Resistencia antimicrobiana en enterobacterias por aguas residuales en latinoamérica: una revisión sistemática
DOI:
https://doi.org/10.26871/ceus.v8i1.297Keywords:
Wastewater , Enterobacteriaceae beta-lactamases, Antimicrobial resistanceAbstract
Objective: To analyze the association between wastewater discharge and the presence of antimicrobial resistance in enterobacteria in surface water bodies in Latin America.
Methods: A systematic review of observational and microbiological studies was conducted using PubMed, Scopus, Web of Science, and LILACS. Studies conducted in Latin America that evaluated antimicrobial resistance in enterobacteria associated with wastewater discharge were included (2020-2026).
Results: Narrative synthesis identified E. coli as the predominant microorganism across all water bodies, with multidrug-resistant (MDR) profiles ranging from 91% to 100%. The resistance genes blaCTX-M, blaKPC, blaNDM, and mcr-1 were detected in hospital effluents, wastewater treatment plants (WWTPs), and agricultural irrigation waters, confirming dissemination pathways into the food chain. Conventional treatment systems were found to be insufficient for the removal of clinically relevant antimicrobial resistance genes (ARGs).
Conclusions: Wastewater in Latin America constitutes an active route for the dissemination of antimicrobial resistance, with critical ARGs detected even in matrices intended for human consumption. Environmental surveillance of ARGs should be incorporated into national epidemiological monitoring systems, while regulatory frameworks should be updated and investments in advanced sanitation technologies promoted under the One Health approach.
Registration: This systematic review was registered in the PROSPERO database (CRD420261360509). Available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261360509
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References
1. Soriano-Moreno DR, Yareta J, Rojas-Cosi AF, Fajardo-Loyola A, León-Luna D, Castillo-Quezada I, et al. Efluentes hospitalarios como reservorio de enterobacterias productoras de betalactamasas y carbapenemasas. Rev Peru Med Exp Salud Pública. 14 de abril de 2021;38(2):302-7. doi:10.17843/rpmesp.2021.382.6202
2. Galarde-López M, Velazquez-Meza ME, Bobadilla-del-Valle M, Cornejo-Juárez P, Carrillo-Quiroz BA, Ponce-de-León A, et al. Antimicrobial Resistance Patterns and Clonal Distribution of E. coli, Enterobacter spp. and Acinetobacter spp. Strains Isolated from Two Hospital Wastewater Plants. Antibiotics. 29 de abril de 2022;11(5):601. doi:10.3390/antibiotics11050601
3. Rodríguez EA, Garzón LM, Gómez ID, Jiménez JN. Multidrug resistance and diversity of resistance profiles in carbapenem-resistant Gram-negative bacilli throughout a wastewater treatment plant in Colombia. J Glob Antimicrob Resist. septiembre de 2020;22:358-66. doi:10.1016/j.jgar.2020.02.033
4. Siqueira JAM, Teixeira DM, da Piedade GJL, Souza C de O, Moura TCF, Bahia M de NM, et al. Environmental health of water bodies from a Brazilian Amazon Metropolis based on a conventional and metagenomic approach. J Appl Microbiol. 1 de mayo de 2024;135(5):lxae101. doi:10.1093/jambio/lxae101 PubMed PMID: 38627246.
5. Aguilar-Rangel EJ, Paredes-Cárcamo F, Andrade MD, Contreras-Sánchez D, Rain-Medina V, Campanini-Salinas J, et al. Hospital Wastewater as a Reservoir of Contaminants of Emerging Concern: A Study Report from South America, Chile.
Antibiotics. 4 de noviembre de 2025;14(11):1111. doi:10.3390/antibiotics14111111
6. Urzua-Abad MM, Aquino-Andrade A, Castelan-Vega JA, Merida-Vieyra J, Ribas-Aparicio RM, Belmont-Monroy L, et al. Detection of carbapenemases in
Enterobacterales and other Gram-negative bacilli recovered from hospital and municipal wastewater in Mexico City. Sci Rep. 4 de noviembre de 2024;14(1):26576. doi:10.1038/s41598-024-76824-w PubMed PMID: 39496672; PubMed Central PMCID: PMC11535501.
7. Ruiz SE, Morandini FN, Panzetta ME, Lipari FG, Irrazábal MG, Toselli R, et al. Urban wastewater overflows as hotspots for dissemination of bacteria producing
extended-spectrum β-lactamases and carbapenemases in the Suquía River, Argentina. Front Microbiol. 2025;16:1669531. doi:10.3389/fmicb.2025.1669531 PubMed PMID: 41070122; PubMed Central PMCID: PMC12504239.
8. Ramalho R, Mezzomo LC, Machado W, da Silva Morais Hein C, Müller CZ, da Silva TCB, et al. The occurrence of antimicrobial residues and antimicrobial resistance genes in urban drinking water and sewage in Southern Brazil. Braz J Microbiol Publ Braz Soc Microbiol. septiembre de 2022;53(3):1483-9. doi:10.1007/s42770-022-00786-2 PubMed PMID: 35764766; PubMed Central PMCID: PMC9433623.
9. Aristizábal-Hoyos AM, Rodríguez EA, Arias L, Jiménez JN. High clonal diversity of multidrug-resistant and extended spectrum beta-lactamase-producing Escherichia coli in a wastewater treatment plant. J Environ Manage. 1 de septiembre de 2019;245:37-47. doi:10.1016/j.jenvman.2019.05.073 PubMed PMID: 31150908.
10. Mendoza-Guido B, Rivera-Montero L, Barrantes K, Chacon L. Plasmid and integron-associated antibiotic resistance in Escherichia coli isolated from domestic
wastewater treatment plants. FEMS Microbiol Lett. 10 de enero de 2025;372:fnaf041. doi:10.1093/femsle/fnaf041
11. Montero L, Irazabal J, Cardenas P, Graham JP, Trueba G. Extended-Spectrum
Beta-Lactamase Producing-Escherichia coli Isolated From Irrigation Waters and Produce in Ecuador. Front Microbiol. 2021;12:709418. doi:10.3389/fmicb.2021.709418 PubMed PMID: 34671324; PubMed Central PMCID: PMC8521160.
12. Corrales-Martínez J, Jaramillo K, Tadesse DA, Satán C, Villavicencio FX,
Sánchez-Gavilanes L, et al. Genomic characterization of a WHO critical priority isolate Enterobacter kobei ST2070 harboring OXA-10, KPC-2, and CTX-M-12 recovered from a water irrigation channel in Ecuador. Heliyon. 15 de marzo de 2024;10(5):e26379. doi:10.1016/j.heliyon.2024.e26379 PubMed PMID: 38449644; PubMed Central PMCID: PMC10915343.
13. Medina-Sánchez JR, Salvatierra M, Espino CI, Martínez-Torres AO, Llanes A,
Querol-Audi J. Prevalence and Differential Plasmid Versus Chromosomal Distribution of Ribosome-Targeting Antibiotic Resistance Genes in Escherichia coli Isolates from River and Untreated Wastewater Environments. Antibiotics. 28 de enero de 2026;15(2):132. doi:10.3390/antibiotics15020132 PubMed PMID: 41750430; PubMed Central PMCID: PMC12937253.
14. Rodríguez Guevara GA, Michelangelli E, Medina-Sánchez JR, Mejía-Meléndez F, Espino CI, Moreno P JE, et al. Determination of Phylogroups, Pathotypes and Antibiotic Resistance Profiles of E. coli Isolates from Freshwater and Wastewater in the City of Panama. Pathogens. 20 de junio de 2025;14(7):617. doi:10.3390/pathogens14070617 PubMed PMID: 40732665; PubMed Central PMCID: PMC12299560.
15. Elías Solís GE, Wong Cabanillas O, Hinostroza Cordova R, Mamani Poma MC, Maquera Canales A, Hernandez Gutierrez F, et al. Enterobacterias multidrogoresistentes productoras de betalactamasas de espectro extendido, Ampc y Carbapenemasas aislados de efluentes hospitalarios del Perú. Rev Cuerpo Méd Hosp Nac Almanzor Aguinaga Asenjo. 18 de mayo de 2025;18(1). doi:10.35434/rcmhnaaa.2025.181.2594
16. VanderYacht T, Salinas L, Remerleitch T, Walas N, Ho T, Trueba G, et al. Lack of wastewater treatment in a small town drives the spread of ESBL-producing Escherichia coli in irrigation waters. J Environ Qual. 2024;53(6):1116-26. doi:10.1002/jeq2.20641 PubMed PMID: 39428701.
17. Duran-Bedolla J, Téllez-Sosa J, Bocanegra-Ibarias P, Schilmann A, Bravo-Romero S, Reyna-Flores F, et al. Citrobacter spp. and Enterobacter spp. as reservoirs of carbapenemase blaNDM and blaKPC resistance genes in hospital wastewater. Appl Environ Microbiol. 21 de agosto de 2024;90(8):e0116524. doi:10.1128/aem.01165-24 PubMed PMID: 39012101; PubMed Central PMCID: PMC11337798.
18. Ayzanoa B, Castillo-Vilcahuaman C, Salvatierra G, Dávila-Barclay A, Cuicapuza D, Huancachoque J, et al. Genomic surveillance of multidrug-resistant Escherichia coli and Klebsiella in clinical and wastewater isolates from a paediatric hospital in Lima, Peru. Access Microbiol. 1 de enero de 2026;8(1). doi:10.1099/acmi.0.001006.v3
19. Montenegro K, Flores C, Nascimento APA, Farias BO, Brito ASG, Magaldi M, et al. Occurrence of Klebsiella pneumoniae ST244 and ST11 extensively drug-resistant producing KPC, NDM, OXA-370 in wastewater, Brazil. J Appl Microbiol. 4 de julio de 2023;134(7):lxad130. doi:10.1093/jambio/lxad130 PubMed PMID: 37391364.
20. Gonçalves DLDR, Chang MR, Nobrega GD, Venancio FA, Higa Júnior MG, Fava WS. Hospital sewage in Brazil: a reservoir of multidrug-resistant carbapenemase-producing Enterobacteriaceae. Braz J Biol. 2024;84:e277750. doi:10.1590/1519-6984.277750
21. Lüneberg K, Amábile-Cuevas CF, Mucito-Varela E, Martínez L, Salinas E, López-Vidal Y, et al. Metallo-beta-lactamase-producing Escherichia coli in the sewage of Mexico City: where do they come from? Can J Microbiol. febrero de 2022;68(2):139-45. doi:10.1139/cjm-2021-0284 PubMed PMID: 34662521.
22. Aristizabal-Hoyos AM, Rodríguez EA, Torres-Palma RA, Jiménez JN. Concern levels of beta-lactamase-producing Gram-negative bacilli in hospital wastewater: hotspot of antimicrobial resistance in Latin-America. Diagn Microbiol Infect Dis. enero de 2023;105(1):115819. doi:10.1016/j.diagmicrobio.2022.115819 PubMed PMID:
36242873.
23. Rodríguez EA, Garzón LM, Gómez ID, Jiménez JN. Multidrug resistance and diversity of resistance profiles in carbapenem-resistant Gram-negative bacilli throughout a wastewater treatment plant in Colombia. J Glob Antimicrob Resist. septiembre de 2020;22:358-66. doi:10.1016/j.jgar.2020.02.033
24. Galdamez IA, Jimenez K, Cira M, Osborn K, Ayad M, Lee CM, et al. Evaluating Antibiotic Resistance in Urban Rivers and Coral Reefs of Belize: Evidence for Hotspots and a Potential Screening Tool. GeoHealth. 2026;10(2):e2025GH001427. doi:10.1029/2025GH001427
25. Global action plan on antimicrobial resistance [Internet]. [citado 3 de mayo de 2026]. Disponible en: https://www.who.int/publications/i/item/9789241509763
26. de Oliveira Gomes B, Lima W, Vargas D, de Paiva MC. Aminoglycoside resistance in domestic sewage and clinical Escherichia coli isolates [Internet]. 2023 [citado 2 de mayo de 2026]. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0034-74182022000200625 &nrm=iso
27. Sierra SDJ, Ilzarbe I, Szpunar J, Moles S, Ruiz-Ripa L, Pérez-Etayo L, et al. Contaminantes emergentes y resistencia antimicrobiana en aguas residuales detección, tratamiento y desafíos desde el enfoque One Health. South Health. 24 de febrero de 2026;3:e002-e002. doi:10.21142/SH-03-2026-e002
28. Hossain H, Ahmed S. Hospital wastewater microbiome & resistome: An overlooked one health crisis driving superbugs in low- and middle-income countries (LMICs). New Microbes New Infect. diciembre de 2025;68:101653. doi:10.1016/j.nmni.2025.101653
29. Vallejos I, Pérez G. Impacto socioeconómico de la resistencia a los antimicrobianos: bajo el enfoque Una Salud en Perú y Latinoamérica. Rev Investig Multidisiplinaria Iberoam. 28 de noviembre de 2025. doi:10.69850/rimi.vi4.187
30. Reichert G, Hilgert S, Fuchs S, Azevedo JCR. Emerging contaminants and antibiotic resistance in the different environmental matrices of Latin America. Environ Pollut. diciembre de 2019;255(Pt 1):113140. doi:10.1016/j.envpol.2019.113140 PubMed PMID: 31541833.
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