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 multid-
rug-resistant E. coli and K. pneumoniae in wastewaters from healthcare centers in Burkina Faso.
Results Eighty-four (84) wastewater samples were collected from five healthcare centers and plated on selec-
tive ESBL ChromAgar. E. coli and Klebsiella pneumoniae isolates were identified using API20E. ESBL-producing bac-
teria were detected in 97.6% of the samples and their average concentration per hospital ranged from 1.10 × 10 5
to 5.23 × 10 6 CFU/mL. Out of 170 putative ESBL-producing isolates (64% of them were E. coli) and 51 putative AmpC-β-
lactamase-producing isolates, 95% and 45% were confirmed, 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 multidrug-
resistant 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 dif-
ficult to treat, especially in the resource-poor settings.

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