WHO Priority Pathogens, ESKAPE Bacteria, and AMR Surveillance in Household Wastewater, Gombe, Nigeria

Abstract Background: WHO bacterial priority pathogens and ESKAPE organisms in household wastewater pose critical community transmission risks, yet surveillance data from Sub-Saharan Africa remains limited. This study provides the first comprehensive priority pathogen detection and antimicrobial resistance assessment in household wastewater from Gombe State, Nigeria, focusing on organisms of highest clinical concern. Methods: We conducted targeted surveillance for WHO priority pathogens in 320 household wastewater samples across seven districts in Gombe using multi-stage sampling. Some priority gram-negative pathogens (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter spp.) were specifically isolated and characterized. Antimicrobial susceptibility testing followed CLSI 2024 guidelines across 12 antibiotics targeting critical resistance patterns. Extended-spectrum beta-lactamase (ESBL) and carbapenemase detection focused on priority pathogen isolates with PCR confirmation of key resistance genes. Results: Priority pathogen detection revealed Escherichia coli (131 isolates, 32.6%) as the dominant WHO priority pathogen, followed by Klebsiella pneumoniae (77 isolates, 19.2%) and Pseudomonas aeruginosa (45 isolates, 11.2%). ESKAPE pathogen P. aeruginosa showed 73.3% multidrug resistance with carbapenemase gene detection (blaVIM 60%, blaKPC 20%). Critical priority pathogen K. pneumoniae demonstrated 79.2% MDR prevalence with universal blaCTX-M gene presence (100%) in ESBL producers. Priority pathogen E. coli exhibited an alarming 84.7% MDR rates with widespread ESBL production (51.5%). Carbapenem resistance in priority pathogens reached 41.3%, indicating last-resort antibiotic failure in critical organisms. Conclusions: Household wastewater in Gombe harbors critical WHO priority pathogens and ESKAPE organisms with alarming antimicrobial resistance burden. The detection of carbapenemase-producing priority pathogens in domestic wastewater signals urgent community transmission risks requiring immediate public health intervention and enhanced priority pathogen surveillance strategies.