Water management practices and antibiotic-resistant <i>Pseudomonas aeruginosa</i> contamination in Ethiopian tertiary hospitals: implications for waterborne healthcare-associated infections

The threat of healthcare-associated infections is significantly heightened when caused by drug-resistant pathogens. This study evaluates water management practices and prevalence of antibiotic-resistant <i>Pseudomonas aeruginosa</i> in water systems of two tertiary hospitals of Ethiopia. We employed a mixed-methods approach, combining the qualitative data thematic analysis with quantitative microbiological results from 120 potable water samples. <i>P. aeruginosa</i> isolates were identified and subjected to antimicrobial susceptibility testing. Data collection was conducted between December 2023 and January 2024. The findings indicate that neither hospital had a dedicated water management programme for preventive maintenance. Microbial analysis revealed a 16% prevalence of <i>P. aeruginosa</i> in the water samples, with 26.3% of isolates demonstrating resistant to at least one antibiotic class. Notably, two isolates from the maternity ward of Hospital A exhibited multidrug resistance (MDR) to ciprofloxacin, amikacin, and imipenem. Overall, the structural and operational standard of the water management programmes in both hospitals were found to be non-conformant to international standards. A higher rate of Pseudomonas positivity, including resistant and MDR strains, indicates persistent hospital water contamination and a tangible risk for HAIs. These results underscore the critical need for the formation of multidisciplinary water safety team to optimize water quality management in these hospitals.