Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals

Occurrence of emerging contaminants in three river basins impacted by wastewater treatment plant effluents: Spatio-seasonal patterns and environmental risk assessment

The concern on the fate and distribution of contaminants of emerging concern (CECs) is a burning topic due to their widespread occurrence and potential harmful effects. Particularly, antibiotics have received great attention due to their implications in antimicrobial resistance occurrence. The impact of wastewater treatment plants (WWTP) is remarkable, being one of the main pathways for the introduction of CECs into aquatic systems. The combination of novel analytical methodologies and risk assessment strategies is a promising tool to find out environmentally relevant compounds posing major concerns in freshwater ecosystems impacted by those wastewater effluents. Within this context, a multi-target approach was applied in three Spanish river basins affected by different WWTP treated effluents for spatio-temporal monitoring of their chemical status. Solid phase extraction followed by ultra-high-performance liquid chromatography were used for the quantification of a large panel of compounds (n = 270), including pharmaceuticals and other consumer products, pesticides and industrial chemicals. To this end, water samples were collected in four sampling campaigns at three locations in each basin: (i) upstream from the WWTPs; (ii) WWTP effluent discharge points (effluent outfall); and (iii) downstream from the WWTPs (500 m downriver from the effluent outfall). Likewise, 24-h composite effluent samples from each of the WWTPs were provided in all sampling periods. First the occurrence and distribution of these compounds were assessed. Diverse seasonal trends were observed depending on the group of emerging compounds, though COVID-19 outbreak affected variations of certain pharmaceuticals. Detection frequencies and concentrations in effluents generally exceeded those in river samples and concentrations measured upstream WWTPs were generally low or non-quantifiable. Finally, risks associated with maximum contamination levels were evaluated using two different approaches to account for antibiotic resistance selection as well. From all studied compounds, 89 evidenced environmental risk on at least one occasion in this study.

Environmental fluoxetine promotes skin cell proliferation and wound healing

This study investigates the effects of environmentally-relevant concentrations of fluoxetine (FLX, commercial name: Prozac) on wound healing. Pollution of water systems with pharmaceutical and personal care products, including antidepressants such as FLX and other selective serotonin reuptake inhibitors, is a growing environmental concern. Environmentally-relevant FLX concentrations are known to impact physiological functions and behaviour of aquatic animals, however, the effects of exposure on humans are currently unknown. Using a combination of human skin biopsies and a human keratinocyte cell line, we show that exposure to environmental FLX promotes wound closure. We show dose-dependent increases in wound closure with FLX concentrations from 125 ng/l. Using several -omics and pharmaceutical approaches, we demonstrate that the mechanisms underlying enhanced wound closure are increased cell proliferation and serotonin signalling. Transcriptomic analysis revealed 350 differentially expressed genes after exposure. Downregulated genes were enriched in pathways related to mitochondrial function and metabolism, while upregulated genes were associated with cell proliferation and tissue morphogenesis. Kinase profiling showed altered phosphorylation of kinases linked to the MAPK pathway. Consistent with this, phosphoproteomic analyses identified 235 differentially phosphorylated proteins after exposure, with enriched GO terms related to cell cycle, division, and protein biosynthesis. Treatment of skin biopsies and keratinocytes with ketanserin, a serotonin receptor antagonist, reversed the increase in wound closure observed upon exposure. These findings collectively show that exposure to environmental FLX promotes wound healing through modulating serotonin signalling, gene expression and protein phosphorylation, leading to enhanced cell proliferation. Our results justify a transition from the study of behavioural effects of environmental FLX in aquatic animals to the investigation of effects of exposure on wound healing in aquatic and terrestrial animals, including direct impacts on human health.

Challenges and effective tracking down strategies of antibiotic contamination in aquatic ecosystem

A growing environmental concern revolves around the widespread use of medicines, particularly antibiotics, which adversely impact water quality and various life forms. The unregulated production and utilization of antibiotics not only affect non-targeted organisms but also exert significant evolutionary pressures, leading to the rapid development of antimicrobial resistance (AMR) in bacterial communities. To address this issue, global studies have been conducted to assess the prevalence and quantities of antibiotics in various environmental components including freshwater, ocean, local sewage, and fish. These studies aim to establish effective analytical methods for identifying and measuring antibiotic residues in environmental matrices that might enable authorities to establish norms for the containment and disposal of antibiotics. This article offers a comprehensive overview of methods used to extract antibiotics from environmental matrices exploring purification techniques such as liquid-liquid extraction, solid-phase extraction, green extraction techniques, and concentration methods like lyophilization and rotary evaporation. It further highlights qualitative and quantitative analysis methods, high-performance liquid chromatography, ultra-high-performance liquid chromatography, and liquid chromatography-tandem along with analytical methods such as UV-Vis and tandem mass spectrometry for detecting and measuring antibiotics. Urgency is underscored for proactive strategies to curb antibiotic contamination, safeguarding the integrity of aquatic ecosystems and public health on a global scale.

Citrobacter spp. and Enterobacter spp. as reservoirs of carbapenemase blaNDM and blaKPC resistance genes in hospital wastewater

Antibiotic resistance has emerged as a global threat to public health, generating a growing interest in investigating the presence of antibiotic-resistant bacteria in environments influenced by anthropogenic activities. Wastewater treatment plants in hospital serve as significant reservoirs of antimicrobial-resistant bacteria, where a favorable environment is established, promoting the proliferation and transfer of resistance genes among different bacterial species. In our study, we isolated a total of 243 strains from 5 hospital wastewater sites in Mexico, belonging to 21 distinct Gram-negative bacterial species. The presence of β-lactamase was detected in 46.9% (114/243) of the isolates, which belonging to the Enterobacteriaceae family. We identified a total of 169 β-lactamase genes; blaTEM in 33.1%, blaCTX-M in 25.4%, blaKPC in 25.4%, blaNDM 8.8%, blaSHV in 5.3%, and blaOXA-48 in 1.1% distributed in 12 different bacteria species. Among the 114 of the isolates, 50.8% were found to harbor at least one carbapenemase and were discharged into the environment. The carbapenemase blaKPC was found in six Citrobacter spp. and E. coli, while blaNDM was detected in two distinct Enterobacter spp. and E. coli. Notably, blaNDM-1 was identified in a 110 Kb IncFII conjugative plasmid in E. cloacae, E. xiangfangensis, and E. coli within the same hospital wastewater. In conclusion, hospital wastewater showed the presence of Enterobacteriaceae carrying a high frequency of carbapenemase blaKPC and blaNDM. We propose that hospital wastewater serves as reservoirs for resistance mechanism within bacterial communities and creates an optimal environment for the exchange of this resistance mechanism among different bacterial strains.

IMPORTANCE

The significance of this study lies in its findings regarding the prevalence and diversity of antibiotic-resistant bacteria and genes identified in hospital wastewater in Mexico. The research underscores the urgent need for enhanced surveillance and prevention strategies to tackle the escalating challenge of antibiotic resistance, particularly evident through the elevated frequencies of carbapenemase genes such as blaKPC and blaNDM within the Enterobacteriaceae family. Moreover, the identification of these resistance genes on conjugative plasmids highlights the potential for widespread transmission via horizontal gene transfer. Understanding the mechanisms of antibiotic resistance in hospital wastewater is crucial for developing targeted interventions aimed at reducing transmission, thereby safeguarding public health and preserving the efficacy of antimicrobial therapies.

Antibiotic residue contamination in the aquatic environment, sources and associated potential health risks

Antibiotic residues are widely recognized as major pollutants in the aquatic environment on a global scale. As a significant class of pharmaceutically active compounds (PhACs), antibiotics are extensively consumed worldwide. The primary sources of these residues include hospitals, municipal sewage, household disposal, and manures from animal husbandry. These residues are frequently detected in surface and drinking waters, sewage effluents, soils, sediments, and various plant species in countries such as China, Japan, South Korea, Europe, the USA, Canada, and India. Antibiotics are used medicinally in both humans and animals, with a substantial portion excreted into the environment as metabolites in feces and urine. With the advancement of sensitive and quantitative analytical techniques, antibiotics are consistently reported in environmental matrices at concentrations ranging from nanograms per liter (ng/L) to milligrams per liter (mg/L). Agricultural soils, in particular, serve as a significant reservoir for antibiotic residues due to their strong particle adsorption capacities. Plants grown in soils irrigated with PhAC-contaminated water can uptake and accumulate these pharmaceuticals in various tissues, such as roots, leaves, and fruits, raising serious concerns regarding their consumption by humans and animals. There is an increasing need for research to understand the potential human health risks associated with the accumulation of antibiotics in the food chain. The present reviews aims to shed light on the rising environmental pharmaceutical contamination concerns, their sources in the environment, and the potential health risks as well as remediation effort. To discuss the main knowledge gaps and the future research that should be prioritized to achieve the risk assessment. We examined and summarized the available data and information on the antibiotic resistance associated with antibiotic residues in the environment. As studies have indicated that vegetables can absorb, transport, and accumulate antibiotics in edible parts when irrigated with wastewater that is either inadequately treated or untreated. These residues and their metabolites can enter the food chain, with their persistence, bioaccumulation, and toxicity contributing to drug resistance and adverse health effects in living organisms.

Seawater Chlorella sp. biofilm for mariculture effluent polishing under environmental combined antibiotics exposure and ecological risk evaluation based on parent antibiotics and transformation products

Mariculture effluent polishing with microalgal biofilm could realize effective nutrients removal and resolve the microalgae-water separation issue via biofilm scraping or in-situ aquatic animal grazing. Ubiquitous existence of antibiotics in mariculture effluents may affect the remediation performances and arouse ecological risks. The influence of combined antibiotics exposure at environment-relevant concentrations towards attached microalgae suitable for mariculture effluent polishing is currently lack of research. Results from suspended cultures could offer limited guidance since biofilms are richer in extracellular polymeric substances that may protect the cells from antibiotics and alter their transformation pathways. This study, therefore, explored the effects of combined antibiotics exposure at environmental concentrations towards seawater Chlorella sp. biofilm in terms of microalgal growth characteristics, nutrients removal, anti-oxidative responses, and antibiotics removal and transformations. Sulfamethoxazole (SMX), tetracycline (TL), and clarithromycin (CLA) in single, binary, and triple combinations were investigated. SMX + TL displayed toxicity synergism while TL + CLA revealed toxicity antagonism. Phosphorus removal was comparable under all conditions, while nitrogen removal was significantly higher under SMX and TL + CLA exposure. Anti-oxidative responses suggested microalgal acclimation towards SMX, while toxicity antagonism between TL and CLA generated least cellular oxidative damage. Parent antibiotics removal was in the order of TL (74.5-85.2 %) > CLA (60.8-69.5 %) > SMX (13.5-44.1 %), with higher removal efficiencies observed under combined than single antibiotic exposure. Considering the impact of residual parent antibiotics, CLA involved cultures were identified of high ecological risks, while medium risks were indicated in other cultures. Transformation products (TPs) of SMX and CLA displayed negligible aquatic toxicity, the parent antibiotics themselves deserve advanced removal. Four out of eight TPs of TL could generate chronic toxicity, and the elimination of these TPs should be prioritized for TL involved cultures. This study expands the knowledge of combined antibiotics exposure upon microalgal biofilm based mariculture effluent polishing.

Occurrence and environmental risk assessment of pharmaceuticals in the Mondego river (Portugal)

In this case study pharmaceuticals were analysed in the Mondego river (Portugal) and their environmental risk assessed by means of risk quotients based on an extensive retrieval of ecotoxicological data for freshwater and saltwater species. The Mondego river crosses Coimbra, the most populated city in the Portuguese Centro Region hosting a complex of regional hospitals. Environmentally relevant and prioritised pharmaceuticals were investigated in this study and their potential hazards were evaluated by conducting a separate risk assessment for the freshwater and estuary parts of the examined river section. A target analysis approach with method detection limits down to 0.01 ng L-1 was used to determine pharmaceuticals. Twenty-one prioritised target analytes out of seven therapeutical classes (antibiotics, iodinated X-ray contrast media (ICM), analgesics, lipid reducers, antiepileptics, anticonvulsants, beta-blockers) were investigated by applying ultra-high pressure liquid chromatography coupled to a triple quadrupole mass spectrometer equipped with an electrospray ionisation source. The relative pattern of pharmaceuticals along the middle to the lower Mondego showed a quite uniform picture while an approximately 40fold increase of absolute concentrations was observed downstream of the wastewater treatment plant (WWTP) discharge of Coimbra. The most frequently measured substance groups were the ICM, represented by the non-ionic ICM iopromide (βmin: 3.03 ng L-1 - βmax: 2,810 ng L-1). Environmentally more critical substances such as carbamazepine, diclofenac, and bezafibrate, with concentrations up to and 52.6 ng L-1, 59.8 ng L-1, and 10.2 ng L-1 respectively, may potentially affect aquatic wildlife. Carbamazepine revealed elevated risk quotients (RQs >1) along the middle and lower Mondego with a maximum RQ of 53 downstream of Coimbra. Especially for saltwater species, carbamazepine and clarithromycin pose high potential risks. Especially in periods of low water discharge of the Mondego river, other pharmaceuticals as diclofenac and bezafibrate may pose additional risks downstream of the WWTP.

Waterborne atenolol disrupts neurobehavioral and neurochemical responses in adult zebrafish

Environmental contamination by pharmaceuticals from industrial waste and anthropogenic activities poses adverse health effects on non-target organisms. We evaluated the neurobehavioral and biochemical responses accompanying exposure to ecological relevant concentrations of atenolol (0, 0.1, 1.0, and 10 µg/L) for seven uninterrupted days in adult zebrafish (Danio rerio). Atenolol-exposed fish exhibited anxiety-like behavior, characterized by significant bottom-dwelling with marked reduction in vertical exploration. Atenolol-exposed fish exhibited marked increase in the duration and frequency of aggressive events without altering their preference for conspecifics. Biochemical data using brain samples indicated that atenolol disrupted antioxidant enzyme activities and induced oxidative stress. Exposure to atenolol markedly decreased ATP and AMP hydrolysis without affecting ADP hydrolysis and acetylcholinesterase (AChE) activity. Atenolol significantly upregulated tryptophan hydroxylase 1 (tph1) mRNA expression but downregulated brain-derived neurotrophic factor (bdnf) mRNA. Collectively, waterborne atenolol elicits aggressive and anxiety-like responses in adult zebrafish, accompanied by oxidative stress, reduced nucleotide hydrolysis, altered tph1 and bdnf mRNA expression, which may impact the survival and health of fish in aquatic environment.

Occurrence of pharmaceuticals in Latin America: case study on hazard assessment and prioritization in Costa Rica

Pharmaceuticals are considered as contaminants of emerging concern, and their occurrence in diverse environmental matrices has been described during the last 25 years. Nonetheless, pharmaceutical occurrence has not been evenly described worldwide, and reports from some geographical areas such as most parts of Latin America are scarce. This work aims to address the situation of water pollution due to pharmaceuticals in Latin America by means of two main goals: i. First, reviewing the monitoring studies performed in Latin America on this topic (period 2009-2024), which were conducted in Brazil, Mexico, Colombia, Ecuador, Peru and Argentina, to highlight the most frequently detected compounds from each therapeutic group in the region. ii. Second, analyzing the case of Costa Rica through the hazard assessment and prioritization of pharmaceuticals based on the monitoring performed in this country (years 2011; 2018-2019). The monitoring in Costa Rica comprised a total of 163 sampling points: wastewater treatment plants (WWTPs) (14 urban WWTPs plus two landfill WWTPs; total samples n = 44 influents and n = 34 effluents), nine hospital effluents (n = 32), wastewater from livestock farms (six swine farms and seven dairy farms; n = 23 influents and n = 37 effluents), 64 continental surface water sampling points (n = 137), and 61 coastal seawater sampling points (n = 61). Risk assessment of detected concentrations by the hazard quotient (HQ) approach (period 2018-2019) revealed a total of 25 medium or high-hazard compounds (out of 37 detected compounds). The prioritization approach (which included the Frequency of Appearance (FoA), the Frequency of PNEC exceedance (FoE), and the Extent of predicted no-effect concentration (PNEC) exceedance (EoE)), showed a critical list of nine pharmaceuticals: caffeine, diphenhydramine, acetaminophen, lovastatin, gemfibrozil, ciprofloxacin, ibuprofen, doxycycline and norfloxacin. These compounds should be taken into account as a first concern during the implementation of environmental policies related to pharmaceutical products in the region.

Antipsychotic drug-induced behavioral abnormalities in common carp: The potential involvement of the gut microbiota-brain axis

The effects of antipsychotic drugs on aquatic organisms have received widespread attention owing to their widespread use and continued release in aquatic environments. The toxicological effects of antipsychotics on aquatic organisms, particularly fish, are unexplored, and the underlying mechanisms remain unelucidated. This study aimed to use common carp to explore the effects of antipsychotics (olanzapine [OLA] and risperidone [RIS]) on behavior and the potential mechanisms driving these effects. The fish were exposed to OLA (0.1 and 10 μg/L) and RIS (0.03 and 3 μg/L) for 60 days. Behavioral tests and neurological indicators showed that exposure to antipsychotics could cause behavioral abnormalities and neurotoxicity in common carp. Further, 16 S rRNA sequencing revealed gut microbiota alteration and decreased relative abundance of some strains related to SCFA production after OLA and RIS exposure. Subsequently, a pseudo-sterile common carp model was successfully constructed, and transplantation of the gut microbiota from antipsychotic-exposed fish caused behavioral abnormalities and neurotoxicity in pseudo-sterile fish. Further, SCFA supplementation demonstrated that SCFAs ameliorated the behavioral abnormalities and neurological damage caused by antipsychotic exposure. To our knowledge, the present study is the first to investigate the effects of antipsychotics on various complex behaviors (swimming performance and social behavior) in common carp, highlighting the potential health risks associated with antipsychotic drug-induced neurotoxicity in fish. Although these results do not fully elucidate the mechanisms underlying the effects of antipsychotic drugs on fish behavior, they serve as a valuable initial investigation and form the basis for future research.

A Review on Fluoroquinolones' Toxicity to Freshwater Organisms and a Risk Assessment

Fluoroquinolones (FQs) have achieved significant success in both human and veterinary medicine. However, regulatory authorities have recommended limiting their use, firstly because they can have disabling side effects; secondly, because of the need to limit the spread of antibiotic resistance. This review addresses another concerning consequence of the excessive use of FQs: the freshwater environments contamination and the impact on non-target organisms. Here, an overview of the highest concentrations found in Europe, Asia, and the USA is provided, the sensitivity of various taxa is presented through a comparison of the lowest EC50s from about a hundred acute toxicity tests, and primary mechanisms of FQ toxicity are described. A risk assessment is conducted based on the estimation of the Predicted No Effect Concentration (PNEC). This is calculated traditionally and, in a more contemporary manner, by constructing a normalized Species Sensitivity Distribution curve. The lowest individual HC5 (6.52 µg L-1) was obtained for levofloxacin, followed by ciprofloxacin (7.51 µg L-1), sarafloxacin and clinafloxacin (12.23 µg L-1), and ofloxacin (17.12 µg L-1). By comparing the calculated PNEC with detected concentrations, it is evident that the risk cannot be denied: the potential impact of FQs on freshwater ecosystems is a further reason to minimize their use.

Enhanced degradation of ciprofloxacin in water using ternary photocatalysts TiO2/SnO2/g-C3N4 under UV, visible, and solar light

In this study, we report on the synthesis of ternary photocatalysts comprising TiO2/SnO2/g-C3N4 for the degradation of ciprofloxacin (CIP) in water. SnO2 nanoparticles were synthesized via the sol-gel method, while g-C3N4 was obtained through melamine calcination. Commercial TiO2 and SnO2 nanopowders were also used. The heterojunctions were synthesized via the wet impregnation method. The photocatalysts were characterized via various techniques, including XRD, TEM, STEM, FTIR, N2 adsorption, UV-Vis DR, and hole tests. Photocatalytic degradation tests of CIP were carried out under UV, visible, and solar radiation. The P25/npA/g-C3N4 (90/10) material exhibited the best performance, achieving CIP degradation of over 97%. The synthesized materials demonstrated excellent initial adsorption of CIP, around 30%, which facilitated subsequent degradation. Notably, the CIP photocatalytic degradation tests performed under solar radiation showed a synergistic effect between the base materials and carbon nitride in highly energetic environments. These results highlight the effectiveness of ternary photocatalysts TiO2/SnO2/g-C3N4 for CIP degradation, particularly under solar radiation.

Elucidating the enhanced role of carbonate radical in propranolol degradation by UV/peroxymonosulfate system

Carbonate radical (CO3•-) has been proved to be an important secondary radical in advanced oxidation processes due to various radical reactions involved HCO3-/CO32-. However, the roles and contributions of CO3•- in organic micropollutant degradation have not been explored systematically. Here, we quantified the impact of CO3•- on the degradation kinetics of propranolol, a representative pollutant in the UV/peroxymonosulfate (PMS) system, by constructing a steady-state radical model. Substantially, the measured values were coincident with the predictive values, and the contributions of CO3•- on propranolol degradation were the water matrix-dependent. Propranolol degradation increased by 130% in UV/PMS system containing 10 mM HCO3-, and the contribution of CO3•- was as high as 58%. Relatively high pH values are beneficial for propranolol degradation in pure water containing HCO3-, and the contributions of CO3•- also enhanced, while an inverse phenomenon was shown for the effects of propranolol concentrations. Dissolved organic matter exhibited significant scavenging effects on HO•, SO4•-, and CO3•-, substantially retarding the elimination process. The developed model successfully predicted oxidation degradation kinetics of propranolol in actual sewage, and CO3•- contribution was up to 93%, which in indicative of the important role of CO3•- in organic micropollutant removal via AOPs treatment.

Determination of antibiotics during treatment of hospital wastewater using automated solid-phase extraction followed by UHPLC-MS: occurrence, removal and environmental risks

The extent of removal of pharmaceuticals by African-based wastewater treatment plants (WWTPs) is relatively unknown with various studies observing high concentrations in effluents. This is mainly due to WWTPs still utilising the traditional treatment methods which are known to be less effective. In this study, 15 selected antibiotics (amoxicillin, ampicillin, azithromycin, ciprofloxacin, doxycycline, erythromycin, gentamicin, metronidazole, norfloxacin, ofloxacin, penicillin, sulfamethoxazole, sulfapyridine, tetracycline and trimethoprim) were monitored in wastewater as it goes through sedimentation (primary and secondary), aeration and chlorination stages of a WWTP. Analytical method involved solid-phase extraction followed by liquid chromatographic determination. Removal efficiencies during sedimentation were generally positive with doxycycline achieving 80-95.8%, while negative removal efficiencies were observed for penicillin V (-46.4 to -17.1%) and trimethoprim (-26.2 to -18.9%). The aeration and agitation stage resulted in concentration enhancement for several antibiotics with seven of them ranging between -273 and -15.5%. This stage was responsible for the relatively low overall removal efficiencies in which only 4 antibiotics (doxycycline, tetracycline, ciprofloxacin, and erythromycin) experienced overall removal efficiencies above 50%. The recorded effluent concentrations ranging between 0.0130 and 0.383 ng/mL were translated to low potential for development of antibiotic resistance genes in the receiving environments while ecotoxicity risk was high for only amoxicillin, ampicillin and sulfapyridine. The study has provided an overview of the performance of common wastewater treatment processes in South Africa and hopes that more monitoring and environmental risk data can be made available towards drafting of antibiotic priority lists that cater for Africa.

Environmental risk assessment of selected pharmaceuticals in hospital wastewater in nothern Vietnam

Pharmaceuticals are progressively employed in both human and veterinary medicine and increasingly recognized as environmental contaminants. This study investigated the occurrence of selected pharmaceuticals in influent and effluent of wastewater treatment plants of 12 hospitals in Hanoi and 3 northern cities of Vietnam during dry and rainy seasons. In addition, environmental risk of pharmaceuticals in both hospital influents and effluents were evaluated based on risk quotients (RQs). Nine selected pharmaceutical compounds including sulfamethoxazole (SMX), naproxen (NPX), diclofenac (DCF), ibuprofen (IBU), acetaminophen (ACT), carbamazepine (CBM), iopromide (IOP), atenolol (ATN), and caffeine (CAF) were frequently detected in most influent and effluent wastewaters of 12 investigated hospitals. Detected compound levels exhibited a wide range, from as low as 1 ng/L for DCF to as high as 61,772 ng/L for ACT. Among these compounds, ACT, CAF, SMX, and IOP were consistently detected at substantial concentrations in both influents and effluents. This investigation also highlighted potential risks posed by SMX, ACT, and CAF residues present in influents and effluents of hospital wastewater treatment plants (WWTPs) to aquatic ecosystem. These finding are expected to provide scientific-based evidence for the development of hospital waste management and environmental management programs in Vietnam.

Comprehensive analysis of a widely pharmaceutical, furosemide, and its degradation products in aquatic systems: Occurrence, fate, and ecotoxicity

Many pharmaceutical compounds end up in the environment due to incomplete removal by wastewater treatment plants (WWTPs). Some compounds are sometimes present in significant concentrations and therefore represent a risk to the aquatic environment. Furosemide is one of the most widely used drugs in the world. Considered as an essential drug by the World Health Organization, this powerful loop diuretic is used extensively to treat hypertension, heart and kidney failure and many other purposes. However, this important consumption also results in a significant release of furosemide in wastewater and in the receiving environment where concentrations of a few hundred ng/L to several thousand have been found in the literature, making furosemide a compound of great concern. Also, during its transport in wastewater systems and WWTPs, furosemide can be degraded by various processes resulting in the production of more than 74 by-products. Furosemide may therefore present a significant risk to ecosystem health due not only to its direct cytotoxic, genotoxic and hepatotoxic effects in animals, but also indirectly through its transformation products, which are poorly characterized. Many articles classify furosemide as a priority pollutant according to its occurrence in the environment, its persistence, its elimination by WWTPs, its toxicity and ecotoxicity. Here, we present a state-of-the-art review of this emerging pollutant of interest, tracking it, from its consumption to its fate in the aquatic environment. Discussion points include the occurrence of furosemide in various matrices, the efficiency of many processes for the degradation of furosemide, the subsequent production of degradation products following these treatments, as well as their toxicity.

Biotransformation activities of fungal strain apiotrichum sp. IB-1 to ibuprofen and naproxen

Ibuprofen (IBU) and naproxen (NPX), as widely prescribed non-steroidal anti-inflammatory drugs (NSAIDs), are largely produced and consumed globally, leading to frequent and ubiquitous detection in various aqueous environments. Previously, the microbial transformation of them has been given a little attention, especially with the isolated fungus. A yeast-like Apiotrichum sp. IB-1 has been isolated and identified, which could simultaneously transform IBU (5 mg/L) and NPX (2.5 mg/L) with maximum efficiencies of 95.77% and 88.31%, respectively. For mono-substrate, the transformation efficiency of IB-1 was comparable to that of co-removal conditions, higher than most of isolates so far. IBU was oxidized mainly through hydroxylation (m/z of 221, 253) and NPX was detoxified mainly via demethylation (m/z of 215) as shown by UPLC-MS/MS results. Based on transcriptome analysis, the addition of IBU stimulated the basic metabolism like TCA cycle. The transporters and respiration related genes were also up-regulated accompanied with higher expression of several dehydrogenase, carboxylesterase, dioxygenase and oxidoreductase encoding genes, which may be involved in the transformation of IBU. The main functional genes responsible for IBU and NPX transformation for IB-1 should be similar in view of previous studies, which needs further confirmation. This fungus would be useful for potential bioremediation of NSAIDs pollution and accelerate the discovery of functional oxidative genes and enzymes different from those of bacteria.

Green synthesis of BiVO4/Eco-graphene nanostructures for the elimination of sulfamethoxazole by adsorption and photo-degradation using blue LED light

Photo-catalysts based on BiVO4 (BV) and Eco-graphene (EG) were synthesized and obtained in a single step with high-quality properties. These nanostructures (NEs) were obtained through a green chemistry route and by adding 2, 3, and 5 wt% of a homemade EG. The BV/X EG NEs (where X = corresponds to the weight % of EG) demonstrated high photocatalytic activity, obtaining Sulfamethoxazole degradation percentages of 40, 45, 52, and 57 for BV, BV/2 EG, BV/3 EG, and BV/5 EG respectively, using a blue LED light. In addition, it was observed that the presence of EG slightly affected the surface area and porosity of BV. Moreover, it was observed that the presence of EG stabilized the scheelite monoclinic phase (m-s), and decreased the crystal size and band-gap values of BV-based samples. It was detected that EG contents increased the BV reduction, creating oxygen vacancies and V4+ states, which favored electron transfer, enhanced the photo-catalytic activity, and decreased the recombination rate. The adsorption influence of the BV/EG system was also studied. Finally, the stability tests of these materials after four cycles of reuse allowed keeping practically the full degradation capacity, demonstrating that these NEs represent a promising material driven by visible light that can be used for wastewater decontamination in the presence of drugs.

An assessment and characterization of pharmaceuticals and personal care products (PPCPs) within the Great Lakes Basin: Mussel Watch Program (2013-2018)

Defining the environmental occurrence and distribution of chemicals of emerging concern (CECs), including pharmaceuticals and personal care products (PPCPs) in coastal aquatic systems, is often difficult and complex. In this study, 70 compounds representing several classes of pharmaceuticals, including antibiotics, anti-inflammatories, insect repellant, antibacterial, antidepressants, chemotherapy drugs, and X-ray contrast media compounds, were found in dreissenid mussel (zebra/quagga; Dreissena spp.) tissue samples. Overall concentration and detection frequencies varied significantly among sampling locations, site land-use categories, and sites sampled proximate and downstream of point source discharge. Verapamil, triclocarban, etoposide, citalopram, diphenhydramine, sertraline, amitriptyline, and DEET (N,N-diethyl-meta-toluamide) comprised the most ubiquitous PPCPs (> 50%) detected in dreissenid mussels. Among those compounds quantified in mussel tissue, sertraline, metformin, methylprednisolone, hydrocortisone, 1,7-dimethylxanthine, theophylline, zidovudine, prednisone, clonidine, 2-hydroxy-ibuprofen, iopamidol, and melphalan were detected at concentrations up to 475 ng/g (wet weight). Antihypertensives, antibiotics, and antidepressants accounted for the majority of the compounds quantified in mussel tissue. The results showed that PPCPs quantified in dreissenid mussels are occurring as complex mixtures, with 4 to 28 compounds detected at one or more sampling locations. The magnitude and composition of PPCPs detected were highest for sites not influenced by either WWTP or CSO discharge (i.e., non-WWTPs), strongly supporting non-point sources as important drivers and pathways for PPCPs detected in this study. As these compounds are detected at inshore and offshore locations, the findings of this study indicate that their persistence and potential risks are largely unknown, thus warranting further assessment and prioritization of these emerging contaminants in the Great Lakes Basin.

Does Environmental Exposure to Pharmaceutical and Personal Care Product Residues Result in the Selection of Antimicrobial-Resistant Microorganisms, and is this Important in Terms of Human Health Outcomes?

The environment plays a critical role in the development, dissemination, and transmission of antimicrobial resistance (AMR). Pharmaceuticals and personal care products (PPCPs) enter the environment through direct application to the environment and through anthropogenic pollution. Although there is a growing body of evidence defining minimal selective concentrations (MSCs) of antibiotics and the role antibiotics play in horizontal gene transfer (HGT), there is limited evidence on the role of non-antibiotic PPCPs. Existing data show associations with the development of resistance or effects on bacterial growth rather than calculating selective endpoints. Research has focused on laboratory-based systems rather than in situ experiments, although PPCP concentrations found throughout wastewater, natural water, and soil environments are often within the range of laboratory-derived MSCs and at concentrations shown to promote HGT. Increased selection and HGT of AMR by PPCPs will result in an increase in total AMR abundance in the environment, increasing the risk of exposure and potential transmission of environmental AMR to humans. There is some evidence to suggest that humans can acquire resistance from environmental settings, with water environments being the most frequently studied. However, because this is currently limited, we recommend that more evidence be gathered to understand the risk the environment plays in regard to human health. In addition, we recommend that future research efforts focus on MSC-based experiments for non-antibiotic PPCPS, particularly in situ, and investigate the effect of PPCP mixtures on AMR. Environ Toxicol Chem 2024;43:623-636. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

A thorough analysis of the occurrence, removal and environmental risks of organic micropollutants in a full-scale hybrid membrane bioreactor fed by hospital wastewater

The Urban Wastewater Treatment Directive recent draft issued last October 2022 pays attention to contaminants of emerging concern including organic micropollutants (OMPs) and requires the removal of some of them at large urban wastewater treatment plants (WWTPs) calling for their upgrading. Many investigations to date have reported the occurrence of a vast group of OMPs in the influent and many technologies have been tested for their removal at a lab- or pilot-scale. Moreover, it is well-known that hospital wastewater (HWW) contains specific OMPs at high concentration and therefore its management and treatment deserves attention. In this study, a 1-year investigation was carried out at a full-scale membrane bioreactor (MBR) treating mainly HWW. To promote the removal of OMPs, powdered activated carbon (PAC) was added to the bioreactor at 0.1 g/L and 0.2 g/L which resulted in the MBR operating as a hybrid MBR. Its performance was tested for 232 target and 90 non-target OMPs, analyzed by UHPLC-QTOF-MS using a direct injection method. A new methodology was defined to select the key compounds in order to evaluate the performance of the treatments. It was based on their frequency, occurrence, persistence to removal, bioaccumulation and toxicity. Finally, an environmental risk assessment of the OMP residues was conducted by means of the risk quotient approach. The results indicate that PAC addition increased the removal of most of the key OMPs (e.g., sulfamethoxazole, diclofenac, lidocaine) and OMP classes (e.g., antibiotics, psychiatric drugs and stimulants) with the highest loads in the WWTP influent. The hybrid MBR also reduced the risk in the receiving water as the PAC dosage increased mainly for spiramycin, lorazepam, oleandomycin. Finally, uncertainties and issues related to the investigation being carried out at full-scale under real conditions are discussed.

Selected widely prescribed pharmaceuticals: toxicity of the drugs and the products of their photochemical degradation to aquatic organisms

Cholesterol-lowering drugs, antidiabetics, antiarrhythmics, antidepressants, and antibiotics belong to the most prescribed drugs worldwide. Because of the manufacture, excretion, and improper disposal of leftover drugs, the drugs enter waste waters and, subsequently, surface waters. They have been detected in surface waters all over the world, from concentrations of ng/l to concentrations several orders of magnitude higher. Since pharmaceuticals are designed to be both biologically and chemically stable, photochemical degradation by sun radiation represents a way of transformation in the natural environment. This review provides a survey of how selected drugs of the above-mentioned classes affect aquatic organisms of different trophic level. The emphasis is on the harmful effects of phototransformation products, an area of scientific investigation that has only attracted attention in the past few years, revealing the surprising fact that products of photochemical degradation might be even more toxic to aquatic organisms than the parent drugs.

Efficacy of new generation biosorbents for the sustainable treatment of antibiotic residues and antibiotic resistance genes from polluted waste effluent

Antimicrobials are frequently used in both humans and animals for the treatment of bacterially-generated illnesses. Antibiotic usage has increased for more than 40% from last 15 years globally per day in both human populations and farm animals leading to the large-scale discharge of antibiotic residues into wastewater. Most antibiotics end up in sewer systems, either directly from industry or healthcare systems, or indirectly from humans and animals after being partially metabolized or broken down following consumption. To prevent additional antibiotic compound pollution, which eventually impacts on the spread of antibiotic resistance, it is crucial to remove antibiotic residues from wastewater. Antibiotic accumulation and antibiotic resistance genes cannot be effectively and efficiently eliminated by conventional sewage treatment plants. Because of their high energy requirements and operating costs, many of the available technologies are not feasible. However, the biosorption method, which uses low-cost biomass as the biosorbent, is an alternative technique to potentially address these problems. An extensive literature survey focusing on developments in the field was conducted using English language electronic databases, such as PubMed, Google Scholar, Pubag, Google books, and ResearchGate, to understand the relative value of the available antibiotic removal methods. The predominant techniques for eliminating antibiotic residues from wastewater were categorized and defined by example. The approaches were contrasted, and the benefits and drawbacks were highlighted. Additionally, we included a few antibiotics whose removal from aquatic environments has been the subject of extensive research. Lastly, a few representative publications were identified that provide specific information on the removal rates attained by each technique. This review provides evidence that biosorption of antibiotic residues from biological waste using natural biosorbent materials is an affordable and effective technique for eliminating antibiotic residues from wastewater.

Hydroxylated transformation products of pharmaceutical active compounds: Generation from processes used in wastewater treatment plants and its environmental monitoring

Pharmaceutical active compounds (PhACs) are organic pollutants detected in wastewater and aquatic environments worldwide in concentrations ranging from ng L-1 to μg L-1. Wastewater effluents containing PhACs residues is discharged in municipal sewage and, subsequently collected in municipal wastewater treatment plants (WWTPs) where are not entirely removed. Thus, PhACs and its transformation products (TPs) are discharged into water bodies. In the current work, the transformation of PhACs under treatments used in municipal WWTPs such as biological, photolysis, chlorination, and ozonation processes was reviewed. Data set of the major transformation pathways were obtained of studies that performed the PhACs removal and TPs monitoring during batch-scale experiments using gas and liquid chromatography coupled with tandem mass spectrometry (GC/LC-MS/MS). Several transformation pathways as dealkylation, hydroxylation, oxidation, acetylation, aromatic ring opening, chlorination, dehalogenation, photo-substitution, and ozone attack reactions were identified during the transformation of PhACs. Especially, hydroxylation reaction was identified as transformation pathway in all the processes. During the elucidation of hydroxylated TPs several isobaric compounds as monohydroxylated and dihydroxylated were identified. However, hydroxylated TPs monitoring in wastewater and aquatic environments is a topic scarcely studied due to that has no environmental significance, lack of available analytic standars of hydroxylated TPs and lack of analytic methods for their identification. Thus, screening strategy for environmental monitoring of hydroxylated TPs was proposed through target and suspect screening using GC/LC-MS/MS systems. In the next years, more studies on the hydroxylated TPs monitoring are necessary for its detection in WWTPs effluents as well as studies on their environmental effects in aquatic environments.

Pharmaceuticals and personal care products in Tunisian hospital wastewater: occurrence and environmental risk

Despite concerns about the potential risk associated with the environmental occurrence of pharmaceuticals and personal care products (PPCPs), few studies address the emissions of hospitals to aquatic compartments. We examined within a 3-month sampling period the occurrence and environmental risk of PPCPs in seven Tunisian hospital wastewaters. From personal care products, UV filters, main metabolites, and benzotriazoles were quantified, with benzophenone 3 (oxybenzone, BP3) and benzotriazole (BZT) the most frequently found (71%) at median concentrations in the range 2.43 ± 0.87 ngL-1-64.05 ± 6.82 ngL-1 for BP3 and 51.67 ± 1.67 ngL-1-254 ± 9.9 ngL-1 for BZT. High concentrations were also found for 4-hydroxybenzophenone (4HB) (221 ± 6.22 ngL-1), one of the main metabolites of BP3. The antibiotics ofloxacin and trimethoprim, the anti-inflammatory acetaminophen, the antiepileptic carbamazepine, and the stimulant caffeine were present in all the wastewaters. The highest median concentration corresponded to acetaminophen, with 1240 ± 94 mgL-1 in Tunis Hospital, followed by ofloxacin with 78850 ± 39 μgL-1 in Sousse Hospital. For ecotoxicity assessment, acute toxicity was observed for Daphnia magna and Vibrio fischeri. The toxicity data were used in a hazard quotient (HQ) approach to evaluate the risk posed by the target PPCPs to aquatic organisms. The calculated HQs revealed that marbofloxacin (234 for V. fischeri), enrofloxacin (121 for D. magna), and BZT (82.2 for D. magna and 83.7 for V. fischeri) posed the highest risk, concluding that potential risk exists toward aquatic microorganisms. This study constitutes the first monitoring of UV filters in Tunisian hospital effluents and provides occurrence and toxicity data of PPCPs for reference in further surveys in the country.

Ecotoxicological mixture risk assessment of 35 pharmaceuticals in wastewater effluents following post-treatment with ozone and/or granulated activated carbon

Reducing the risk posed by mixtures of pharmaceuticals is a goal of current initiatives such as the European Green Deal to reduce anthropological environmental impacts. Wastewater effluent typically contains large numbers of active pharmaceutical ingredients (APIs). For some APIs, existing technology such as conventional activated sludge (CAS) wastewater treatment plants (WWTPs) have removal rates below 20 %, thus the WWTP discharges are adding to the toxic burden of receiving waters. We present an environmental risk assessment of mixtures of 35 APIs in effluent samples from 82 Northern European WWTPs using the concentration addition model, and identify the respective risk-driving APIs. This is then compared to a corresponding mixture risk assessment of effluent samples from the Danish Hillerød WWTP subjected to post-treatment with varying specific ozone doses (0.15-1.05 mgO3/mgDOC) and/or granulated activated carbon (GAC). All 82 WWTP effluent samples exceeded risk thresholds by at least a factor of 30, with a median RQSUM of 92.9, highlighting the need for effluent post-treatment and/or a substantial dilution in the recipient waters. Antibiotics, analgesics and anti-depressants were among the top risk drivers with 99 % of the average mixture risk attributable to azithromycin, diclofenac, venlafaxine, clarithromycin and mycophenolic acid. Effluent mixture risk was reduced by ozonation in a concentration-dependent manner, decreasing below threshold levels to a median RQSUM of 0.83 following treatment with 0.65 mgO3/mg DOC. Fresh GAC was also effective at reducing the mixture risk both alone and with ozone treatment, with median RQSUM of 0.04 and 0.07 respectively. To our knowledge, this is the first study to present a risk assessment of pharmaceutical mixtures in effluent comparing "conventional" WWTP processes with additional post-treatment with ozone and/or GAC for reducing the joint risks of pharmaceutical mixtures for recipient waters. We demonstrate the need for additional WWTP treatment technologies, and the efficacy of GAC and ozonation in decreasing the risk to the aquatic environment from pharmaceutical mixtures to below acceptable threshold limits.

Effective adsorption of amoxicillin by using UIO-66@ Cr-MIL-101 nanohybrid: isotherm, kinetic, thermodynamic, and optimization by central composite design

In this research, the amoxicillin (AMX) removal was studied on a prepared nanosorbent from MOFs. The aim of this research work is to prepare nanohybrids based on metal-organic frameworks (MOFs) as an efficient nanosorbent for the absorption of amoxicillin drug. In this study, UIO-66 nanoparticles (UIO-66 NPs) were prepared from Zirconium (Zr) metal and 1,4-benzene dicarboxylic acid (BDC). Then UIO-66@Cr-MIL-101 nanohybrid was synthesized by hydrothermal method. Structural and physicochemical properties of nanohybrid UIO-66@Cr-MIL-101 were characterized by different analyses such as X-ray diffraction analysis (XRD), fourier transform infrared spectrometer (FT-IR), scanning electron microscopy (SEM), energy dispersive X-ray (EDX), transmission electron microscopy (TEM), therapeutic goods administration (TGA), and Brunauer-Emmett-Teller (BET). The effect of four fundamental variables effective on adsorption was optimized by the central composite response surface methodology (CCRSM). This parameters including loading percentage of Cr-MIL-101 NPs (10-30%), initial concentration of AMX (20-140 mg L-1), contact time (20-60 min), and pH (20-10). The removal percentage (Re%) of AMX equal to 99.50% was obtained under the following conditions: The loading value of 20% Wt%, the initial concentration of AMX 80 mg L-1, contact time 20 min, and pH = 6. Also, the experimental data were investigated with famous kinetic models and isotherms, and it was observed that AMX removal by nanohybrid is correlated with the PSO kinetic model and Langmuir isotherm.

Assessing the Ecotoxicity of Eight Widely Used Antibiotics on River Microbial Communities

Global prevalence of antibiotic residues (ABX) in rivers requires ecotoxicological impact assessment. River microbial communities serve as effective bioindicators for this purpose. We quantified the effects of eight commonly used ABXs on a freshwater river microbial community using Biolog EcoPlates™, enabling the assessment of growth and physiological profile changes. Microbial community characterization involved 16S rRNA gene sequencing. The river community structure was representative of aquatic ecosystems, with the prevalence of Cyanobacteria, Proteobacteria, Actinobacteria, and Bacteroidetes. Our findings reveal that all ABXs at 100 µg/mL reduced microbial community growth and metabolic capacity, particularly for polymers, carbohydrates, carboxylic, and ketonic acids. Chloramphenicol, erythromycin, and gentamicin exhibited the highest toxicity, with chloramphenicol notably impairing the metabolism of all studied metabolite groups. At lower concentrations (1 µg/mL), some ABXs slightly enhanced growth and the capacity to metabolize substrates, such as carbohydrates, carboxylic, and ketonic acids, and amines, except for amoxicillin, which decreased the metabolic capacity across all metabolites. We explored potential correlations between physicochemical parameters and drug mechanisms to understand drug bioavailability. Acute toxicity effects at the river-detected low concentrations (ng/L) are unlikely. However, they may disrupt microbial communities in aquatic ecosystems. The utilization of a wide array of genetically characterized microbial communities, as opposed to a single species, enables a better understanding of the impact of ABXs on complex river ecosystems.

Transmission of clones of carbapenem-resistant Escherichia coli between a hospital and an urban wastewater treatment plant

Carbapenem-resistant Enterobacterales (CRE) constitute an urgent threat to worldwide public health. The spread of CRE is facilitated by transmission via the environment. Wastewater treatment plants (WWTPs) are considered to be important sources of antibiotic resistance and hot spots of antibiotic-resistant bacteria (ARB) which can facilitate dissemination of antibiotic resistance genes. In this study, water samples were collected over one year from a WWTP in Jinan, Shandong province, China, from different functional sites in the wastewater treatment process. Carbapenem-resistant Escherichia coli (CREC) were isolated by selective cultivation and whole-genome sequenced to investigate the occurrence and characteristics of CREC in the WWTP. A total of 77 CREC isolates were included in the study and the detection rate of CREC in the WWTP water inlet was found to be 85%. An additional 10 CREC were isolated from a nearby teaching hospital during the sampling period and included for comparison to the environmental isolates. Susceptibility testing showed that all CREC were multidrug-resistant. 6 different carbapenem resistance genes (CRGs) were detected, including blaNDM-5 (n = 75), blaNDM-1 (n = 6), blaNDM-4 (n = 3), blaNDM-6 (n = 1), blaNDM-9 (n = 1), and blaKPC-2 (n = 4). 42 CREC isolates were whole-genome sequenced with Illumina short-read sequencing. 11 of these were also sequenced with Nanopore long-read sequencing. Plasmids carrying CRGs were found to belong to IncX3 (n = 35), IncFII (n = 12), IncFIA (n = 5), IncFIB (n = 2), IncC (n = 1), and IncP6 (n = 1). Clonal dissemination of CREC belonging to ST167, ST448, and ST746 was observed between different parts of the WWTP. Furthermore, isolates from the WWTP, including an isolate belonging to the high-risk ST167 strain, were found to be clonally related to CREC isolated at the hospital. The spread of CRGs is of considerable concern and strategies to prevent environmental dissemination of this contaminant urgently needs to be implemented.

Pharmaceutical residues in the ecosystem: Antibiotic resistance, health impacts, and removal techniques

Hospital wastewater has emerged as a major category of environmental pollutants over the past two decades, but its prevalence in freshwater is less well documented than other types of contaminants. Due to compound complexity and improper operations, conventional treatment is unable to remove pharmaceuticals from hospital wastewater. Advanced treatment technologies may eliminate pharmaceuticals, but there are still concerns about cost and energy use. There should be a legal and regulatory framework in place to control the flow of hospital wastewater. Here, we review the latest scientific knowledge regarding effective pharmaceutical cleanup strategies and treatment procedures to achieve that goal. Successful treatment techniques are also highlighted, such as pre-treatment or on-site facilities that control hospital wastewater where it is used in hospitals. Due to the prioritization, the regulatory agencies will be able to assess and monitor the concentration of pharmaceutical residues in groundwater, surface water, and drinking water. Based on the data obtained, the conventional WWTPs remove 10-60% of pharmaceutical residues. However, most PhACs are eliminated during the secondary or advanced therapy stages, and an overall elimination rate higher than 90% can be achieved. This review also highlights and compares the suitability of currently used treatment technologies and identifies the merits and demerits of each technology to upgrade the system to tackle future challenges. For this reason, pharmaceutical compound rankings in regulatory agencies should be the subject of prospective studies.

Occurrence and removal rate of typical pharmaceuticals and personal care products (PPCPs) in an urban wastewater treatment plant in Beijing, China

The occurrence and removal rate of 52 typical pharmaceuticals and personal care products (PPCPs) were investigated in a wastewater treatment plant in Beijing, China. Thirty-three PPCPs were found in the influent, with caffeine (CF, 11387.0 ng L-1) being the most abundant, followed by N,N-diethyl-meta-toluamide (DEET, 9568.4 ng L-1), metoprolol (MTP, 930.2 ng L-1), and diclofenac (DF, 710.3 ng L-1). After treatment processes, the cumulative concentration of PPCPs decreased from 2.54 × 104 ng L-1 to 1.44 × 103 ng L-1, with the overall removal efficiency (RE) of 94.3%. Different treatment processes showed varying contributions in removing PPCPs. PPCPs were efficiently removed in sedimentation, anoxic, and ultraviolet units. For individual compounds, a great variation in RE (52.1-100%) was observed. Twenty-two PPCPs were removed by more than 90%. The highly detected PPCPs in the influent were almost completely removed. Aerated grit chamber removed nearly 50% of fluoroquinolone (FQs) and more than 60% of sulfonamides. Most PPCPs showed low or negative removals during anaerobic treatment, except for CF which was eliminated by 64.9%. Anoxic treatment demonstrated positive removals for most PPCPs, with the exceptions of DF, MTP, bisoprolol, carbamazepine (CBZ), and sibutramine. DEET and bezafibrate were efficiently removed during the secondary sedimentation. Denitrification biological filter and membrane filtration also showed positive effect on most PPCPs removals. The remaining compounds were oxidized by 16-100% in ozonation. DF, sulpiride, ofloxacin (OFL), trimethoprim, and phenolphthalein were not amenable to ultraviolet. After the treatment, the residue OFL, CBZ, and CF in receiving water were identified to pose high risk to aquatic organisms. Considering the complex mixtures emitted into the environment, therapeutic groups psychotropics, stimulant, and FQs were classified as high risk. These findings provide valuable insights into adopting appropriate measures for more efficient PPCPs removals, and emphasize the importance of continued monitoring specific PPCPs and mixtures thereof to safeguard the ecosystem.

Quantification of pharmaceuticals in hospital effluent: Weighted ranking of environmental risk using a fuzzy hybrid multicriteria method

An analytical method for quantification of seventeen pharmaceuticals and one metabolite was validated and applied in the analysis of hospital effluent samples. Two different sampling strategies were used: seasonal sampling, with 7 samples collected bimonthly; and hourly sampling, with 12 samples collected during 12 h. Thus, the variability was both seasonal and within the same day. High variability was observed in the measured concentrations of the pharmaceuticals and the metabolite. The quantification method, performed using weighted linear regression model, demonstrated results of average concentrations in seasonal samples ranged between 0.19 μgL-1 (carbamazepine) and higher than 61.56 μgL-1 (acetaminophen), while the hourly samples showed average concentrations between 0.07 μgL-1 (diazepam) and higher than 54.91 μgL-1 (acetaminophen). It is described as higher because the maximum concentration of the calibration curve took into account the dilution factor provided by DLLME. The diurnal results showed a trend towards higher concentrations in the first and last hours of sampling. The risk quotient (RQ) was calculated using organisms from three different trophic levels, for all the analytes quantified in the samples. Additionally, in order to understand the level of importance of each RQ, an expert panel was established, with contributions from 23 specialists in the area. The results were analyzed using a hybrid decision-making approach based on a Fuzzy Analytic Hierarchy Process (FAHP) and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method, in order to rank the compounds by environmental risk priority. The compounds of greatest concern were losartan, acetaminophen, 4-aminoantipyrine, sulfamethoxazole, and metoclopramide. Comparison of the environmental risk priority ranking with the potential human health risk was performed by applying the same multicriteria approach, with the prediction of endpoints using in silico (Q)SAR models. The results obtained suggested that sulfamethoxazole and acetaminophen were the most important analytes to be considered for monitoring.

Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica

This work aims to determine the occurrence, hazard and prioritization of pharmaceuticals from hospital wastewater in Costa Rica through the monitoring of 70 compounds and assessing their environmental risk through a hazard quotient approach (HQ). Moreover, the quantification of selected antibiotic resistance genes (ARGs) was conducted for the first time in this matrix in this geographical location. Thirty-four pharmaceuticals were detected, being caffeine, 1,7-dimethylxanthine, acetaminophen, ibuprofen, naproxen, ciprofloxacin and ketoprofen the most frequent (>50% of the samples). Eighteen pharmaceuticals exhibited high hazard (HQ ≥ 1), while five more showed medium hazard (1 > HQ ≥ 0.1). Prioritization, which also included frequency parameters, revealed caffeine, lovastatin, diphenhydramine, acetaminophen, ibuprofen, ciprofloxacin, and sildenafil as the compounds of major concern. Similarly, cumulative hazard per sample (ΣHQ) estimated high hazard towards aquatic organisms in every sample. All selected ARGs, except mcr-1 (polymyxin resistance), were detected. Among genes conferring resistance to beta-lactams, blaCTX-M and blaKPC were the most abundant, related to resistance to cephalosporins and carbapenems. Ecotoxicological evaluation showed mostly low toxicity towards Daphnia magna and Vibrio fischeri, contrary to the marked effect observed towards Lactuca sativa. These findings provide relevant and novel information on the risk posed by hospital wastewater and their pharmaceutical content in the Latin American environmental context.

Pharmaceuticals in hospital wastewaters: an analysis of the UBA's pharmaceutical database

The presence of pharmaceuticals in hospital wastewaters (HWW) has been a focus of interest for researchers in the last decades. Certain therapeutic classes, such as X-ray contrast media, broad-spectrum antimicrobials and cytotoxics among others, are mainly used in hospitals-health care facilities. This study is focused on available studies monitoring the presence of pharmaceuticals in HWW around the world. To that end, the last available version (v3. 2021) of the "Pharmaceuticals in the Environment" database published by the Federal German Environment Agency (Umweltbundesamt) has been used. Almost half of all studies included (107) have been conducted in Europe. Pharmaceuticals have been monitored in HWW in 38 different countries across all five continents. The country with the greatest number of studies is Brazil (11), followed by Spain (8), China (7), and France (6). Our analysis revealed that 271 different pharmaceuticals have been detected at least once in HWW. The five drugs with more studies showing a positive detection are ciprofloxacin (38), sulfamethoxazole (36), diclofenac (34), ibuprofen (29), and trimethoprim (27). A total of 47 out of 271 drugs are considered in the NIOSH "Hazardous drug" list. However, monitoring data for some widely used drugs in hospital settings such as muscle relaxants, anesthetics, and antidotes is lacking. In conclusion, this study provides the first large-scale metadata analysis for the pharmaceuticals in HWW worldwide.

An overview on the prevalence and potential impact of antimicrobials and antimicrobial resistance in the aquatic environment of India

India at present is one of the leading countries in antimicrobial drug production and use, leading to increasing antimicrobial resistance (AMR) and public health problems. Attention has mainly been focused on the human and food animals' contribution to AMR neglecting the potential contribution of the perceptibly degraded aquatic environment in India. The paper reviews the available published literature in India on the prevalence of antimicrobial residues and their dissemination pathways in wastewater of pharmaceutical industries, sewage treatment plants, hospitals, riverine, community pond water, and groundwater. The prevalence of antimicrobial residue concentration, pathogenic and non-pathogenic bacteria antimicrobial resistant bacteria (ARB), their drug resistance levels, and their specific antimicrobial resistant genes (ARGs) occurring in various water matrices of India have been comprehensively depicted from existing literature. The concentration of some widely used antimicrobials recorded from the sewage treatment plants and hospital wastewater and rivers in India has been compared with other countries. The ecotoxicological risk posed by these antimicrobials in the various water matrices in India indicated high hazard quotient (HQ) values for pharmaceutical effluents, hospital effluents, and river water. The degraded aquatic environment exhibited the selection of a wide array of co-existent resistant genes for antibiotics and metals. The review revealed improper use of antibiotics and inadequate wastewater treatment as major drivers of AMR contaminating water bodies in India and suggestion for containing the challenges posed by AMR in India has been proposed.

Global trends in the research and development of medical/pharmaceutical wastewater treatment over the half-century

The COVID-19 pandemic has severely impacted public health and the worldwide economy. The overstretched operation of health systems around the world is accompanied by potential and ongoing environmental threats. At present, comprehensive scientific assessments of research on temporal changes in medical/pharmaceutical wastewater (MPWW), as well as estimations of researcher networks and scientific productivity are lacking. Therefore, we conducted a thorough literature study, using bibliometrics to reproduce research on medical wastewater over nearly half a century. Our primary goal is systematically to map the evolution of keyword clusters over time, and to obtain the structure and credibility of clusters. Our secondary objective was to measure research network performance (country, institution, and author) using CiteSpace and VOSviewer. We extracted 2306 papers published between 1981 and 2022. The co-cited reference network identified 16 clusters with well-structured networks (Q = 0.7716, S = 0.896). The main trends were as follows: 1) Early MPWW research prioritized sources of wastewater, and this cluster was considered to be the mainstream research frontier and direction, representing an important source and priority research area. 2) Mid-term research focused on characteristic contaminants and detection technologies. Particularly during 2000-2010, a period of rapid developments in global medical systems, pharmaceutical compounds (PhCs) in MPWW were recognized as a major threat to human health and the environment. 3) Recent research has focused on novel degradation technologies for PhC-containing MPWW, with high scores for research on biological methods. Wastewater-based epidemiology has emerged as being consistent with or predictive of the number of confirmed COVID-19 cases. Therefore, the application of MPWW in COVID-19 tracing will be of great interest to environmentalists. These results could guide the future direction of funding agencies and research groups.

Pharmaceutical waste management system - Are the current techniques sustainable, eco-friendly and circular? A review

Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.

Assessment of selected pharmaceuticals in Riyadh wastewater treatment plants, Saudi Arabia: Mass loadings, seasonal variations, removal efficiency and environmental risk

Despite increasing interest in pharmaceutical emissions worldwide, studies of environmental contamination with pharmaceuticals arising from wastewater discharges in Saudi Arabia are scarce. Therefore, this study examined occurrence, mass loads and removal efficiency for 15 pharmaceuticals and one metabolite (oxypurinol) from different therapeutic classes in three wastewater treatment plants (WWTPs), in Riyadh city in Saudi Arabia. A total of 144 samples were collected from the influents and effluents between March 2018 and July 2019 and analyzed using Solid Phase Extraction followed by triple quadrupole LC-MS/MS. The average concentrations in the influents and effluents were generally higher than their corresponding concentrations found either in previous Saudi Arabian or global studies. The four most dominant compounds in the influent were acetaminophen, ciprofloxacin, caffeine, and diclofenac, with caffeine and acetaminophen having the highest concentrations ranging between 943 and 2282 μg/L. Metformin and ciprofloxacin were the most frequently detected compounds in the effluents at concentrations as high as 33.2 μg/L. Ciprofloxacin had the highest mass load in the effluents of all three WWTPs, ranging between 0.20 and 20.7 mg/day/1000 inhabitants for different WWTPs. The overall average removal efficiency was estimated high (≥80), with no significant different (p > 0.05) between the treatment technology applied. Acetaminophen and caffeine were almost completely eliminated in all three WWTPs. The samples collected in the cold season generally had higher levels of detected compounds than those from the warm seasons, particularly for NSAID and antibiotic compounds. The estimated environmental risk from pharmaceutical compounds in the studied effluents was mostly low, except for antibiotic compounds. Thus, antibiotics should be considered for future monitoring programmes of the aquatic environment in Saudi Arabia.

Health risk assessment for uptake and accumulation of pharmaceuticals in jute mallow (Corchorus olitorius) irrigated with treated hospital wastewater

The use of reclaimed water for crop irrigation presents a route through which pharmaceuticals enter the agro-environment, raising concerns about their potential inclusion into the food chain and associated health risks. The main objective of this study was to determine the accumulation of six pharmaceuticals (paracetamol, diclofenac and ibuprofen, ciprofloxacin, tetracycline, and sulfamethoxazole) in edible part of jute mallow (JM) (Corchorus olitorius) irrigated with treated hospital wastewater (THWW) and potential health risks associated with the consumption of the contaminated JM. In a greenhouse experiment, JM vegetable was grown in soils irrigated with groundwater and THWW. After 4 weeks of cultivation, the pharmaceutical concentrations in the soil and JM tissues were determined. The uptake and accumulation of the pharmaceuticals in the irrigated JM and the human health risks associated with their consumption were evaluated. Results showed that the THWW-irrigated and groundwater-irrigated soils accumulated all the studied pharmaceuticals except paracetamol and sulfamethoxazole, with the concentrations in the soil before and after irrigation ranging from 0.01 to 0.14 μg g-1 and 0.03 to 1.35 μg g-1, respectively. In JM leaves, the accumulation was in the order of tetracycline > ciprofloxacin > ibuprofen > diclofenac and tetracycline > ciprofloxacin > diclofenac > ibuprofen under THWW-irrigated and groundwater-irrigated treatments, respectively. Under both treatments, the uptake and accumulation of the studied pharmaceuticals were in the order of roots > stem > leaves. The health risk assessment indicated that the consumption of the studied pharmaceuticals through JM implies some risks to human health and the risks were in the order of tetracycline > diclofenac > ciprofloxacin > ibuprofen > paracetamol > sulfamethoxazole. This study has demonstrated that irrigation with reclaimed water is a major route of pharmaceuticals into the food chain and a key determinant of associated health risks.

The Synthesis and Evaluation of Porous Carbon Material from Corozo Fruit (Bactris guineensis) for Efficient Propranolol Hydrochloride Adsorption

This study explores the potential of the corozo fruit (Bactris guineensis) palm tree in the Colombian Caribbean as a source for porous carbon material. Its specific surface area, pore volume, and average pore size were obtained using N₂ adsorption/desorption isotherms. The images of the precursor and adsorbent surface were obtained using scanning electron microscopy (SEM). Fourier transform infrared (FTIR) spectra were obtained to detect the main functional groups present and an X-ray diffraction analysis (XRD) was performed in order to analyze the structural organization of the materials. By carbonizing the fruit stone with zinc chloride, a porous carbon material was achieved with a substantial specific surface area (1125 m² g⁻¹) and pore volume (3.241 × 10-¹ cm³ g⁻¹). The material was tested for its adsorption capabilities of the drug propranolol. The optimal adsorption occurred under basic conditions and at a dosage of 0.7 g L⁻¹. The Langmuir homogeneous surface model effectively described the equilibrium data and, as the temperature increased, the adsorption capacity improved, reaching a maximum of 134.7 mg g⁻¹ at 328.15 K. The model constant was favorable to the temperature increase, increasing from 1.556 × 10^-1 to 2.299 × 10^-1 L mg^-1. Thermodynamically, the adsorption of propranolol was found to be spontaneous and benefited from higher temperatures, indicating an endothermic nature (12.39 kJ mol⁻¹). The negative ΔG⁰ values decreased from -26.28 to -29.99 kJ mol^-1, with the more negative value occurring at 328 K. The adsorbent material exhibited rapid kinetics, with equilibrium times ranging from 30 to 120 min, depending on the initial concentration. The kinetics data were well-represented by the general order and linear driving force models. The rate constant of the general order model diminished from 1.124 × 10^-3 to 9.458 × 10^-14 with an increasing concentration. In summary, the leftover stone from the Bactris guineensis plant can be utilized to develop activated carbon, particularly when activated using zinc chloride. This material shows promise for efficiently adsorbing propranolol and potentially other emerging pollutants.

Hospitals and households as primary emission sources for risk-posing pharmaceuticals in municipal wastewater

A wide range of pharmaceutical residues is known to occur in the environment. While they are released into surface waters mainly through centralized wastewater treatment plants (WWTPs), their primary emission sources are located upstream in the sewer network. Information on emissions from different types of primary emission sources is scarce. However, such information could help direct emission reduction measures more efficiently. In this study, we analysed the concentrations of selected active pharmaceutical ingredients (APIs) in wastewater samples taken from altogether ten sites, covering primary emission sources (hospitals and households), and conventional WWTPs. The concentrations in WWTP effluents were used to identify APIs causing risk in recipient waterbodies. Furthermore, the API loads from households and hospitals were compared to those reaching the WWTP in mixed influents. Our results confirm previously published observations of several pharmaceuticals exceeding their predicted no-effect concentrations in effluent wastewaters. Moreover, the concentrations of most of the analysed APIs are comparatively high in hospital wastewaters, resulting in elevated risk quotients. While the total API loads are relatively low from primary emission sources, owing to the low wastewater volume generated at those sites, per capita emissions were shown to be several times higher at hospital sites than at household sites for APIs such as metronidazole, trimethoprim, and ofloxacin. These findings indicate, that directing emission reduction measures to hospitals could be an effective way to decrease the loads of several risk-posing APIs into the environment, especially where hospital contribution to overall wastewater flow to WWTPs is high.

Antimicrobial Transformation Products in the Aquatic Environment: Global Occurrence, Ecotoxicological Risks, and Potential of Antibiotic Resistance

The global spread of antimicrobial resistance (AMR) is concerning for the health of humans, animals, and the environment in a One Health perspective. Assessments of AMR and associated environmental hazards mostly focus on antimicrobial parent compounds, while largely overlooking their transformation products (TPs). This review lists antimicrobial TPs identified in surface water environments and examines their potential for AMR promotion, ecological risk, as well as human health and environmental hazards using in silico models. Our review also summarizes the key transformation compartments of TPs, related pathways for TPs reaching surface waters and methodologies for studying the fate of TPs. The 56 antimicrobial TPs covered by the review were prioritized via scoring and ranking of various risk and hazard parameters. Most data on occurrences to date have been reported in Europe, while little is known about antibiotic TPs in Africa, Central and South America, Asia, and Oceania. Occurrence data on antiviral TPs and other antibacterial TPs are even scarcer. We propose evaluation of structural similarity between parent compounds and TPs for TP risk assessment. We predicted a risk of AMR for 13 TPs, especially TPs of tetracyclines and macrolides. We estimated the ecotoxicological effect concentrations of TPs from the experimental effect data of the parent chemical for bacteria, algae and water fleas, scaled by potency differences predicted by quantitative structure-activity relationships (QSARs) for baseline toxicity and a scaling factor for structural similarity. Inclusion of TPs in mixtures with their parent increased the ecological risk quotient over the threshold of one for 7 of the 24 antimicrobials included in this analysis, while only one parent had a risk quotient above one. Thirteen TPs, from which 6 were macrolide TPs, posed a risk to at least one of the three tested species. There were 12/21 TPs identified that are likely to exhibit a similar or higher level of mutagenicity/carcinogenicity, respectively, than their parent compound, with tetracycline TPs often showing increased mutagenicity. Most TPs with increased carcinogenicity belonged to sulfonamides. Most of the TPs were predicted to be mobile but not bioaccumulative, and 14 were predicted to be persistent. The six highest-priority TPs originated from the tetracycline antibiotic family and antivirals. This review, and in particular our ranking of antimicrobial TPs of concern, can support authorities in planning related intervention strategies and source mitigation of antimicrobials toward a sustainable future.

Effect of ibuprofen on the sulfur autotrophic denitrification process and microbial toxic response mechanism

The effect of ibuprofen (IBU) on the sulfur autotrophic denitrification (SAD) process and microbial toxic response mechanism were investigated. Nitrate removal performance was inhibited by high IBU concentrations (10 and 50 mg/L), and the effect of low IBU concentrations (1 mg/L) on nitrate removal performance was negligible. The low IBU concentration induced basal oxidative stress for microbial self-protection, while the high IBU concentration induced high-intensity oxidative stress to damage the microbial cell membrane structure. Electrochemical characterization showed that the low IBU concentration stimulated the electron transfer efficiency, which was inhibited at the high IBU concentration. Moreover, the variation content of nicotinamide adenine dinucleotide (NADH) and nitrate reductase showed that metabolic activity increased at low IBU concentrations and decreased at high IBU concentrations during the sulfur autotrophic nitrate reduction process. This study proposed the hormesis toxic response mechanism of the SAD process to IBU exposure.

Performance of a Pilot-Scale Continuous Flow Ozone-Based Hospital Wastewater Treatment System

Antimicrobial resistance (AMR) is becoming a global concern. Recently, research has emerged to evaluate the human and environmental health implications of wastewater from medical facilities and to identify acceptable wastewater treatment methods. In this study, a disinfection wastewater treatment system using an ozone-based continuous flow system was installed in a general hospital located in Japan. The effectiveness of antimicrobial-resistant bacteria (ARB) and antimicrobials in mitigating the environmental impact of hospital wastewater was evaluated. Metagenomic analysis was conducted to characterize the microorganisms in the wastewater before and after treatment. The results demonstrated that ozone treatment enables effective inactivation of general gut bacteria, including Bacteroides, Prevotella, Escherichia coli, Klebsiella, DNA molecules, and ARGs, as well as antimicrobials. Azithromycin and doxycycline removal rates were >99% immediately after treatment, and levofloxacin and vancomycin removal rates remained between 90% and 97% for approximately one month. Clarithromycin was more readily removed than the other antimicrobials (81-91%), and no clear removal trend was observed for ampicillin. Our findings provide a better understanding of the environmental management of hospital wastewater and enhance the effectiveness of disinfection wastewater treatment systems at medical facilities for mitigating the discharge of pollutants into aquatic environments.

Effective removal of selected pharmaceuticals from sewerage treatment plant effluent using natural clay (Na-montmorillonite)

The consumption of pharmaceuticals has rapidly increased on a global scale due to the serious increase in Covid-19, influenza and respiratuar sinsityal virus, which is called "triple epidemic" in the world. The use of non-prescription analgesic and anti-inflammatory drugs (AAIDs), especially paracetamol, is higher compared to pre-pandemic. This increased the AAIDs load discharged to the aqueous media through sewerage treatment plant (STP). Therefore, simple and effective treatment options for removing AAIDs from STP effluents are needed. The aim of the study was to remove AAIDs (paracetamol, acetylsalicylic acid, codeine, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, and phenylbutazone) from STP effluents by nearly pure natural clay Na-montmorillonite. The Na-montmorillonite taken from the Ordu region in the northern part of Turkey. Surface area of the Na-montmorillonite is 99.58 m2/g and CEC is 92.40 meq/100 g. The removal efficiencies of AAIDs using Na-montmorillonite were between 82 ± 5% (ibuprofen) and 94 ± 4% (naproxen). Paracetamol was used as a model compound in kinetic and isotherm model studies. Freundlich isotherm model and the pseudo second order kinetic model were the best-fit using the obtained experimental data. Film diffusion governed its rate mechanism. The paracetamol adsorption capacity was acquired as 244 mg/g at 120 min contact time at pH 6.5 at 25 °C. With this study, it could be shown that montmorillonite can be used effectively to eliminate paracetamol from STP effluent. Natural clay can be used as a simple, inexpensive and effective adsorbent for removing AAIDs from STP effluents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13201-023-01930-5.

Quantification and antibiotic resistance risk assessment of chlorination-residual viable/VBNC Escherichia coli and Enterococcus in on-site hospital wastewater treatment system

On-site hospital wastewater treatment system widely applying chlorination has been regarded as an important barrier to curb the dissemination of antibiotic resistance. Chlorination-residual viable and viable but non-culturable (VBNC) bacteria probably lead to overestimate the effect of disinfection, while their antibiotic resistance risks imported from hospital effluents to municipal pipe network may be ignored. In this study, we quantified viable/VBNC Escherichia coli and Enterococcus in chlorination of an on-site hospital wastewater treatment system and assessed their antibiotic resistance risks. The numbers of viable/VBNC Escherichia coli and Enterococcus in raw wastewater were detected as high as 5.76-6.34/5.76-6.33 and 5.44-5.76/5.44-5.75 log₁₀(cells/mL). Meanwhile, high proportions of antibiotic-resistant Escherichia coli and Enterococcus to culturable Escherichia coli and Enterococcus were observed, especially carrying ampicillin resistance (22.25-41.70 % and 28.09-54.05 %). Chlorination could remove 0.44-1.88-/0.43-1.88- and 0.29-1.29-/0.28-1.28-log of viable/VBNC and complete culturable Escherichia coli and Enterococcus, but cause antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) to be released outside cells, and possibly further enhance the antibiotic resistance of viable bacteria. Low detections of antibiotics suggested that the occurrence of antibiotic-resistant bacteria (ARB) may not be accompanied by the corresponding antibiotics. Different sampling months had some impacts on above results, while the results were basically stable at different sampling times of hospital daily working period. The high release rates (11.26-13.02 and 11.59-12.98 log₁₀(cells/h)) and cumulative amounts (15.41-16.12 and 15.75-16.14 log₁₀(cells)) of chlorination-residual viable/VBNC Escherichia coli and Enterococcus indirectly assessed the potential risks of bacterial antibiotic resistance entering municipal pipe network. Additionally, the contributions from the corresponding antibiotic ceftazidime, ciprofloxacin, and vancomycin with the cumulative amounts of 2.57-4.85, 5.73-7.50, and 5.21-7.14 kg should also be taken seriously. Residual chlorine could serve as an important signal indicator for the risk assessment.

Occurrence and fate of an emerging drug pollutant and its by-products during conventional and advanced wastewater treatment: Case study of furosemide

Conventional wastewater treatment systems are not designed to remove pharmaceutical compounds from wastewater. These compounds can be degraded into many other transformation products which are hardly, if at all, studied. In this context, we studied the occurrence and degradation of furosemide, a very frequently detected diuretic, along with its known degradation products in several types of wastewater. Influent and effluent from the Seine-Centre Wastewater Treatment Plant (WWTP) (Paris, France) as well as outlet of residential care homes (Dordogne, France) were analyzed by Ultra-Performance Liquid Chromatography-tandem Mass Spectrometry (UPLC-MS/MS) to quantify furosemide and its known degradation products, saluamine and pyridinium of furosemide. Oxidation experiments (chlorination, ozonation and UV photolysis with hydrogen peroxide) were then performed on furosemide solutions and on water from residential care facilities to study the degradation of furosemide by potential advanced processes, and also to identify unknown oxidation products by high-resolution mass spectrometry. Furosemide was well degraded in Seine-Centre WWTP (>75%) but did not increase the concentrations of its main degradation products. Saluamine and pyridinium of furosemide were already present at similar concentrations to furosemide in the raw wastewater (∼2.5-3.5 μg.L^-1), and their removal in the WWTPs were very high (>80%). Despite their removal, the three compounds remained present in treated wastewater effluents at concentrations of hundreds of nanograms per liter. Chlorination degraded furosemide without pyridinium production unlike the other two processes. Chlorination and ozonation were also effective for the removal of furosemide and pyridinium in residential care home water, but they resulted in the production of saluamine. To our knowledge this is the first evidence of saluamine and pyridinium of furosemide in real water samples in either the particulate or dissolved phase.

A forecast effects of climate change and anthropogenic compounds in Gambusia holbrooki: ecotoxicological effects of salinity and metformin

Due to global warming and extreme weather events, estuarine and coastal ecosystems are facing sudden fluctuations in salinity. These ecosystems are also threatened by organic and inorganic compounds that increase water pollution. Metformin is an antidiabetic drug commonly used by patients with type-2 diabetes, and an increase in environmental concentration has been recorded. To better understand the impacts of these two stressors on aquatic organisms, this study assessed: 1) the acute (96 h) ecotoxicological effects (antioxidant and biotransformation capacity, oxidative damage, energetic reserves, and protein content, neurotoxicity) induced by a range of metformin concentrations in Gambusia holbrooki under different salinities (17, 24, 31 expressed as Practical Salinity Units - PSU); and 2) the same endpoints after chronic exposure (28 d) under a range of metformin concentrations at a salinity of 17. The results obtained from the acute exposure showed interactions between salinity and metformin in G. holbrooki superoxide dismutase (SOD) activity, body protein, and glycogen (GLY) contents. The results revealed that an increase in salinity can modulate the response of G. holbrooki to metformin. Chronically exposed organisms showed that metformin led to a significant decrease in SOD activity at most of the tested concentrations (0.5, 1.0, and 10 µg/L). In addition, glutathione S-transferases increased and glutathione peroxidase activity decreased significantly at concentrations of metformin of 5 and 10 at the µg/L, respectively. Therefore, overall, metformin can lead to potential oxidative stress in G. holbrooki the highest metformin concentrations tested and the GLY content in G. holbrooki increased after exposure to metformin concentrations of 0.5, 1.0 and 5.0 μg/L. Published studies have already shown that metformin alone can lead to oxidative damage in aquatic species, endangering the biodiversity of aquatic ecosystems. Therefore, additional ecotoxicological studies should be performed to characterize if other metformin concentrations combined with salinity, or other climate change-related factors, might impact non-target species. Standard toxicity bioassays may not be predictive of actual pollutants (e.g. metformin) toxicity under variable environmental conditions, and the investigation of a wider range of exposure conditions could improve the accuracy of chemical risk assessments.

Occurrences of UV filters, endocrine disruptive chemicals, alkyl phenolic compounds, fragrances, and hormones in the wastewater and coastal waters of the Antarctica

We present a simplified status description of the prevalence and occurrences of organic micropollutants including endocrine disruptive chemicals (EDCs), therapeutic drugs, hormones, fragrances and ultraviolet (UV) filters in the wastewaters and the adjacent coastal oceans in the Northern and Southern Antarctica. Different treatment technologies adopted in the research stations and their efficacy in removing pharmaceuticals and personal care products (PPCPs) are reviewed. Till date, 56 PPCPs are reported in the wastewaters of Antarctic research stations, and 23 in the adjacent coastal waters and sea ice. The reported concentrations in the wastewaters are at the levels of μg L^-1 for UV filters, plasticizer Bisphenol A, metabolites, antibiotics, alkyl phenolic compounds, and stimulants. Concentrations in the coastal waters and sea ice are two orders of magnitude lower than the wastewaters because of dilution and degradation. It is apparent however, that the PPCP-laden effluents discharged from the research stations contaminate them. If left unchecked, pollution of the coastal waters and sea-ice can lead to toxic levels. Through this review, we have established widespread occurrence of PPCPs in the polar coastal oceans; this study will also provide the status quo for the researchers and policymakers to seriously consider the issue and initiate remedial action in the near future. The existing substantial gaps in understanding of the impact of PPCPs on the flora and fauna of Antarctica, and the ineffectiveness of the current treatment technologies adopted by the research stations are highly evident. Future-oriented polar research should focus on protecting the pristine ecosystem by utilizing climate-sensitive, cost-effective treatment technologies.

Knowledge graph of wastewater-based epidemiology development: A data-driven analysis based on research topics and trends

Wastewater-based epidemiology (WBE) has contributed significantly to the monitoring of drug use and transmission of viruses that has been published in numerous research papers. In this paper, we used LitStraw, a self-developed text extraction tool, to extract, analyze, and construct knowledge graphs from nearly 900 related papers in PDF format collected in Web of Science from 2000 to 2021 to analyze the research hotspots and development trends of WBE. The results showed a growing number of WBE publications in multidisciplinary cross-collaboration, with more publications and close collaboration between the USA, Australia, China, and European countries. The keywords of illicit drugs and pharmaceuticals still maintain research hotness, but the specific research hotspots change significantly, among which the research hotspots of new psychoactive substances, biomarkers, and stability show an increasing trend. In addition, judging the spread of COVID-19 by the presence of SARS-CoV-2 RNA in sewage has become the focus since 2020. This work can show the development of WBE more clearly by constructing a knowledge graph and also provide new ideas for the paper mining analysis methods in different fields.