Background Extended-spectrum β-lactamase (ESBL), plasmid-mediated AmpC-β-lactamase and carbapenemase producing Escherichia coli and Klebsiella pneumoniae have spread into the environment worldwide posing a potential public health threat. However, the prevalence data for low- and middle-income countries are still scarce. The aim of this study was to evaluate the presence of ESBL, AmpC-β-lactamase and carbapenemase-producing and multidrug-resistant E. coli and K. pneumoniae in wastewaters from healthcare centers in Burkina Faso. Results Eighty-four (84) wastewater samples were collected from fve healthcare centers and plated on selective ESBL ChromAgar. E. coli and Klebsiella pneumoniae isolates were identifed using API20E. ESBL-producing bacteria were detected in 97.6% of the samples and their average concentration per hospital ranged from 1.10× 105 to 5.23× 106 CFU/mL. Out of 170 putative ESBL-producing isolates (64% of them were E. coli) and 51 putative AmpC-βlactamase-producing isolates, 95% and 45% were confrmed, respectively. Carbapenemase production was detected
in 10 isolates, of which 6 were NDM producers, 3 were OXA-48 producers and 1 was NDM and OXA-48 producer. All
isolates were multidrug resistant and, moreover, all of them were resistant to all tested β-lactams. Resistance to ESBL
inhibitors was also common, up to 66% in E. coli and 62% in K. pneumoniae. Amikacin, fosfomycin and nitrofurantoin
were the antibiotics to which the least resistance was detected. Conclusions This study showed that wastewater from healthcare centers constitutes a reservoir of multidrugresistant bacteria in Burkina Faso, including carbapenemase producers. Untreated healthcare wastewater entering the environment exposes people and animals to infections caused by these multi-resistant bacteria, which are diffcult to treat, especially in the resource-poor settings

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AmpC-β-lactamase, Carbapenemases, Multidrug-resistance, Hospital wastewater, E. coli, Klebsiella pneumoniae, EBSL