Rapid and sensitive screening and selective quantification of antibiotics in human urine by two-dimensional ultraperformance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry

Maternal-Fetal Exposure to Antibiotics: Levels, Mother-to-Child Transmission, and Potential Health Risks

Due to its widespread applications in various fields, antibiotics are continuously released into the environment and ultimately enter the human body through diverse routes. Meanwhile, the unreasonable use of antibiotics can also lead to a series of adverse outcomes. Pregnant women and developing fetuses are more susceptible to the influence of external chemicals than adults. The evaluation of antibiotic exposure levels through questionnaire surveys or prescriptions in medical records and biomonitoring-based data shows that antibiotics are frequently prescribed and used by pregnant women around the world. Antibiotics may be transmitted from mothers to their offspring through different pathways, which then adversely affect the health of offspring. However, there has been no comprehensive review on antibiotic exposure and mother-to-child transmission in pregnant women so far. Herein, we summarized the exposure levels of antibiotics in pregnant women and fetuses, the exposure routes of antibiotics to pregnant women, and related influencing factors. In addition, we scrutinized the potential mechanisms and factors influencing the transfer of antibiotics from mother to fetus through placental transmission, and explored the adverse effects of maternal antibiotic exposure on fetal growth and development, neonatal gut microbiota, and subsequent childhood health. Given the widespread use of antibiotics and the health threats posed by their exposure, it is necessary to comprehensively track antibiotics in pregnant women and fetuses in the future, and more in-depth biological studies are needed to reveal and verify the mechanisms of mother-to-child transmission, which is crucial for accurately quantifying and evaluating fetal health status.

A sensitive assay for the determination of E7090, a novel selective inhibitor of fibroblast growth factor receptors, and its metabolite in human plasma by UPLC-MS/MS with at-column dilution

E7090, a novel fibroblast growth factor receptors inhibitor, is currently under clinical development for the treatment of patients with solid tumors. The previous assay was insufficient in detection sensitivity for E7090 and high exposure of a dealkylated metabolite, M2, was noted in a clinical trial at low doses. Thus, a sensitive assay for the simultaneous determination of E7090 and M2 in human plasma has been developed using ultra-performance liquid chromatography with tandem mass spectrometer (UPLC-MS/MS). E7090 and M2 were extracted from 0.1 mL of plasma by protein precipitation and chromatographed on a reverse phase column utilizing at-column dilution which enables larger volume sample injection to the UPLC-MS/MS. E7090 and M2 were quantifiable from 0.025 ng/mL, which was 40-fold higher sensitivity than the previous assay. Accuracy as relative error and precision as relative standard deviation were within ± 15% and 15%, respectively, ensuring the reproducibility of the assay. The developed assay method was applied to a clinical trial of E7090, and plasma concentrations of E7090 and M2 were quantifiable up to 144 h postdose. These results indicated that the developed more sensitive assay was reproducible and was successfully applied to a clinical trial of E7090.

Urinary antibiotic levels and risk of overweight/obesity in preschool children: A biomonitoring-based study from eastern China

There is limited evidence linking antibiotic exposure, particularly from contaminated food or drinking water, to childhood obesity. The study aimed to investigate the association between urinary antibiotic levels and overweight/obesity in preschool children. In the case-control study, 121 overweight/obese preschoolers and 242 controls (aged 3-6 years) from eastern China were enrolled in 2022 based on age, sex, and study site matching. Overweight/obesity was determined using body mass index (BMI) and weight for height (WFH) criteria derived from national data. A total of 50 antibiotics from 8 categories were analyzed using ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS/MS). We identified major dietary patterns using principal component analysis (PCA) and examined the associations of antibiotic exposure with childhood overweight/obesity using multivariate logistic regression. Twenty-four individual antibiotics were detected in more than 10 % of the samples, and overall detection rates were up to 100 %. Overweight/obese children had a higher exposure to veterinary antibiotics (VAs) than normal weight children. PCA analysis showed that children who were overweight/obese had higher scores of "Aquatic products preferred dietary pattern" and "Cereals preferred dietary pattern" compared to children with normal weight. Multivariate logistic regression analyses indicated that exposure to elevated levels of deoxytetracycline (OR: 1.72; 95 %CI: 1.00-2.93) and quinolones (OR: 1.63; 95 %CI: 1.04-2.57) was significantly related to an increased risk of BMI-based overweight/obesity. Quinolones exposure was also significantly associated with WFH-based overweight/obesity, primarily in boys. After adjustment for all covariates, higher exposure to ofloxacin (of the quinolones) was significantly related to overweight/obesity in girls. Exposure to certain antibiotics, especially quinolones, may increase the risk of overweight/obesity in preschoolers. More prospective, well-designed studies are needed to clarify these findings.

Young people exposure to antibiotics: Implication for health risk and the impact from eating habits of takeaway food

Exposure to antibiotics, mainly from animal food ingestion, may have adverse effects on human health. Takeaway food is the preferred choice for the dietary of most Chinese young people nowadays, but the relationship between takeaway eating and antibiotic exposure is not yet adequately understood. In the present study, 297 young people were recruited to collect urine samples and questionnaires with an emphasis on their takeaway eating habits. The internal exposure to 16 antibiotics and three metabolites was measured in urine samples by high-performance liquid chromatography-tandem mass spectrometry, as well as a DNA oxidative damage marker, 8-hydroxydeoxyguanosine (8-OHdG). At least one kind of antibiotic was found in over 90 % of urine samples, with total concentrations from 0.667 to 3.02 × 104 ng/mL. High exposure levels of antibiotics were more likely to be found in individuals with a larger body mass index. The concentrations of six antibiotics were significantly different among people with different overall weekly eating frequencies, usually an upward trend. The estimated daily intakes of antibiotics were on the levels of 0.001-1.0 μg/kg/day, mainly contributed by clarithromycin, ciprofloxacin and oxytetracycline, indicating a potential health risk based on the microbiological effect. A significantly positive correlation was found between DNA oxidative damage and exposure for four categories of antibiotics, conformed by both Spearman correlation and multiple linear regression analysis. The levels of 8-OHdG were 355 %, 239 %, 234 %, and 334 % higher with elevated levels of phenicols, macrolides, tetracyclines and sulfonamides from quartiles 2 to 4. Our results suggest that high-frequency consumption of takeaways may exacerbate oxidative stress trends through human exposure to antibiotics.

Early life environmental antibiotic exposure and preschool allergic diseases: A biomonitoring-based prospective study in eastern China

Background

Globally, the prevalence of allergic diseases remains high, as does the level of environmental antibiotics. It has been found that clinical antibiotic application may increase preschool allergy risk. However, few biomonitoring studies have been conducted about the association between early life environmental trace dose antibiotic exposure and preschool allergy.

Objective

To analyze the association between prenatal environmental antibiotic levels and allergic diseases using logistic regression models.

Methods

A total of 743 pregnant women and their offspring from the Shanghai Allergy Birth Cohort completed five years follow-up, and 251 mother-infant pairs were finally included. Maternal urine samples were collected for 15 antibiotic quantitative measurements using liquid chromatography-tandem mass spectrometry. The high-antibiotic group was defined as having at least half of antibiotics exceeding the median concentration. Allergic diseases were assessed by clinicians through clinical history, standardized questionnaires, and annual physical examinations until the age of five. Skin-prick-test (SPT) was performed at 5 years old.

Results

The incidence of allergic diseases was generally higher in the high-antibiotic than that in the low-antibiotic group. Compared to the low-comprehensive antibiotic group, children in the high-antibiotic group were weakly associated with allergic diseases but had a 6-fold increased risk of food allergens sensitivity (OR: 7.09, 95% CI: 1.59, 31.74). Association of above-median single prenatal antibiotic concentration exposure and allergic diseases was also observed (azithromycin and asthma, OR: 2.72, 95% CI: 1.15, 6.42; enrofloxacin and wheeze, OR: 2.22, 95% CI: 1.22, 4.05; trimethoprim and atopic dermatitis, OR: 2.00, 95% CI: 1.08, 3.71). Moreover, children with higher prenatal norfloxacin levels were more sensitive to food allergens (OR: 5.52, 95%CI: 1.54, 19.71).

Conclusion

Early-life environmental antibiotic exposure may be correlated with an increased risk of asthma, wheeze, atopic dermatitis, and SPT positivity for food allergens in 5-year-old children.

Association between prenatal antibiotics exposure and measures of fetal growth: A repeated-measure study

The abuse of antibiotics in animal husbandry has brought many public health problems, among which the passive use of antibiotics caused by eating food containing residual antibiotics has attracted the most attention. However, few studies have examined the possible adverse effects of prenatal antibiotics exposure on fetal growth and development. In this study, we investigated the associations between prenatal antibiotics exposure and measures of fetal growth. A total of 429 mother-newborn pairs from a birth cohort were enrolled and spot urine samples (N = 1287) were collected during each trimester of pregnancy. Sixteen antibiotics from 7 categories, were selected for the determination of the targeted antibiotics in maternal urines by UHPLC-MS/MS. Fetal growth indicators including newborn birth weight, birth length and gestational age (GA), were obtained from medical record. Sixteen antibiotics were found in 92.3% of the urine samples with detection frequencies ranging from 0.3% to 41.3%. Among the 16 antibiotics detected, we found that the exposure level of ciprofloxacin in the first trimester of pregnancy was negatively correlated with GA (β = -0.17 day, 95% CI, -0.32 to -0.02 day), which would increase the risk of preterm birth (OR=1.05, 95% CI, 1.00, 1.09). The exposure level of norfloxacin in the second trimester of pregnancy was negatively correlated with fetal birth weight (β = -17.56 g, 95% CI, -31.13 to -3.99 g) and birth length (β = -0.05 cm, 95% CI, -0.08 to -0.02 cm), and the exposure level of sulfamethoxazole in the third trimester of pregnancy was negatively correlated with fetal birth length (β = -0.15 cm, 95% CI, -0.29 to -0.02 cm). Our findings suggest that prenatal exposure to norfloxacin and sulfamethoxazole may adversely affect fetal growth and development.

Antibiotic exposure and risk of overweight/obesity in school children: A multicenter, case-control study from China

BACKGROUND

Although the use of antibiotics during early life has been associated with increased risk of adipogenesis, effect of antibiotic exposure from various sources, including food or drinking water, on adiposity in children is largely unknown.

OBJECTIVE

To investigate associations between urinary biomarkers of multiple antibiotics and risk of adipogenesis in school children.

METHODS

This case-control study recruited 410 overweight/obese school children aged 6-9 years and 410 controls from Shandong and Guangdong Province, China, matched on sex, age and school. Diagnosis of overweight and obesity was based on body mass index-based criteria derived from national data. Urinary concentrations of 45 antibiotics from 8 categories (macrolides, β-lactams, tetracyclines, fluoroquinolones, sulfonamides, phenicols, lincosamides, and quinoxalines), including 6 human antibiotics (HAs), 6 antibiotics preferred as HAs (PHAs), 16 veterinary antibiotics (VAs), and 17 antibiotics preferred as VA (PVAs), were measured by ultra-performance liquid chromatography coupled to triple-quadrupole tandem mass spectrometry. Conditional logistic regression analyses were used to assess odds ratios (ORs) of childhood overweight/obesity in relation to urinary antibiotic concentrations.

RESULTS

A total of 32 antibiotics were found in urine samples with an overall detection frequency of 92.93 %. Children with overweight/obesity have higher veterinary antibiotic levels than those with normal weight. Compared with undetected levels of antibiotics, the multivariable-adjusted ORs (95 % confidence interval) of overweight/obesity for high levels of antibiotics divided according to median values were 1.63 (1.02, 2.62) for florfenicol, 1.62 (1.04, 2.54) for phenicols, and 1.41 (0.97, 2.04) for sum of VAs and PVAs. These associations predominantly existed in boys and remained significant in florfenicol after FDR multiple testing correction (FDR adjusted p < 0.05).

CONCLUSION

Exposure to certain antibiotic for veterinary use mainly from food or drinking water was associated with an increased risk of adipogenesis in children. Further studies are needed to confirm our findings and clarify the underlying mechanisms.

A short review of human exposure to antibiotics based on urinary biomonitoring

Antibiotics play a role in preventing and treating infectious diseases and also contribute to other health risks for humans. With the overuse of antibiotics, they are widely distributed in the environment. Long-term exposure to multiple antibiotics may occur in humans through medication and dietary intake. Therefore, it is critical to estimate daily intake and health risk of antibiotics based on urinary biomonitoring. This review compares the strengths and weaknesses of current analytical methods to determine antibiotics in urine samples, discusses the urinary concentration profiles and hazard quotients of individual antibiotics, and overviews correlations of antibiotic exposure with the risk of diseases. Liquid chromatography-tandem mass spectrometry is most applied to simultaneously determine multiple types of antibiotics at trace levels. Solid-phase extraction with a hydrophilic-lipophilic balance adsorbent is commonly used to extract antibiotics in urine samples. Fifteen major antibiotics with relatively higher detection frequencies and concentrations include sulfaclozine, trimethoprim, erythromycin, azithromycin, penicillin V, amoxicillin, oxytetracycline, chlortetracycline, tetracycline, doxycycline, ofloxacin, enrofloxacin, ciprofloxacin, norfloxacin, and florfenicol. Humans can be easily at microbiological effect-based risk induced by florfenicol, ciprofloxacin, azithromycin, and amoxicillin. Positive associations were observed between specific antibiotic exposure and obesity, allergic diseases, and mental disorders. Overall, the accessible, automated, and environmentally friendly methods are prospected for simultaneous determinations of antibiotics at trace level in urine. To estimate human exposure to antibiotics more accurately, knowledge gaps need to be filled up, including the transformation between parent and metabolic antibiotics, urinary excretion proportions of antibiotics at low-dose exposure and pharmacokinetic data of antibiotics in humans, and the repeated sampling over a long period in future research is needed. Longitudinal studies about antibiotic exposure and the risk of diseases in different developmental windows as well as in-depth research on the pathogenic mechanism of long-term, low-dose, and joint antibiotic exposure are warranted.

COVID-19 Pandemic Impacts on Humans Taking Antibiotics in China

The outbreak of the novel coronavirus 2019 (COVID-19) pandemic has resulted in the increased human consumption of medicines. Antibiotics are of great concern due to their adverse effects, such as increased bacterial resistance and dysbiosis of gut microbiota. Nevertheless, very little is known about the changes in self-medication with antibiotics during the COVID-19 pandemic and the resultant potential health risks. Herein, we examined the concentration profiles of some commonly used antibiotics in human urine collected from several geographical regions in China between 2020 and 2021. Antibiotics were found in 99.2% of the urine samples at concentrations ranging from not detected (nd) to 357 000 (median: 10.2) ng/mL. During the COVID-19 pandemic, concentrations of urinary antibiotics were remarkably higher than those found either before the pandemic or in the smooth period of the pandemic. Moreover, elevated levels of antibiotics were determined in urine samples from the regions with more confirmed cases. The exposure assessment showed that hazard index values >1 were determined in 35.2% of people. These findings show that human exposure to antibiotics increased during the COVID-19 pandemic, and further research is imperative to identify the public health risks.

Urinary concentrations of amphenicol antibiotics in relation to biomarkers of oxidative DNA and RNA damage in school children

Previous studies implied that elevated exposure to amphenicol antibiotics may induce increased oxidative stress. However, the effects of amphenicol antibiotics exposure on oxidative stress damage in human have not been well studied. This study examined the associations between amphenicol antibiotics exposure and oxidative damage biomarkers in school children. Three major amphenicols including chloramphenicol (CAP), thiamphenicol (TAP), florfenicol (FF) and two biomarkers of 8-hydroxydeoxyguanosine (8-OHdG) for oxidative DNA damage and 8-oxo-7,8- dihydroguanosine (8-OHG) for oxidative RNA damage were measured in 414 morning urine samples collected from 70 school children in Shanghai, China. School children were exposed to CAP, TAP, and FF with median concentrations of 1.37, 0.36, and 0.06 μg/g Cre, respectively. Linear mixed models revealed that an interquartile range (IQR) increase of urinary TAP was positively associated with 7.75%(95% CI: 4.40%, 11.1%) increase of 8-OHdG and 7.48%(95% CI: 2.49%, 15.6%) increase of 8-OHG, respectively; in addition, CAP was associated with elevated 8-OHdG. Although FF was not found to be significantly associated with either 8-OHdG or 8-OHG, it is warranted to further investigate FF and its metabolites levels in relation to oxidative stress in future study. Our findings provide new evidence for the effects of exposure to TAP and CAP on nucleic acid oxidative damage in Children.

Chemical and computational strategy for design of "switchable" sorbent based on hydroxyapatite nanoparticles for dispersive micro-solid phase extraction of tetracyclines

A challenging task in analytical chemistry is an application of renewable and natural materials for isolation of hazardous substances such as antimicrobial drugs from environmental samples. The energy-efficient scalable hydrothermal procedure to fabricate the eco-friendly "switchable" sorbent based on hydroxyapatite nanoparticles with in situ modified surface using a small amount of capping agents was developed. Sorbents characterization including the surface composition investigation via quantum-chemical calculation based on the original approach was provided. The sorbents demonstrated well expressed controllable surface switching and high values of the sorption and elution efficiency for tetracycline, oxytetracycline, and chlortetracycline achieved by simple change of the medium pH. These processes were thoroughly discussed based on the results of chemical and computational experiments. A simple and universal strategy for choosing a suitable sorbent for solid phase extraction of target analytes was proposed for the first time. It was shown that the developed eco-friendly sample preparation procedure with use of biocompatible sorbents could be applied both for removal of target analytes from sample matrix (water samples) as well as for the quantitative analytes determination after elution step. It is believed that the presented research is significant for the determination of different amphoteric analytes in wide variety of samples.

A simple, rapid and sensitive method for the simultaneous determination of eighteen environmental phenols in human urine

Environmental phenols are a typical group of endocrine disrupting compounds (EDCs) and have caused growing concerns upon the potential adverse effects on humans. Urinary concentrations of phenols can be used as valid biomarkers for the assessment of human exposure. A method was developed for the simultaneous determination of eighteen environmental phenols (six parabens, seven bisphenols, four benzophenones and triclosan) in human urine using liquid-liquid extraction (LLE) coupled to high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The optimized LLE was time saving and required low volumes of organic solvents. A volume of only 0.2 mL urine sample was extracted and analyzed. The method yielded good linearity (0.9925-0.9994) and satisfactory limit of detection (LOD) (≤0.08 ng mL^-1). The relative recoveries ranged between 76.7% and 116% at three spiked levels, with intra- and inter-day precision less than 8.04% and 13.5%, respectively. Our method has been proved to be simple, rapid and sensitive by a comprehensive comparison between methods. This proposed method provides a large-scale biomonitoring tool for exposure assessment of human population to environmental phenols.

Detection of antibiotics in the urine of children and pregnant women in Jiangsu, China

Exposure to low concentrations of antibiotics links to multiple health hazards, such as drug resistance of bacteria, and childhood obesity. In this study, seven antibiotics were measured in the urine of 107 children and 126 pregnant women in Jiangsu Province by ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS/MS). The overall urinary antibiotics detection rate was 38.6%. Most (98.3%) of the participants' antibiotics concentrations were no more than 10 ng/mL. Children had a significantly higher detection rate than pregnant women (47.7% vs. 31.0%, P = 0.009), as well as the concentration (95th percentile: 6.49 vs. 4.08 ng/mL, P = 0.002). The detection rates of individual antibiotics ranged from 0.4% to 15.0%, and the concentrations ranged from lower than the limit of detection (LOD) through up to 31.96 ng/mL individually. Two or more antibiotics were detected in 11.2% of the urines. Tetracyclines were more frequently detected than phenicols (30.9% vs.12.4%). Oxytetracycline was the most frequently detected (15.0%). Multivariate logistic regression showed that consuming puffed food every day was associated with a significantly increased likelihood of detection, and higher concentration of overall antibiotics, and of doxycycline. Children were more likely to be detected of doxycycline and florfenicol, and to have elevated concentration of doxycycline, compared with pregnant women. This study highlights the relatively heavier antibiotics exposure in children, and a possible impact of puffed food on it, which needs to be warranted in future studies.

Maternal antibiotic concentrations in pregnant women in Shanghai and their determinants: A biomonitoring-based prospective study

Consumption of antibiotics is continuing to increase, with China accounting for approximately one quarter of the global intake. As a class of emerging environmental contaminants, antibiotics may pose a potential threat to human health, especially in children. However, the internal antibiotic exposure levels in pregnant women and their determinants remain unclear. Here we investigated the urinary creatinine-corrected concentration of 15 antibiotics in 762 pregnant women from the Shanghai Prenatal Cohort, by liquid chromatography-tandem mass spectrometry. Logistic regression analysis identified associations between high-antibiotic-level and maternal dietary factors. Results show that cumulatively antibiotics were detected at a frequency of 0.13 - 82.7%, with veterinary antibiotics (VAs) and preferred veterinary antibiotics (PVAs) detected in 76.9% and 98.2% of samples, respectively; PVAs were the most significant contributors to hazard index values > 1. Further, ciprofloxacin was the predominant antibiotic (median: 73.5 μg/mg creatinine), followed by norfloxacin (54.2 μg/mg creatinine); while sulfamethoxazole, enrofloxacin, and ciprofloxacin levels, used as a PVA or VA, were significantly higher in normal-weight and underweight women compared to overweight and obese women. Also, sulfamethoxazole, sulfadiazine, and ciprofloxacin were more frequently detected in mothers with a relatively low education degree. Interestingly, pregnant women with higher milk intake had a 1.96-times (95% CI: 1.10-3.49) greater risk of high-VA-exposure-level than the lower-intake group. The odds of exposure to high PVA, VA, PVA + VA, and all antibiotics levels for mothers with high egg consumption frequency were more than twice that of low-consumption individuals. Collectively, pregnant women in Shanghai are exposed to multiple environmental antibiotics, primarily as PVAs and VAs. Herein, we provide evidence for the association between dietary factors and maternal environmental antibiotic exposure in China. Special attention to antibiotic exposure and confirmation of potential determinants should be taken in the future.

Antibiotic burden of school children from Tibetan, Hui, and Han groups in the Qinghai-Tibetan Plateau

BACKGROUND

Given their geographical proximity but differences in cultural and religious dietary customs, we hypothesize that children from the three main ethnic populations (Han, Hui, and Tibetan) residing in the Qinghai-Tibetan Plateau region differs in their non-iatrogenic antibiotic loads.

METHODS

To determine the antibiotic burden of the school children unrelated to medical treatment, we quantified the antibiotic residues in morning urine samples from 92 Han, 72 Tibetan, and 85 Muslim Hui primary school children aged 8 to 12 years using high-performance liquid chromatography-tandem mass spectrometry, and performed correlation analysis between these data and concurrent dietary nutrition assessments.

RESULTS

Sixteen of the 18 targeted antibiotics (4 macrolides, 3 β-lactams, 2 tetracyclines, 4 quinolones, 3 sulfonamides, and 2 aminoanols) were identified in the urine samples with an overall detection frequency of 58.63%. The detection frequency of the six antibiotic classes ranged from 1.61% to 32.53% with ofloxacin showing the single highest frequency (18.47%). Paired comparison analysis revealed significant differences in antibiotic distribution frequency among groups, with Tibetans having higher enrofloxacin (P = 0.015) and oxytetracycline (P = 0.021) than Han children. Norfloxacin (a human/veterinary antibiotic) was significantly higher in the Hui children than in the Han children (P = 0.024). Dietary nutrient intake assessments were comparable among participants, showing adequate levels of essential vitamins and minerals across all three ethnic groups. However, significant differences in specific foods were observed among groups, notably in lower fat consumption in the Hui group.

CONCLUSIONS

The introduction and accumulation of antibiotic residues in school children through non-iatrogenic routes (food or environmental sources) poses a serious potential health risk and merits closer scrutiny to determine the sources. While the exact sources of misused or overused antibiotics remains unclear, further study can potentially correlate ethnicity-specific dietary practices with the sources of contamination.

Antibiotic body burden of elderly Chinese population and health risk assessment: A human biomonitoring-based study

Recently, the widespread use of antibiotic has raised concerns about the potential health risks associated with their microbiological effect. In the present study, we investigated 990 elderly individuals (age ≥ 60 years) from the Cohort of Elderly Health and Environment Controllable Factors in West Anhui, China. A total of 45 representative antibiotics and two antibiotic metabolites were monitored in urine samples through liquid chromatography electrospray tandem mass spectrometry. The results revealed that 34 antibiotics were detected in 93.0% of all urine samples and the detection frequencies of each antibiotic varied between 0.2% and 35.5%. The overall detection frequencies of seven human antibiotics (HAs), 10 veterinary antibiotics (VAs), three antibiotics preferred as HAs (PHAs), and 14 preferred as VAs (PVAs) in urines were 27.4%, 62.9%, 30.9% and 72.7%, respectively. Notably, the samples with concentrations of six PVAs (sulfamethoxazole, trimethoprim, oxytetracycline, danofloxacin, norfloxacin and lincomycin) above 5000 ng/mL accounted for 1.7% of all urine samples. Additionally, in 62.7% of urine samples, the total antibiotic concentration was in the range of the limits of detection to 20.0 ng/mL. Furthermore, the elderly individuals with the sum of estimated daily intakes of VAs and PVAs more than 1 μg/kg/day accounted for 15.2% of all participants, and a health risk related to change in gut microbiota under antibiotic stimulation was expected in 6.7% of the elderly individuals. Especially, ciprofloxacin was the foremost contributor to the health risk, and its hazard quotient value was more than one in 3.5% of all subjects. Taken together, the elderly Chinese people were extensively exposed to VAs, and some elderly individuals may have a health risk associated with dysbiosis of the gut microbiota.

Determination of antibiotic concentration in meconium and its association with fetal growth and development

BACKGROUND

The association between antibiotic use during pregnancy and neonatal birth outcomes has received considerable attention. Most of the previous assessment of antibiotic exposure during pregnancy relied on questionnaires and clinical prescriptions, and very few studies examined pregnancy exposure to antibiotics using human biomonitoring data.

OBJECTIVE

To explore the association between the cumulative exposure of antibiotics during the whole pregnancy and neonatal birth measurements using biomonitoring data of antibiotics in meconium.

METHODS

Three hundred and sixty nine pregnant women within the Maternal Psychological and Environmental Assessments of Kids Cohort Study were randomly selected into this study. Eighteen common antibiotics of six categories (six β‑lactams, three tetracyclines, four sulfonamides, one phenicols, one lincosamides and three fluoroquinolones) were selected as the target antibiotics in meconium. The measurement was conducted by ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry platform. Neonatal birth measurements were obtained from the medical records. Multiple linear regression models were used to examine the associations of antibiotic exposure with neonatal birth outcome (birth weight, birth length) and placental growth indicators (placental surface area, placental weight). Logistic regressions were used to evaluate associations with small for gestational age (SGA) and large for gestational age (LGA).

RESULTS

Twelve of the eighteen antibiotics were found in 62.1% of the meconium, with detection rates ranging from 0.3% to 43.9%. The three antibiotics with the highest detection rates were chlortetracycline (43.9%), penicillin (16.5%) and chloramphenicol (10.8%), respectively. The highest antibiotic concentration among detected antibiotics was penicillin (24,243.15 μg/kg). The concentration of penicillin was positively associated with the birth weight (β: 0.025; 95% CIs: 0.003-0.047). A significant positive association was also observed between the concentration of chlortetracycline and the placental surface area (β: 2.559; 95% CIs: 0.296-4.822). These associations were sex related and mainly observed in female newborns. Exposure to penicillin was also found to be associated with increased risk of LGA, which was consistent with changes in birth weight.

CONCLUSIONS

Pregnancy exposure to certain antibiotics was associated with altered fetal growth and development, which may affect the normal growth trajectory of infants and children in later life.

Exposure of Adults to Antibiotics in a Shanghai Suburban Area and Health Risk Assessment: A Biomonitoring-Based Study

An extensive exposure to antibiotics has been demonstrated in children and pregnant women by biomonitoring, but data from general adults remain limited. In the current study, we studied 822 adults aged 21-75 years in Shanghai in 2017 and analyzed 18 common antibiotics (five veterinary antibiotics (VAs), four human antibiotics (HAs), and nine human/veterinary antibiotics (H/VAs)) in spot urine by liquid chromatography coupled to high-resolution mass spectrometry. All 18 antibiotics were detected in urine with an overall detection frequency of 45.9% and the detection frequency for each ranged from 0.1% to 15.2%. HAs, VAs, H/VAs, and VAs+H/VAs were detected in 4.4%, 11.6%, 38.0, and 44.5% of urine samples, respectively. Adults with the sum of estimated daily exposure dose of all the antibiotics below 1.55 μg/kg/day accounted for 89.1% of adults tested positive. A hazard index value beyond one was seen in 7.2% of adults based on microbiological effect. Ciprofloxacin was the biggest contributor to HI and its hazard quotient value more than one was seen in 5.6% of adults. These findings indicated an extensive exposure to low-dose multiple antibiotics in adults in Shanghai and some adults were at health risk related to the disturbance of gut microbiota.

Predictors of urinary antibiotics in children of Shanghai and health risk assessment

BACKGROUND

An extensive exposure to antibiotics has been confirmed in children, but the predictors and potential health risk remain unclear.

OBJECTIVE

To investigate the predictors of antibiotics in urine and potential health risk in children of Shanghai.

METHODS

We selected 284 school children aged 8-11 years from a central area of Shanghai, China, in 2017. Ultra-performance liquid chromatography coupled with high-resolution mass spectrometry was used to measure 20 antibiotics, including four human antibiotics (HAs), six veterinary antibiotics (VAs), 10 human/veterinary antibiotics (H/VAs), and three metabolites in first morning urine. Logistic regression model was used to examine the associations of 17 variables related to demographic and socioeconomic factors, recent antibiotic use, drinking water intake, food consumption, and anthropometric measurements with the detection frequency of HAs, VAs, or H/VAs in urine. After daily intake was estimated, health risk was assessed for VAs and H/VAs by using hazard quotient (HQ) and hazard index (HI) based on microbiological or toxicological effects.

RESULTS

The detection frequencies of 20 antibiotics and three metabolites ranged from 0 to 27.8% with an overall detection frequency being 56.0%. The detection frequency of HAs increased with age and screen time at weekend. Sex, age, family income and screen time were positively associated with the detection frequencies of VAs and H/VAs. Children reporting antibiotic use in the past three months had a higher detection frequency of HAs. Children with a higher consumption frequency of dairy products had a higher detection frequency of VAs + H/VAs, but a lower detection frequency of HAs. An increased overall detection frequency of all antibiotics was seen in children with higher consumption frequencies of aquatic products, livestock and poultry meat, or milk and dairy products. HQ >1 was only found for ciprofloxacin (5.6%) and ofloxacin (0.4%) based on microbiological effect. HI >1 was found in 6.0% of children for microbiological effect and none was found for toxicological effect.

CONCLUSIONS

Predictors for antibiotics in urine for children included sex, age, family income, screen time, clinical use, and animal-derived food consumption. There was potential health risk for children with exposure to antibiotics.

An automated salting-out assisted liquid-liquid microextraction approach using 1-octylamine: On-line separation of tetracycline in urine samples followed by HPLC-UV determination

An automated salting-out assisted liquid-liquid microextraction (SALLME) procedure based on a flow system was developed as new approach for pretreatment of complex sample matrix. In this procedure 1-octylamine was investigated as novel extractant for the SALLME. The procedure involved aspiration of the 1-octylamine and sample solution into a mixing chamber of a flow system followed by their air-bubble mixing resulting to isotropic solution formation. To provide phase separation a salting-out agent solution was added into the mixing chamber. After phase separation, the micellar 1-octylamine phase containing analyte was mixed with methanol and transported to a HPLC-UV system. To demonstrate the efficiency of the suggested approach, the automated procedure was applied for the HPLC-UV determination of tetracycline as a proof-of-concept analyte in human urine samples. Under the optimal conditions, the detector response of the analytes was linear in the concentration ranges of 0.5-20 mg L^-1. The limit of detection, calculated from a blank test based on 3σ, was 0.17 mg L^-1. The results demonstrate that the developed approach is highly cost-effective, simple and rapid.

Urinary Antibiotics of Pregnant Women in Eastern China and Cumulative Health Risk Assessment

Exposure to antibiotics during pregnancy can pose a systematic effect on human health. A few biomonitoring studies have demonstrated an extensive exposure of children to antibiotics, but there is still a lack of data for pregnant women. To assess the exposure of pregnant women to antibiotics and potential health risk, we investigated 536 pregnant women aged 16-42 years from two geographically different study sites in Eastern China in 2015. We measured 21 antibiotics of five categories (seven fluoroquinolones, three phenicols, four tetracyclines, three macrolides, and four sulfonamides) in urine using the isotope dilution ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. The hazard index (HI) was calculated on the basis of estimated daily exposure dose and acceptable daily intakes. A total of 16 antibiotics were found in urine, with detection frequencies between 0.2 and 16.0%. Antibiotics were overall detected in 41.6% of urine, and two or more antibiotics were detected in 13.1% of urine. Ciprofloxacin, ofloxacin, and trimethoprim were most frequently detected in urine, with detection frequencies between 10 and 20%. The majority of the antibiotics tested had an estimated daily exposure dose less than 1 μg/kg/day, and 4.3% of pregnant women had a HI value of more than 1. These findings indicated that pregnant women were frequently exposed to antibiotics and some individuals were in the potential risk of adverse microbiological effects induced by antibiotics.

Trends in the application of high-resolution mass spectrometry for human biomonitoring: An analytical primer to studying the environmental chemical space of the human exposome

Global profiling of xenobiotics in human matrices in an untargeted mode is gaining attention for studying the environmental chemical space of the human exposome. Defined as the study of a comprehensive inclusion of environmental influences and associated biological responses, human exposome science is currently evolving out of the metabolomics science. In analogy to the latter, the development and applications of high resolution mass spectrometry (HRMS) has shown potential and promise to greatly expand our ability to capture the broad spectrum of environmental chemicals in exposome studies. HRMS can perform both untargeted and targeted analysis because of its capability of full- and/or tandem-mass spectrum acquisition at high mass accuracy with good sensitivity. The collected data from target, suspect and non-target screening can be used not only for the identification of environmental chemical contaminants in human matrices prospectively but also retrospectively. This review covers recent trends and advances in this field. We focus on advances and applications of HRMS in human biomonitoring studies, and data acquisition and mining. The acquired insights provide stepping stones to improve understanding of the human exposome by applying HRMS, and the challenges and prospects for future research.

High throughput-screening of animal urine samples: It is fast but is it also reliable?

Advanced analytical technologies like ultra-high-performance liquid chromatography coupled to high resolution mass spectrometry can be used for veterinary drug screening of animal urine. The technique is sufficiently robust and reliable to detect veterinary drugs in urine samples of animals where the maximum residue limit of these compounds in organs like muscle, kidney, or liver has been exceeded. The limitations and possibilities of the technique are discussed. The most critical point is the variability of the drug concentration ratio between the tissue and urine. Ways to manage the false positive and false negatives are discussed. The capability to confirm findings and the possibility of semi-targeted analysis are also addressed. Copyright © 2016 John Wiley & Sons, Ltd.

Multiclass method for the quantification of 92 veterinary antimicrobial drugs in livestock excreta, wastewater, and surface water by liquid chromatography with tandem mass spectrometry

A simple multiresidue method was developed for detecting and quantifying 92 veterinary antimicrobial drugs from eight classes (β-lactams, quinolones, sulfonamides, tetracyclines, lincomycins, macrolides, chloramphenicols, and pleuromutilin) in livestock excreta and water by liquid chromatography with tandem mass spectrometry. The feces samples were extracted by ultrasound-assisted extraction with a mixture of acetonitrile/water (80:20, v/v) and edetate disodium, followed by a cleanup using solid-phase extraction with an amino cartridge. Water samples were purified with hydrophilic-lipophilic balance solid-phase extraction column. Urine samples were extracted with acetonitrile and edetate disodium. Detection of veterinary antimicrobial drugs was achieved by liquid chromatography with tandem mass spectrometry using both positive and negative electrospray ionization mode. The recovery values of veterinary antimicrobial drugs in feces, urine, and water samples were 75-99, 85-110, and 85-101% and associated relative standard deviations were less than 15, 10, and 8%, respectively. The limits of quantification in feces, urine, and water samples were 0.5-1, 0.5-1, and 0.01-0.05 μg/L, respectively. This method was applied to determine real samples obtained from local farms and provides reliable quantification and identification results of 92 veterinary antimicrobial drugs in livestock excreta and water.

A Critical Review of Properties and Analytical Methods for the Determination of Oxytetracyline in Biological and Pharmaceutical Matrices

Antibiotics have an unquestionable importance in the treatment of many infections. Oxytetracycline is an antibiotic belonging to the class of tetracyclines, available for use in human and veterinary medicine. Development of analytical methods that prove the quality and efficacy of these drugs is fundamentally important to the pharmaceutical industry. In this context, the research presents an overview of the analytical profile of oxytetracycline, describing its chemical and pharmacological properties, and analytical methods for quantification of this drug in biological samples and pharmaceutical products. Oxytetracycline can be analyzed in these matrices by many types of methodologies. However, high-performance liquid chromatography is the most widely used, being recommended by official compendia. This kind of study can be useful to support the development of new efficient and sustainable analytical methods that may be utilized in the quality control routine of oxytetracycline in pharmaceutical products and pharmacokinetic monitoring in biological samples.

Antibiotics detected in urines and adipogenesis in school children

BACKGROUND

Although antibiotic use during early life has been demonstrated to be related to the altered adipogenesis in later life, limited data are available for the effect of antibiotic exposure in school children on adiposity from various sources, including from the use or contaminated food or drinking water.

OBJECTIVE

To explore the association between the internal exposure of antibiotics from various sources and adipogenesis in school children using the biomonitoring of urinary antibiotics.

METHODS

After 586 school children aged 8-11years were selected from Shanghai in 2013, total urinary concentrations (free and conjugated) of 21 common antibiotics from six categories (macrolides, β-lactams, tetracyclines, fluoroquinolones, sulfonamides, and phenicols), including five human antibiotics (HAs), two antibiotics preferred as HA, four veterinary antibiotics (VAs), and ten antibiotics preferred as VA, were measured by ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. Creatinine-corrected urinary concentrations of antibiotics were used to assess their exposure. Overweight or obesity was determined by the body mass index or waist circumference-based criteria deriving from national data.

RESULTS

All 21 antibiotics were found in urines with the overall detection frequency of 79.6%. The multinomial logistic regression analyses showed the significant associations of overweight and obesity with the exposure to VAs and antibiotics preferred as VA, but not with HAs or antibiotics preferred as HA. After adjusted for a number of obesity-relevant variables, the odds ratios (95% confidence interval) of BMI-based obesity risk of tertiles 2 and 3 of urinary concentrations relative to tertile 1 were respectively 2.54 (1.27, 5.07) and 2.92 (1.45, 5.87) for florfenicol, 0.57 (0.12, 2.63) and 3.63 (1.41, 9.32) for trimethoprim, and 3.00 (1.56, 5.76) and 1.99 (0.99, 4.01) for sum of veterinary antibiotics. Similar results were found when the outcome used WC-based obesity risk. The associations were sex related and mainly observed in boys.

CONCLUSIONS

Some types of antibiotic exposure, which were mainly from food or drinking water, were associated with an increased risk of obesity in school children. Due to the cross-sectional design, more longitudinal and experimental studies are warranted to further test these findings.

Antibiotics in Drinking Water in Shanghai and Their Contribution to Antibiotic Exposure of School Children

A variety of antibiotics have been found in aquatic environments, but antibiotics in drinking water and their contribution to antibiotic exposure in human are not well-explored. For this, representative drinking water samples and 530 urine samples from schoolchildren were selected in Shanghai, and 21 common antibiotics (five macrolides, two β-lactams, three tetracyclines, four fluoquinolones, four sulfonamides, and three phenicols) were measured in water samples and urines by isotope dilution two-dimensional ultraperformance liquid chromatography coupled with high-resolution quadrupole time-of-flight mass spectrometry. Drinking water included 46 terminal tap water samples from different spots in the distribution system of the city, 45 bottled water samples from 14 common brands, and eight barreled water samples of different brands. Of 21 antibiotics, only florfenicol and thiamphenicol were found in tap water, with the median concentrations of 0.0089 ng/mL and 0.0064 ng/mL, respectively; only florfenicol was found in three bottled water samples from a same brand, with the concentrations ranging from 0.00060 to 0.0010 ng/mL; no antibiotics were found in barreled water. In contrast, besides florfenicol and thiamphenicol, an additional 17 antibiotics were detected in urine samples, and the total daily exposure doses and detection frequencies of florfenicol and thiamphenicol based on urine samples were significantly and substantially higher than their predicted daily exposure doses and detection frequencies from drinking water by Monte Carlo Simulation. These data indicated that drinking water was contaminated by some antibiotics in Shanghai, but played a limited role in antibiotic exposure of children.

Antibiotic body burden of Chinese school children: a multisite biomonitoring-based study

To explore the antibiotic body burden of Chinese school children, total urinary concentrations (free and conjugated) of 18 representative antibiotics (5 macrolides, 2 β-lactams, 3 tetracyclines, 4 quinolones, and 4 sulfonamides) were measured by ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry among 1064 school students recruited from 3 economically and geographically distinct areas in east China in 2013. All 18 antibiotics were detected in urine samples with the detection frequencies ranging from 0.4 to 19.6%. The antibiotics were detected in 58.3% of urine samples overall, and this detection frequency reached at 74.4% in one study site. Of them, 47.8% of the urine samples had a sum of mass concentration of all antibiotics between 0.1 (minimum) and 20.0 ng/mL, and 8 antibiotics had their concentrations of above 1000 ng/mL in some urine samples. Three veterinary antibiotics, 4 human antibiotics, and 11 human/veterinary antibiotics were found overall in 6.3, 19.9, and 49.4% of urine samples, respectively. The detection frequencies and concentration levels of antibiotics in urine samples differed by study areas. Concerning mixed exposures, a total of 137 combinations of antibiotics and 20 combinations of antibiotic categories were found overall. Two or more antibiotics or categories were concurrently detected in more than 20% of urine samples. On the basis of a usage analysis, contaminated food or environment might be relevant exposure sources for tetracyclines, quinolones, and sulfonamides.