 This study examined the occurrence of multidrug-resistant E. coli and club-sealer pneumoniae in sewage flowing from a referral hospital through the urban sewage system to the point of discharge in the Indian Ocean. The results showed that 80.9 percent of E. coli and 71.6 percent of K pneumoniae were resistant to multiple drugs with 27.2 percent of the strains showing resistance to four or more classes of antibiotics. Additionally, extended spectrum beta-lactamase production was observed in 40 percent of E. coli and 36.2 percent of K pneumoniae strains. Furthermore, carbon and resistance was detected in 39.6 percent of E. coli and 32.6 percent of K pneumoniae strains. These findings suggest that the sewage released from the hospital poses a serious public health risk due to its potential to spread antimicrobial-resistant pathogens and genes. This article was authored by Nemganga Z. Siguni, Zahora I. Kimira, Frank Musafiri, and others. We are article.tv, links in the description below.