Abstract
<jats:p>Hospital wastewater poses a major public health threat in West Africa due to the high prevalence of pathogenic and multidrug-resistant bacteria. Untreated effluents facilitate the dissemination of antibiotic resistance and virulence genes into the environment, yet their genetic profiles remain poorly documented in the region. This systematic review aimed to synthesize available evidence on the genetic characteristics of bacteria identified in hospital wastewater in West Africa. A systematic review and quantitative synthesis were conducted following PRISMA guidelines. Literature searches were performed in Scopus, PubMed, and Google Scholar databases, in English and French, covering studies published between 2014 and 2025. Studies were included if they reported bacteria isolated from hospital wastewater in any of the 16 West African countries and described resistance genes, virulence genes, or mobile genetic elements. Extracted data were statistically analyzed. Among 412 records identified, 14 studies met the inclusion criteria, mainly from five West African countries. Raw hospital wastewater was 3–4 times more likely to contain multidrug-resistant bacteria than treated effluents. The most frequently reported bacteria were Escherichia coli (87%), Klebsiella pneumoniae (68%), Pseudomonas spp. (45%), and Staphylococcus aureus (42%). Common resistance genes included blaTEM, blaCTX-M,blaNDM, tetA, qnrVC, and mcr-5, frequently associated with integrons, plasmids (Col3M, IncF), and transposons (Tn3). Most hospitals lacked adequate wastewater treatment systems, with 58% discharging untreated wastewater directly into the environment, significantly increasing the genetic load of resistant bacteria. Hospital wastewater in West Africa represents a critical reservoir of multidrug-resistant bacteria carrying resistance and virulence genes that threaten human, animal, and environmental health. Strengthening wastewater treatment infrastructure, surveillance systems, staff training, and regional One Health collaboration is essential to mitigate the spread of antimicrobial resistance.</jats:p>