Antibiotic Resistance and Phylogenetic Diversity of Escherichia coli Isolated from Hospital Wastewater in Gabon.

Hospital wastewater represents a critical hotspot for the dissemination of antibiotic resistance genes (ARGs), serving both as an environmental reservoir and a transmission pathway for multidrug-resistant bacteria into receiving ecosystems. The intense antibiotic selective pressure within healthcare facilities promotes the emergence, persistence and amplification of resistant strains, posing substantial risks to public health and environmental integrity. This study aimed to characterize Escherichia coli (E. coli) isolates recovered from hospital wastewater effluents in multiple cities across Gabon, with emphasis on bacterial loads, antimicrobial resistance patterns and associated genetic determinants. Wastewater samples were aseptically collected from sewer outlets of eleven healthcare facilities distributed across five provinces over a 12-week period, structured into two six-week sampling campaigns to capture temporal variability. A total of 158 bacterial isolates were obtained, among which 49 were confirmed as E. coli. Mean concentrations of presumptive E. coli ranged from 7.1 × 103 to 1.49 × 109 CFU/mL, indicating substantial microbial contamination of hospital effluents. Antimicrobial susceptibility testing using the Kirby-Bauer disk diffusion method against 19 antibiotics revealed that all isolates exhibited multidrug-resistant phenotypes. Resistance rates were particularly high to β-lactams and third-generation cephalosporins, reaching 90-100% in most facilities, reflecting strong selective pressure and widespread circulation of resistance mechanisms in urban aquatic environments. In contrast, carbapenems and amikacin remained comparatively effective, with resistance levels below 40%, suggesting partial preservation of last-resort therapeutic options. The values of the Multiple Antibiotic Resistance Index (MARI) ranged from 0.21 to 0.84, indicating selection pressure on different classes of antibiotics. Phylogenetic analysis showed a predominance of phylogroup A, traditionally considered commensal but increasingly associated with the spread of resistance. Groups B2, D/E and F proved to be the most resistant. These groups showed marked resistance to first-line antibiotics. The blaCTX-M-1 was the most prevalent resistance determinant (66.6%), occurring twice as frequently as blaSHV (33.3%), a finding that confirms the significant circulation of extended-spectrum β-lactamase-producing E. coli. Overall, these findings highlight hospital wastewater as a major reservoir and dissemination source of multidrug-resistant E. coli, underscoring the urgent need for improved wastewater treatment, strengthened antimicrobial stewardship and integrated One Health-based surveillance strategies.