The Silent Spread of Antibiotic-Resistant E. coli in Cemetery Soils of Sana’a City, Yemen: Implications for the One Health Approach

Abstract

Antibiotic?resistant Escherichia coli (E. coli) in environmental reservoirs represent an emerging One health concern, yet cemetery soils remain largely overlooked. This study aimed to determine E. coli prevalence and characterize resistance profiles in 115 soil samples collected from ten cemeteries (A–J) in Sana’a City, Yemen. E. coli was recovered from 44% (50/115) of samples, with prevalence varying markedly between sites, ranging from 0% (cemetery I) to 89% (cemetery F), reflecting spatial heterogeneity likely related to site-specific environmental factors. Antibiotic susceptibility testing of **50 selected isolates** against 15 clinically important antibiotics revealed high resistance to ?-lactams [Ampicillin/Sulbactam (78%), Cefotaxime (89%), Amoxicillin/clavulanate (55%)], fluoroquinolones (Ciprofloxacin 69%, Levofloxacin 65%), Doxycycline (93%), sulfonamides, and phenicols. Meropenem retained high activity (92% susceptible); Gentamicin and Ceftolozane/Tazobactam showed moderate susceptibility (70–80%). Phenotypic analysis confirmed 82% ESBL producers (double-disc synergy test), 52% MDR (non-susceptibility to ?3 classes), and 12% suspected pre-XDR strains. These findings confirm cemetery soils in Sana'a as significant reservoirs of ESBL/MDR E. coli within Yemen's One Health continuum. The data justify integrating cemetery environments into national AMR surveillance, with priorities for monitoring high-prevalence sites and protecting nearby groundwater resources.