The global emergence and increased spread of antibiotic resistance threaten the effectiveness of antibiotics and, thus, the health of the entire population. Therefore, understanding the resistomes in different geographical locations is crucial in the global fight against the antibiotic resistance crisis.

Background: The presence of diarrheagenic Escherichia coli (DEC) in drinking water, is a grave public health problem. This study was aimed at characterization of diarrheagenic Escherichia coli isolated from drinking water and faecal samples from diarrheic patients in Ouagadougou, Burkina Faso. Materials and Methods: A total of 242 water samples consisting of 182 potable sachets and 60 from boreholes were collected in the period between October 2018 and April 2019 in the city of Ouagadougou. Faecal samples were also collected from 201 diarrheic patients visiting National Public Health Laboratory for a biological diagnosis by coproculture. The presence of virulence genes associated with DEC was determined by 16-plex polymerase chain reaction from bacteria culture. Results: From drinking water, we found 17% (42/242) Escherichia coli isolates in which 1% (2/242) DEC were detected. Among analyzed samples (182 sachet water versus 60 borehole water), the two DEC (01 ETEC and 01 EPEC) were detected in sachet water. DEC were detected in 20% (40/201) of patients. Enteroaggregative Escherichia coli (EAEC) were mostly detected in 10% followed by Enteropathogenic Escherichia coli (EPEC) in 4%, Enteroinvasive Escherichia coli (EIEC) in 2%, and Shiga toxin-producing Escherichia coli (STEC) 0.5%. However, Enterotoxigenic Escherichia coli (ETEC) was not detected alone, but in co-infections with EAEC. Conclusion: The present study documented the prevalence of Escherichia coli pathovars associated in patients with diarrhea, and shows that drinking water might be a source of DEC transmission in human.

Antimicrobial resistance (AMR) is one of the greatest global threats to human health, but substantial gaps in AMR data exist in West African countries. To obtain in-depth data, we explored the presence of antimicrobial resistance genes (ARGs) in the hospital wastewaters (HWW) of nine hospitals in Benin and Burkina Faso and, for comparison, of four hospitals in Finland. The highest total relative abundance of ARGs in HWWs was observed in Benin and the lowest in Finland. HWW resistomes were more similar to each other in Benin and Burkina Faso than in Finland. Different clinically relevant carbapenemases were detected in varying abundances, especially in HWWs from Burkina Faso and Finland. The most widespread carbapenemase gene in the Beninese hospitals, blaGES, was also found in water used for handwashing. blaNDM was present in the HWW of one Beninese hospital and was also detected in the stools of a hospitalized patient. Mobile colistin ARGs were detected in the HWWs of all the three studied countries, with mcr-5 variants being the most common. These and other mcr genes were observed in very high abundance in treated wastewater released into rivers in Burkina Faso. In Benin, only little is done to treat wastewaters, including HWWs. The results provide evidence for public health decision-makers in Benin and Burkina Faso for the dire need to increase wastewater treatment capacity, with particular attention to HWWs.SynopsisMetagenomic analysis of HWWs revealed high abundances of ARGs and their potential transmission to other environments in Benin and Burkina Faso.

Background Extended-spectrum β-lactamase (ESBL), plasmid-mediated AmpC-β-lactamase and carbapenemase producing Escherichia coli and Klebsiella pneumoniae have spread into environment worldwide posing a possible public health threat. However, the prevalence data in low- and middle-income countries are still scarce. The aim of this study was to assess the occurrence of ESBL, AmpC-β-lactamase and carbapenemase producing and multidrug-resistant E. coli and K. pneumoniae in wastewater collected from healthcare centers in Burkina Faso. Methodology Eighty-four (84) wastewater samples were collected from 5 healthcare centers and bacterial counts on ESBL ChromAgar were performed. E. coli and K. pneumoniae isolates were identified using API20E. ESBL production was confirmed using the double disc synergy test (DDST). AmpC-β-lactamase detection was performed on Muller Hinton (MH) agar supplemented with cloxacillin (4µg/l). Carbapenemase testing was carried out using O.K.N.V.I. RESIST-5 immunochromatography test. Result E. coli and/ or K. pneumoniae strains were isolated from 82 wastewater samples (97.6%). In total, 170 strains were isolated, E. coli more commonly (64%). Average concentrations of ESBL producing bacteria per hospital varied from 1.10x105 to 5.23x106 CFU/ml. Out of 170 presumptive ESBL producing isolates and 51 presumptive AmpC-β-lactamase producing isolates, 95% and 45% were confirmed, respectively. Carbapenemase production was detected in 10 isolates, 6 were NDM producers, 3 were OXA-48 producers and 1 was NDM and OXA-48 producer. All isolates were multidrug resistant and, furthermore, all of them were resistant to all β-lactams tested. Also, resistance to ESBL inhibitors was common, up to 66% E. coli and 62% in K. pneumoniae. Amikacin, fosfomycin and nitrofurantoin were the antibiotics for which least resistance was detected. Conclusion This study showed that wastewater from healthcare centers constitutes a reservoir of multidrug-resistant bacteria in Burkina Faso, including those capable of producing carbapenemases, which may disseminate into environment and further back to humans. Therefore, following the microbiological quality of the wastewaters released from healthcare centers is important to include in the future national AMR surveillance program.

Introduction: In low- and middle-income countries, surveillance of antimicrobial resistance (AMR) is mostly hospital-based and, in view of poor access to clinical microbiology, biased to more resistant pathogens. We assessed AMR among Escherichia coli isolates obtained from urine cultures of pregnant women as an indicator for community AMR and compared the AMR results with those from E. coli isolates obtained from febrile patients in previously published clinical surveillance studies conducted within the same population in Nanoro, rural Burkina Faso.Results: Between October 2016 – September 2018, midstream urine samples collected as part of routine antenatal in Nanoro district were cultured by a dipslide method and screened for antibiotic residues. Among 6018 consenting women (median (IQR) age 25 (20 - 30)), 84 (1.4%) were excluded because of symptoms of urinary tract infection and 96 (1.6%) screened positive for antibiotic residues. Significant growth - defined as a monoculture of Enterobacterales at counts of ≥ 104 colony forming units/ml – was observed in 202 (3.4%) cultures; E. coli represented 155 (76.7%) of isolates. Among these E. coli isolates, resistance rates to ampicillin, cotrimoxazole and ciprofloxacin were respectively 65.8%, 64.4% 16.2%, compared to 89.5%, 89.5% and 62.5% among E. coli from historical clinical isolates (n = 48 of which 45 from blood cultures). Proportions of extended spectrum beta-lactamase producers and multidrug resistance were 3.2% and 5.2% among E. coli isolates from urine in pregnant women versus 35.4%, and 60.4% respectively among clinical isolates. Adding urine culture to the routine urine analysis (protein and glucose) of antenatal was feasible. The dipslide culture method was affordable and user-friendly and allowed on-site inoculation and easy transport; challenges were contamination (midstream urine sampling) and the semi-quantitative reading. Conclusions: The E. coli isolates obtained from healthy pregnant women had significantly lower AMR rates compared to clinical E. coli isolates, probably reflecting the lower antibiotic pressure in the pregnant women population. Provided confirmation of the present findings in other settings, E. coli from urine samples in pregnant women may be a potential indicator for benchmarking, comparing, and monitoring community AMR rates across populations over different countries and regions.