From Waste Streams to Superbugs: How Pharmaceutical and Hospital Effluents Drive Antimicrobial Resistance in Urban Ecosystems
Rashidat Abolore Adeyemo
*
Department of Medical Laboratory Science, Fountain University, Osogbo, Osun State, Nigeria.
Olukunle O. Akanbi
Graduate School of Pharmacy, Cedarville University, Ohio, USA.
Ogunmekan Inumimo
Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
Chibuoke Chinenye Telma
Department of Biology, University of Benin, Benin City, Nigeria.
Tosin Abiodun Aderanti
Department of Chemical and Environmental Sciences, Babcock University, Ilishan-Remo, Nigeria.
Mmesoma Somtochukwu Chime
Department of Medical Laboratory Science, Enugu State University of Science and Technology, Enugu State, Nigeria.
Chinasa Francis Njoba
Defence Reference Laboratory, Mogadishu Cantonment, Abuja, FCT, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Antimicrobial resistance (AMR) is a major global public health challenge, and environmental pathways are increasingly recognised as important drivers of resistance emergence and dissemination. Pharmaceutical manufacturing activities and hospital wastewater systems release antibiotic residues, resistant microorganisms, and antimicrobial resistance genes into urban aquatic environments, creating conditions that favour resistance selection and persistence.
Objective: This narrative review synthesises current evidence on the contribution of pharmaceutical and hospital effluents to antimicrobial resistance in urban ecosystems, identifies major environmental pathways, and examines existing mitigation and regulatory strategies.
Methods: Relevant literature published between January 2000 and August 2025 was identified through searches of PubMed, Scopus, and Web of Science, supplemented by reports from international organisations. Evidence relating to pharmaceutical pollution, hospital wastewater, environmental reservoirs, wastewater treatment technologies, and policy responses was synthesised using a thematic narrative approach.
Key Findings: Studies across diverse geographical settings indicate that pharmaceutical and hospital effluents frequently contain antibiotic concentrations capable of promoting resistance selection and introducing multidrug-resistant organisms and mobile resistance genes into municipal wastewater systems. Conventional treatment processes do not consistently remove these contaminants, enabling their persistence and dissemination within urban environments. Regulatory oversight remains uneven, with limited implementation of enforceable effluent standards and targeted pretreatment requirements.
Conclusions: Reducing environmentally mediated AMR requires strengthened environmental surveillance, improved wastewater treatment infrastructure, responsible pharmaceutical waste management, and integrated One Health governance frameworks. Coordinated action across healthcare, industry, and environmental sectors is essential to mitigate resistance amplification in urban ecosystems.
Keywords: Antimicrobial resistance, pharmaceutical effluents, hospital wastewater, urban ecosystems, environmental surveillance, one health