Identification and quantification of 19 pharmaceutical active compounds and metabolites in hospital wastewater in Cameroon using LC/QQQ and LC/Q-TOF

Monitoring Pharmaceuticals and Personal Care Products in Healthcare Effluent Wastewater Samples and the Effectiveness of Drug Removal in Wastewater Treatment Plants Using the UHPLC-MS/MS Method

A multi-residue UHPLC-MS/MS analytical method, previously developed for monitoring 52 pharmaceuticals in drinking water, was used to analyse these pharmaceuticals in wastewater originating from healthcare facilities in the Czech Republic. Furthermore, the methodology was expanded to include the evaluation of the effectiveness of drug removal in Czech wastewater treatment plants (WWTPs). Of the 18 wastewater samples analysed by the validated UHPLC-MS/MS, each sample contained at least one quantifiable analyte. This study reveals the prevalence of several different drugs; mean concentrations of 702 μg L-1 of iomeprol, 48.8 μg L-1 of iopromide, 29.9 μg L-1 of gabapentin, 42.0 μg L-1 of caffeine and 82.5 μg L-1 of paracetamol were present. An analysis of 20 samples from ten WWTPs revealed different removal efficiencies for different analytes. Paracetamol was present in the inflow samples of all ten WWTPs and its removal efficiency was 100%. Analytes such as caffeine, ketoprofen, naproxen or atenolol showed high removal efficiencies exceeding 80%. On the other hand, pharmaceuticals like furosemide, metoprolol, iomeprol, zolpidem and tramadol showed lower removal efficiencies. Four pharmaceuticals exhibited higher concentrations in WWTP effluents than in the influents, resulting in negative removal efficiencies: warfarin at -9.5%, indomethacin at -53%, trimethoprim at -54% and metronidazole at -110%. These comprehensive findings contribute valuable insights to the pharmaceutical landscape of wastewater from healthcare facilities and the varied removal efficiencies of Czech WWTPs, which together with the already published literature, gives a more complete picture of the burden on the aquatic environment.

A systematic review of pharmaceutical and personal care products as emerging contaminants in waters: The panorama of West Africa

Pharmaceutical and Personal Care Products (PPCPs) are widely used to prevent or treat human and animal diseases, thereby improving the quality of daily life. Poor management of post-consumer products is recognized worldwide, as they negatively affect the ecosystems where they are discharged. The first action to prevent negative impacts is the state of knowledge regarding their occurrence. This paper critically reports the panorama of West Africa in terms of PPCPs occurrence in different water sources. To achieve this objective, a systematic review was conducted on PPCPs in West Africa following the PRISMA guidelines. Databases, including African Journals Online, PubMed, Google Scholar, Scopus, and Dimensions, were used for this search. Thirty-five articles, representing 58 % of West African countries, were selected according to the inclusion and exclusion criteria. Of these articles, one included data from multiple West African countries, while the remaining 34 exclusively focused on Benin, Cameroon, Ghana, and Nigeria. The results revealed a variety of PPCPs investigated, about 27 groups and 112 compounds, with greater emphasis on antibiotics, analgesics and PSHXEs. HPLC was the predominant analytical method used, resulting in total concentrations of PPCPs in the range of 200,000 to 3,200,000 ng/L in drinking water, 12 to 700,000 ng/L in groundwater, 0.42 to 107,800,000 ng/L in surface water, 8.5 to 121,310,000 ng/L in wastewater, and 440 to 421,700 ng/L in tap water. Ghana, Nigeria and Cameroon reported the highest number of PPCPs investigated and consequently the highest concentration of cases. These compounds present a high potential ecological risk, with >50 % exceeding the risk quotient limit. Therefore, West Africa as a community needs integrated approaches and strategies to monitor water, especially transboundary resources. This review is timely and provides pertinent information to policymakers and researchers on PPCPs in water.

Single and combined effects of caffeine and salicylic acid on mussel Mytilus galloprovincialis: Changes at histomorphological, molecular and biochemical levels

Caffeine (CAF) and salicylic acid (SA) are frequently detected in waterbody, though information on their biological impact is poor. This work assesses the effects of CAF (5ng/L to 10µg/L) and SA (0.05µg/L to 100µg/L) alone and combined as CAF+SA (5ng/L+0.05µg/L to 10µg/L+100µg/L) on mussel Mytilus galloprovincialis under 12-days exposure by histomorphology of digestive gland and oxidative stress defense at molecular and biochemical levels. Besides evaluating tissue accumulation, absence of histomorphological damage and haemocyte infiltration highlighted activation of defensive mechanisms. Up-regulation of Cu/Zn-sod, Mn-sod, cat and gst combined with increased catalase and glutathione S-transferase activity were found in CAF-exposed mussels, while SA reduced ROS production and mitochondrial activity. CAF+SA exposure induced differential responses, and the integrated biomarker response (IBR) revealed more pronounced effects of SA than CAF. These results enlarge knowledge on pharmaceuticals impact on non-target organisms, emphasizing the need for proper environmental risk assessment.

Review of hospital effluents: special emphasis on characterization, impact, and treatment of pollutants and antibiotic resistance

Health care institutions generate large volumes of liquid effluents from specific activities related to healthcare, analysis, and research. Their direct discharge into the environment has various negative effects on aquatic environments and human health, due to their high organic matter charges and the presence of various emerging contaminants such as disinfectants, drugs, bacteria, viruses, and parasites. Moreover, hospital effluents, by carrying antibiotics, contribute to the development of antibiotic-resistant microorganisms in the environment. This resistance has become a global issue that manifests itself variously in different countries, causing the transmission of different infections. In this respect, an effort is provided to protect water resources by current treatment methods that imply physical-chemical processes such as adsorption and advanced oxidation processes, biological processes such as activated sludge and membrane bioreactors and other hybrid techniques. The purpose of this review is to improve the knowledge on the composition and impact of hospital wastewater on man and the environment, highlighting the different treatment techniques appropriate to this type of disposal before discharge into the environment.

Overview of African water resources contamination by contaminants of emerging concern

This review look at several classes of contaminants of emerging concern (CECs) in conventional and non-conventional water resources across the African continent's five regions. According to the review, pharmaceuticals, endocrine-disrupting chemicals, personal care products, pesticides, per- and polyfluoroalkyl compounds, and microplastics were found in conventional and non-conventional water resources. Most conventional water resources, such as rivers, streams, lakes, wells, and boreholes, are used as drinking water sources. Non-conventional water sources, such as treated wastewater (effluents), are used for domestic and agricultural purposes. However, CECs remain part of the treated wastewater, which is being discharged to surface water or used for agriculture. Thus, wastewater (effluent) is the main contributor to the pollution of other water resources. For African countries, the prevalence of rising emerging pollutants in water poses a severe environmental threat. There are different adverse effects of CECs, including the development of antibiotic-resistant bacteria, ecotoxicological effects, and several endocrine disorders. Therefore, this needs the urgent attention of the African Union, policymakers, Non-Governmental Organizations, and researchers to come together and tackle the problem.

Pharmaceutical pollution of hospital effluents and municipal wastewaters of Eastern Canada

Quantification of drugs residues in wastewaters of different sources could help better understand contamination pathways, eventually leading to effluent regulation. However, limited data are available for hospital-derived wastewaters. Here, an analytical method based on automated on-line solid-phase extraction liquid chromatography tandem mass spectrometry (on-line SPE - UPLC-MS/MS) was developed for the quantification of multi-class pharmaceuticals in wastewaters. Filtrate phase and suspended solids (SPM) were both considered to evaluate the distribution of targeted analytes. Experimental design optimization involved testing different chromatographic columns, on-line SPE columns, and loading conditions for the filtrate phase, and different organic solvents and cleanup strategies for suspended solids. The selected methods were validated with suitable limits of detection, recovery, accuracy, and precision. A total of 30 hospital effluents and 6 wastewater treatment plants were sampled to evaluate concentrations in real field-collected samples. Certain pharmaceuticals were quantified at high levels such as caffeine at 670,000 ng/L in hospital wastewaters and hydroxyibuprofen at 49,000 ng/L in WWTP influents. SPM samples also had high contaminant concentrations such as ibuprofen at 31,000 ng/g in hospital effluents, fluoxetine at 529 ng/g in WWTP influents or clarithromycin at 295 ng/g in WWTP effluents. Distribution coefficients (K_d) and particle-associated fractions (Φ) indicate that pharmaceuticals tend to have better affinity to suspended solids in hospital wastewater than in municipal wastewaters. The results also bring arguments for at source treatment of these specific effluents before their introduction into urban wastewater systems.

Metformin as an emerging concern in wastewater: Occurrence, analysis and treatment methods

Metformin is a wonder drug used as an anti-hypoglycemic medication; it is also used as a cancer suppression medicament. Metformin is a first line of drug choice used by doctors for patients with type 2 diabetes. It is used worldwide where the drug's application varies from an anti-hypoglycemic medication to cancer oppression and as a weight loss treatment drug. Due to its wide range of usage, metformin and its byproducts are found in waste water and receiving aquatic environment. This leads to the accumulation of metformin in living beings and the environment where excess concentration levels can lead to ailments such as lactic acidosis or vitamin B12 deficiency. This drug could become of future water treatment concerns with its tons of production per year and vast usage. As a result of continuous occurrence of metformin has demanded the need of implementing and adopting different strategies to save the aquatic systems and the exposure to metformin. This review discuss the various methods for the elimination of metformin from wastewater. Along with that, the properties, occurrence, and health and environmental impacts of metformin are addressed. The different analytical methods for the detection of metformin are also explained. The main findings are discussed with respect to the management of metformin as an emerging contaminants and the major recommendations are discussed to understand the major research gaps.

QuEChERS-based analysis and ecotoxicological risk of select antibiotics in dumpsite leachates, hospital wastewater and effluent receiving water in Ibadan, Nigeria

There is currently a dearth of information on the determination, occurrence and ecotoxicological risk of antibiotics in dumpsite leachates and hospital wastewater in Africa. A quick, easy, cheap, effective, rugged and safe (QuEChERS) protocol which combines extraction and clean-up in one step was optimized for the determination of antibiotics sulfadoxine, sulfamethazine and trimethoprim in dumpsite leachates and hospital wastewater. The occurrence and ecotoxicological risk of target antibiotics were investigated in wastewater from two hospitals, effluent receiving water and leachates from three dumpsites in Ibadan, Nigeria. Recoveries in hospital wastewater ranged from 53 to 116% while recoveries ranged from 50 to 89% in leachates. Method limits of quantification ranged from 0.7 to 12.1 µg L^-1 in hospital wastewater and from 6.2 to 38.8 µg L^-1 in leachates. Intra-day precisions (% RSD) were ≤ 21%. High concentrations of target antibiotics were measured: up to 475 µg L^-1 for sulfamethazine in leachates, 118 µg L^-1 for trimethoprim in hospital wastewater and 117 µg L^-1 for sulfadoxine in effluent receiving water. Sulfadoxine presented high risk to algae, daphnid and fish in hospital wastewater, effluent receiving water and leachates. This work highlights the need for adequate and sound management of wastes containing pharmaceuticals in Nigeria.

Detailed characterization, antibiotic resistance and seasonal variation of hospital wastewater

This study investigates the presence of the different classes of micro-pollutants such as pharmaceutical active compounds (PhACs) (20 antibiotics, 8 analgesics and anti-inflammatories, 5 cytostatic agents, 7 β-blockers, 4 lipid regulators, 13 psychiatrics, 1 antidiabetic, 1 receptor antagonist, 1 local anaesthetic, 1 antihypertensive and their 5 metabolites), hormones (8 compounds), X-ray contrast agents (6 compounds), benzotriazoles (3 compounds) and pesticides (6 compounds), and antibiotic resistance in hospital wastewater (HWW) of a medical faculty in Istanbul, Turkey. In addition, the seasonal variations of the selected PhACs and X-ray contrast agents and antibiotic resistance were evaluated for 2 years in a total of eight samples. In the PhACs, sulfamethoxazole and its metabolite (4 N-acethyl-sulfamethoxazole) in the antibiotic group and paracetamol in the analgesic and anti-inflammatory group were found at 100% of frequency and the highest concentrations as 35, 43 and 210 μg/L, respectively. The mean concentrations of psychiatric compounds were found less than 0.25 μg/L except carbamazepine (1.36 μg/L). Bisphenol A in hormone group had the highest concentration up to 14 μg/L. In the hormone group compounds, 17-α-Ethinylestradiol and 17-β-Estradiol were detected at lower mean concentrations of 0.2 and 0.05 μg/L, respectively. 1H-benzotriazole had the highest concentration with the mean concentration of 24.8 μg/L in benzotriazole group compounds. The compounds in X-ray contrast agents group were noted as compounds detected at the highest concentration in HWW up to 3000 μg/L. Antibiotic resistance against azithromycin, clindamycin and trimethoprim-sulfamethoxazole antibiotics was observed around 50% in the winter period. The seasonal variation was detected for the most of the investigated PhACs, especially in antibiotic group which was in line with those significant differences in antibiotic resistance rates in the studied antibiotics between winter and summer seasons.

Detection of N-nitrosodimethylamine (NDMA) and its formation potential in hospital wastewater

Hospital wastewaters contain high concentrations of pharmaceutical residues and other chemicals, and may present an important source for NDMA (N-nitrosodimethylamine) and its precursors in the aquatic environment. The present study evaluates the contribution of hospital wastewater to NDMA environmental load and identifies important sources within the hospital itself. For this purpose, wastewaters from five large hospitals in Israel were analyzed, and concentrations of NDMA were found in the range of 20.7-56.7 ng/L, which are similar to NDMA concentrations typically detected in domestic wastewater. The relative contribution of day surgery, oncology, laboratories, and central kitchen (in Sheba hospital) to the daily load of NDMA was calculated as 20.2%, 8.2%, 10%, and 43.2%, respectively. In addition, NDMA concentration in Sheba's mixed wastewater stream, measured throughout a complete working day, was highest at 14:00. This suggests the possible impact of lunchtime on NDMA concentration, and emphasizes the dominant contribution of central kitchen waste. Finally, formation potential of NDMA in the mixed stream was 7300 ng/L, in the upper range of domestic wastewater, but could be decreased by 70% during subsequent aerobic biological wastewater treatment.

QuEChERS Approach for the Analysis of Three Fluoroquinolone Antibiotics in Wastewater: Concentration Profiles and Ecological Risk in Two Nigerian Hospital Wastewater Treatment Plants

Hospital wastewater is regarded as a primary and very important source of antibiotics in the aquatic environment. Studies on the analysis, occurrence, and ecological risk assessment of fluoroquinolone antibiotics in wastewater are still limited in Africa. A quick, easy, cheap, effective, rugged, and safe extraction method was optimized and applied for determination of three fluoroquinolone antibiotics (ciprofloxacin, norfloxacin, and ofloxacin) in wastewater from two Nigerian hospital wastewater treatment plants (WWTPs) and effluent receiving water. Separation, detection, and quantification of target fluoroquinolone antibiotics were performed by high-performance liquid chromatography. Ecological risk of the three fluoroquinolone antibiotics was evaluated for three trophic levels: fish, daphnid, and algae. The method LODs were 4.1 µg L^-1, 7.0 µg L^-1, and 18.5 µg L^-1 for ciprofloxacin, norfloxacin, and ofloxacin, respectively. Satisfactory recoveries and precisions were achieved, in addition to the correlation coefficients of greater than 0.993. Target fluoroquinolones were quantified in influents up to 228 µg L^-1 (UCH influent) for ciprofloxacin, 561 µg L^-1 (Ijaiye influent) for norfloxacin, and 198 µg L^-1 (UCH influent) for ofloxacin. Norfloxacin had the highest concentration (386 µg L^-1) in effluent receiving water. All three fluoroquinolones posed low risk to fish, whereas ciprofloxacin and norfloxacin presented moderate risk to daphnid and algae. To the best of our knowledge, this work presents the first data on the occurrence and risk assessment of the target fluoroquinolones in wastewater from Nigerian hospital WWTPs. The findings revealed the importance of developing local and nationwide surveys of fluoroquinolone antibiotics in the Nigerian aquatic environment.

Environmental knowledge, behaviors, and attitudes regarding caffeine consumption among Chinese university students from the perspective of ecopharmacovigilance

Caffeine is considered the most representative pharmaceutical emerging contaminant (PEC) because of its ubiquity, high environmental abundance, uncovered ecological risks, and its indicator property for anthropogenic environmental inputs of PECs. Ecopharmacovigilance (EPV) targeting caffeine has been proposed as an optimized measure for the control of caffeine pollution sources and the related anthropogenic behaviors from the perspective of pharmacy administration. This cross-sectional study was conducted to evaluate the environmental knowledge, behaviors, and attitudes regarding caffeine consumption among university students, one of the groups with high caffeine consumption, from an EPV perspective. Three hundred and seven usable survey instruments were acquired. The mean score for environmental knowledge about caffeine consumption was 3.66 out of a total of 7. The consumption frequency of caffeinated drinks, food, or drugs among student respondents was low. Throwing away in "household garbage" was an important disposal mechanism for unconsumed caffeinated products. Most students showed positive attitudes and strong intentions toward caffeine pollution control from the perspective of targeted EPV. These data suggested high acceptance of EPV program targeting caffeine among university students. However, more should be done to enhance their related knowledge, and some strengthening interventions for the effective removal of residual caffeine in garbage are needed.

Occurrence, toxic effects and removal of metformin in the aquatic environments in the world: Recent trends and perspectives

Metformin (MET) is the most common drug used to treat type 2 diabetes, but also it is used as an anticancer agent and as a treatment for polycystic ovary syndrome. This drug is not metabolized in the human body, and may enter into the environment through different pathways. In wastewater treatments plants (WWTPs), this contaminant is mainly transformed to guanylurea (GUA). However, three further transformation products (TPs): (a) 2,4- diamino-1,3,5-triazine, 4-DAT; (b) 2-amino-4-methylamino-1,3,5-triazine, 2,4-AMT; and (c) methylbiguanide, MBG; have also been associated with its metabolism. MET, GUA and MBG have been found in WWTPs influents, effluents and surface waters. Furthermore, MET and GUA bioaccumulate in edible plants species, fish and mussels potentially contaminating the human food web. MET is also a potential endocrine disruptor in fish. Phytoremediation, adsorption and biodegradation have shown a high removal efficiency of MET, in laboratory. Nonetheless, these removal methods had less efficiency when tried in WWTPs. Therefore, MET and its TPs are a threat to the human being as well as to our environment. This review comprehensively discuss the (1) pathways of MET to the environment and its life-cycle, (2) occurrence of MET and its transformation products (3) removal, (4) toxic effects and (5) future trends and perspectives of possible methods of elimination in water in order to provide potential options for managing these contaminants.

Mass loads, source apportionment, and risk estimation of organic micropollutants from hospital and municipal wastewater in recipient catchments

Understanding the occurrence and sources of organic micropollutants (OMPs) in aquatic environments is essential for environmental risk assessment and adequate interventions to secure good status of aquatic environments. The occurrence and source apportionment of 77 OMPs in the River Fyris catchment (Uppsala, Sweden) were investigated by comparing hospital wastewater, wastewater treatment plant (WWTP) effluent, and surface water. Hospital wastewater was identified as an important source for some classes of OMPs, e.g., antibiotics (number of OMPs (n) = 6) and antidepressants (n = 4), contributing 38% and 31%, respectively, of the mass loads in total WWTP influent. Painkillers (n = 5) and hormones (n = 3), originating mainly from urban Uppsala, contributed 94% and 95%, respectively. WWTP removal efficiency varied from 100% for acetaminophen to <0% for i.e. clindamycin, lamotrigine, bicalutamide, and sucralose. In the recipient River Fyris, the ΣOMP concentration downstream of the WWTP (738 ng L^-1) was more than double that upstream (338 ng L^-1), demonstrating the high impact of the WWTP on recipient water quality. Surface water risk quotients (RQs) showed a moderate risk of adverse chronic effects (RQ > 0.1) for trimethoprim, norsertraline, and metoprolol downstream of the WWTP, and for norsertraline in the recipient river upstream and Lake Ekoln downstream of the WWTP. Recipient metoprolol and trimethoprim, compounds poorly removed in the WWTP, mainly (>90%) originated from wastewater from urban Uppsala, whereas recipient norsertraline originated upstream of the city. No risk compound was apparently sourced from hospital wastewater.

Wastewater analysis for nicotine, cocaine, amphetamines, opioids and cannabis in New York City

According to current surveys and overdoses data, there is a drug crisis in the USA. Wastewater-based epidemiology (WBE) is an evolving discipline that analyses wastewater samples to detect drugs and metabolites to estimate drug consumption in a certain community. This study demonstrates how drug relative presence could be tracked by testing wastewater, providing real-time results, in different boroughs in New York City throughout 1 year. We developed and fully validated two analytical methods, one for 21 drugs and metabolites, including nicotine, cocaine, amphetamines, opioids and cannabis markers; and another for the normalization factor creatinine. Both methods were performed by liquid chromatography tandem mass spectrometry (LC-MS/MS) using positive electrospray ionization, achieving a limit of quantification of 5–10 ng/L for drugs and metabolites, and 0.01 mg/L for creatinine. These methods were applied to 48 one-time grab wastewater samples collected from six wastewater treatment plants in New York City (Manhattan, The Bronx, Queens and Brooklyn), eight different times throughout 2016, before and after major holidays, including Memorial Day, 4th of July, Labour Day and New Year’s. In this study, the drug group normalized concentrations present in the wastewater samples, in decreasing order, were cocaine, nicotine, opioids, cannabis and amphetamines. When looking at individual compounds, the one with the highest normalized concentration was benzoylecgonine (BE), followed by cotinine, morphine and 11-nor-9-carboxy-tetrahydrocannabinol (THCCOOH). To estimate community use, these concentrations were multiplied by the corresponding correction factor, and the most present were THCCOOH, followed by BE, cotinine and morphine. When comparing the treatment plants by drug group (nicotine, cocaine, amphetamines, opioids and cannabis), samples collected from The Bronx had the highest normalized concentrations for nicotine, cocaine and opioids; The Bronx and Manhattan for cannabis; and Manhattan and Queens for amphetamines. In most of the cases, no effect due to holiday was observed. This study provides the first snapshot of drug use in New York City and how that changes between key calendar dates employing wastewater analysis.