Household wastewater as a sentinel for community-level antimicrobial resistance: a cross-sectional study in Gombe, Nigeria

This study shows that household wastewater can act as a powerful indicator of community-level antimicrobial resistance (AMR) in Gombe, Nigeria. Analysis of 320 household wastewater samples (December 2024–February 2025) yielded 402 bacterial isolates, of which 81% were multidrug-resistant (MDR), with significant variation between districts. Gram-negative bacteria dominated—especially Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. More than half of tested isolates produced ESBLs, and all genetically analysed isolates carried the clinically important blaCTX-M resistance gene. MDR bacteria were resistant to a median of eight antibiotics, compared with one to two in non-MDR isolates. Overall, the findings highlight wastewater as a major environmental reservoir of AMR and support wastewater-based epidemiology as a cost-effective complement to clinical surveillance, particularly in resource-limited settings.