Tilahun Mihret, Shibabaw Agumas, Adane Metadel
Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
BMC Infect Dis. 2025 Feb 22;25(1):250. doi: 10.1186/s12879-025-10660-9.
Wastewater systems worldwide can transport bacterial pathogens alongside antimicrobial resistance genes and pharmaceutical residues. The presence of these pathogens and resistance genes in wastewater systems poses significant public health risks, especially in regions like Ethiopia, where limited wastewater treatment and sanitation infrastructure exist. The spread of infectious diseases and the exacerbation of antimicrobial resistance through wastewater can contribute to the growing global health challenge, with specific implications for local healthcare systems.
This systematic review and meta-analysis aimed to assess the prevalence of bacterial pathogens and their multidrug resistance patterns within wastewater and drinking water systems in Ethiopia, focusing on both hospital and non-hospital environments.
A comprehensive search was conducted across electronic databases and grey literature using relevant terms and phrases. Studies meeting the eligibility criteria were extracted into MS Excel and analyzed using STATA version 17 software. A random-effects model was employed to estimate the pooled prevalence of bacterial pathogens in hospital and non-hospital wastewater. Heterogeneity was evaluated using the Cochrane Q test and I² statistics, with a significance threshold of p < 0.05. Publication bias was assessed using a funnel plot and Egger's test. A sensitivity analysis was also performed to determine the influence of individual studies on the overall effect size. Studies included in the meta-analysis reported the prevalence of bacterial species and their corresponding multidrug resistance phenotypes.
Out of 472 studies initially identified, 80 met the eligibility criteria for full-text review. Of these, 17 studies were included in the meta-analysis, comprising a total of 848 wastewater and 325 drinking water samples and 2,961 bacterial strains. The most frequently identified bacterium was Pseudomonas aeruginosa (or related species), with an overall prevalence of 41.25% (95% CI: 10.04-81.46%). The pooled prevalence of bacterial pathogens in hospital and non-hospital wastewater systems in Ethiopia was 70.02% (95% CI: 59.90-80.13%), exhibiting substantial heterogeneity (I² = 99.1%, p < 0.001) and the data provides environmental measurements across different categories: wastewater 82.57% (CI: 72.88-92.25%), drinking water 42.18% (CL:10.33, 88.83%). Additionally, the overall prevalence of multidrug-resistant bacterial strains in wastewater was 65.26% (95% CI: 57.23-75.30%), with high heterogeneity (I² = 98.6%, p < 0.001) across different bacterial species and study settings.
This systematic review and meta-analysis reveal high levels of bacterial contamination and multidrug resistance within Ethiopian wastewater systems, with significant variability across studies. The findings highlight the urgent need for enhanced wastewater management and monitoring to tackle these public health issues. Future research should focus on standardizing methodologies and investigating the sources of variability to effectively manage and mitigate the risks associated with wastewater systems.
全球的废水系统能够携带细菌病原体，以及抗微生物药物耐药基因和药物残留。废水系统中这些病原体和耐药基因的存在构成了重大的公共卫生风险，尤其是在像埃塞俄比亚这样废水处理和卫生基础设施有限的地区。通过废水传播传染病和加剧抗微生物药物耐药性会导致日益严峻的全球健康挑战，对当地医疗系统产生特定影响。
本系统评价和荟萃分析旨在评估埃塞俄比亚废水和饮用水系统中细菌病原体的流行率及其多重耐药模式，重点关注医院和非医院环境。
使用相关术语和短语在电子数据库和灰色文献中进行全面检索。将符合纳入标准的研究提取到MS Excel中，并使用STATA 17软件进行分析。采用随机效应模型估计医院和非医院废水中细菌病原体的合并流行率。使用Cochrane Q检验和I²统计量评估异质性，显著性阈值为p < 0.05。使用漏斗图和Egger检验评估发表偏倚。还进行了敏感性分析，以确定个别研究对总体效应大小的影响。纳入荟萃分析的研究报告了细菌种类的流行率及其相应的多重耐药表型。
在最初识别的472项研究中，80项符合全文审查的纳入标准。其中，17项研究纳入荟萃分析，共包括848份废水样本、325份饮用水样本和2961株细菌菌株。最常鉴定出的细菌是铜绿假单胞菌（或相关菌种），总体流行率为41.25%（95%置信区间：10.04 - 81.46%）。埃塞俄比亚医院和非医院废水系统中细菌病原体的合并流行率为70.02%（95%置信区间：59.90 - 80.13%），表现出高度异质性（I² = 99.1%，p < 0.001），数据提供了不同类别的环境测量结果：废水82.57%（置信区间：72.88 - 92.25%），饮用水42.18%（置信区间：10.33，88.83%）。此外，废水中多重耐药细菌菌株的总体流行率为65.26%（95%置信区间：57.23 - 75.30%），在不同细菌种类和研究环境中具有高度异质性（I² = 98.6%，p < 0.001）。
本系统评价和荟萃分析揭示了埃塞俄比亚废水系统中高水平的细菌污染和多重耐药性，各研究之间存在显著差异。研究结果突出了加强废水管理和监测以解决这些公共卫生问题的迫切需求。未来的研究应侧重于规范方法，并调查变异性的来源，以有效管理和减轻与废水系统相关的风险。
