and the most common clinical manifestations
seem to be otitis, soft tissue infection, bacteremia, and hepatobiliary
infection [43]. The isolation of these pathogens from the
effluent is worrisome because the effluents were collected prior to
contact with the external environment. The increase in the number
of antibiotic resistant bacteria strain in the environment may occur
and multiple antibiotic resistant bacteria may be generated as a
result of selective adaptation and transfer of antibiotic resistanceencoding
plasmid