Prevalence of Extended-Spectrum β-Lactamase-Producing Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae in Wastewater Effluent in Blantyre, Malawi

<b>Background/Objectives</b>: Wastewater treatment plants (WWTPs) serve as a sink for both antimicrobial residues and bacteria carrying resistant genes, which are later disseminated into the environment, facilitating the spread of antimicrobial resistance. This study investigated the presence of extended-spectrum beta-lactamase (ESBL) producing <i>Escherichia coli (Ec)</i>, <i>Klebsiella pneumoniae (Kp)</i>, and <i>Enterobacter cloacae (Enc)</i> in effluent from WWTP in Blantyre, Malawi, to generate evidence and provide baseline information for interventions. <b>Methods</b>: Selective chromogenic agar was used to identify ESBL-producing bacteria. <b>Results</b>: A total of 288 samples were collected between April 2023 and March 2024, and 97.6% (281/288) yielded one or more presumptive ESBL isolates. Bacterial growth was confirmed as 48.9% <i>Ec</i> (255/522), 33.0% <i>Kp</i> (172/522), and 10.0% <i>Enc</i> (52/522). Antibiotic susceptibility testing showed the highest resistance to ceftriaxone (<i>Ec</i>, 100.0%; <i>Kp</i>, 98.3%; <i>Enc</i>, 100.0%) and the lowest resistance to meropenem (<i>Ec</i>, 6.3%, <i>Kp</i>, 1.2%; <i>Enc</i>, 3.8%) among the antibiotics that were tested. Multiple antibiotic resistance phenotypes were observed in 73.1% of the isolates, with the most prevalent phenotype being amoxicillin + clavulanate/cotrimoxazole/doxycycline/ciprofloxacin/gentamicin/azithromycin/ceftriaxone (55, 15.7%). <b>Conclusions</b>: The study demonstrated ongoing environmental contamination with antibiotic-resistant bacteria from sewage effluent. Therefore, the functionality of WWTPs should be improved to minimize the release of these organisms into the environment.