AUTHOR=Hounmanou Yaovi Mahuton Gildas , Houefonde Adonias ,  I-CRECT Consortium , Nguyen Tram Thuy , Dalsgaard Anders , Nguyen Linh Viet , Nguyen Tung Xuan , My Troung Nhat , Le Lan Thi , Vu Huyen Thi , Hoang Ngoc Thi Bich , Tran Dien M. , Pham Thi Anh Mai , Pham Phuc D. , Nurjadi Dennis , Goutard Flavie , Velavan Thirumalaisamy P. , Dinh Van Anh Thi , Jörgensen Bent , Song Le Huu , Nguyen Nhung T.T. , Loire Etienne , Östholm Åse , Nilsson Lennart E. , Tran Tuyet Hanh T. , Phan Phuc H. , Larsson Mattias , Olson Linus , Hanberger Håkan 

TITLE=Mitigating antimicrobial resistance through effective hospital wastewater management in low- and middle-income countries

JOURNAL=Frontiers in Public Health

VOLUME=Volume 12 - 2024

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1525873

DOI=10.3389/fpubh.2024.1525873

ISSN=2296-2565

ABSTRACT=Hospital wastewater (HWW) is a significant environmental and public health threat, containing high levels of pollutants such as antibiotic-resistant bacteria (ARB), antibiotic-resistant genes (ARGs), antibiotics, disinfectants, and heavy metals. This threat is of particular concern in low- and middle-income countries (LMICs), where untreated effluents are often used for irrigating vegetables crops, leading to direct and indirect human exposure. Despite being a potential hotspot for the spread of antimicrobial resistance (AMR), existing HWW treatment systems in LMICs primarily target conventional pollutants and lack effective standards for monitoring the removal of ARB and ARGs. Consequently, untreated or inadequately treated HWW continues to disseminate ARB and ARGs, exacerbating the risk of AMR proliferation. Addressing this requires targeted interventions, including cost-effective treatment solutions, robust AMR monitoring protocols, and policy-driven strategies tailored to LMICs. This perspective calls for a paradigm shift in HWW management in LMIC, emphasizing the broader implementation of onsite treatment systems, which are currently rare. Key recommendations include developing affordable and contextually adaptable technologies for eliminating ARB and ARGs and enforcing local regulations for AMR monitoring and control in wastewater. Addressing these challenges is essential for protecting public health, preventing the environmental spread of resistance, and contributing to a global effort to preserve the efficacy of antibiotics. Recommendations include integrating scalable onsite technologies, leveraging local knowledge, and implementing comprehensive AMR-focused regulatory frameworks.