen, Copenhagen, Denmark

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.