Occurrence, fate and antibiotic resistance of fluoroquinolone antibacterials in hospital wastewaters in Hanoi, Vietnam

Antibiotic resistant bacteria and antibiotic resistance genes as contaminants of emerging concern: Occurrences, impacts, mitigations and future guidelines

Antibiotic resistance, driven by the proliferation of antibiotic resistance genes (ARGs) and antibiotic resistance bacteria (ARBs), has emerged as a pressing global health concern. Antimicrobial resistance is exacerbated by the widespread use of antibiotics in agriculture, aquaculture, and human medicine, leading to their accumulation in various environmental compartments such as soil, water, and sediments. The presence of ARGs in the environment, particularly in municipal water, animal husbandry, and hospital environments, poses significant risks to human health, as they can be transferred to potential human pathogens. Current remediation strategies, including the use of pyroligneous acid, coagulants, advanced oxidation, and bioelectrochemical systems, have shown promising results in reducing ARGs and ARBs from soil and water. However, these methods come with their own set of challenges, such as the need for elevated base levels in UV-activated persulfate and the long residence period required for photocatalysts. The future of combating antibiotic resistance lies in the development of standardized monitoring techniques, global collaboration, and the exploration of innovative remediation methods. Emphasis on combination therapies, advanced oxidation processes, and monitoring horizontal gene transfer can pave the way for a comprehensive approach to mitigate the spread of antibiotic resistance in the environment.

Antibiotic resistance genes, colistin-resistant Escherichia coli, and physicochemicals in health care wastewater in Vinh Long General Hospital, Vietnam

This study collected ten treated wastewater samples from Vinh Long General Hospital to determine their physicochemical characteristics and antibiotic properties. All treated wastewater samples collected during the monitoring periods complied with national regulations. In addition, these samples did not contain bacteria such as Salmonella, Shigella, and Vibrio cholerae. The investigation yielded a total of 25 Escherichia coli isolates. The E. coli isolates exhibied highest antibiotic resistance rate to ampicillin (100%), followed by ciprofloxacin, amoxicillin/clavulanic acid, and cefazolin (96%, 92%, and 92%, respectively). The resistance rate to fosfomycin was 88%, whereas 80% of the isolates were resistant to sulfamethoxazole-trimethoprim. The resistance rate to gentamicin was 72%, whereas that to imipenem and tetracycline was 52%. In addition, 44% isolates were resistant to chloramphenicol, and 32% of isolates were colistin-resistant. Among analyzed isolates, three were resistant to 10 of 11 tested antibiotics but only displayed intermediate resistance to imipenems (carbapenems). Surprisingly, 23 out of 25 isolates showed a positive ESBL phenotype. Eleven of them had both the blaTEM and blaCTX-M-1 group structural genes, while twelve only had the blaCTX-M-1 group gene. Furthermore, none of the isolated E. coli isolates exhibited the blaSHV gene. The minimum inhibitory concentration (MIC) of colistin exceeded 4 μg/mL in 8 out of 25 (32%) isolates. Seven of eight isolates (87.5%) carried the mcr-1 gene, while one (12.5%) carried the mcr-8 gene. None of the other mcr (mcr-2 to mcr-9) genes were found.

Occurrence, removal and environmental risk assessment of pharmaceutical active compounds (PhACs) and metabolites in hospital wastewater

In recent years, the widespread detection of pharmaceuticals and personal care products (PPCPs) in aquatic environments has become a global concern, and wastewater discharged from hospitals is an important source. This study investigated the occurrence, removal efficiency and risk assessment of 74 commonly used pharmaceutical active compounds (PhACs), including 58 antibiotics, seven psychiatric drugs, four nonsteroidal anti-inflammatory drugs, three β-blockers and two lipid regulators, at wastewater treatment plants (WWTPs) in 11 hospitals. A total of 51 PhACs were detected in the wastewater effluents of 11 hospitals, with concentrations of 0.00089 (alprenolol) ∼ 69 µg/L (acetaminophen) in the influent samples and 0.00057 (alprenolol) ∼ 5.7 µg/L (theophylline) in the effluent samples. Under the same scales, the concentrations of PhACs in the influent of psychiatric hospital WWTP were 1.16 times and 2.28 times greater than those of general hospital and infectious disease hospital, respectively, and the concentrations in small and large hospitals were comparable and were approximately 1.73 times greater than those in medium hospitals, suggesting the influence of the hospital type and scale on the discharge characteristics of PhACs. The removal efficiency of PhACs ranged from negative to 100 %. The removal efficiency of the membrane bioreactor (MBR) was 53.98 %, which was better than that of the biological contact oxidation (BCO). An environmental risk assessment revealed that the PhACs detected in hospital wastewater might pose potential risks to the aquatic environment. In addition, attention should be paid to the management of wastewater discharge in special hospitals and small and medium hospitals. This study provides a basis for the management and control of PhACs in hospitals in China.

Photodegradation of Ciprofloxacin and its interaction with Cu(II) in different water matrices: insight into degradation pathways

Co-contamination of ciprofloxacin (CIP) and Cu(II) is common in marine aquaculture water. However, the transmission and transformation of these substances in natural water matrices are often overlooked. This study sought to assess the impact of Cu(II) on CIP degradation in distilled (DI) and simulated (SI) mariculture water, as well as to develop a relationship between Cu(II), CIP, and its degradation products. First, complexation assays and analog computations revealed that Cu (II) forms complexes by binding to the oxygen atoms of the carbonyl (C=O) and carboxyl (COOH) groups in the CIP molecule. Second, photodegradation experiments showed that Cu(II) significantly hindered the degradation effect of CIP in DI water, while Cu(II) did not significantly hinder the degradation of CIP in SI water. Furthermore, the effect of Cu(II) on the degradation mechanism of CIP was determined by combining quenching and EPR experiments, Materials Studio software calculations, and UPLC-MS results. It was demonstrated that Cu(II) enhanced the production of singlet oxygen (1O2), hydroxyl radicals (•OH), and superoxide radicals (•O2-) in DI water. In the presence of Cu(II), CIP undergoes hydroxylation and decarbonylation reactions, forming hydroxylated and nitroxylated products. Additionally, direct defluorination and cleavage of the piperazine ring occur, followed by complexation reactions with Cu(II). However, in SI water, the production of 1O2 depends on the indirect action of Cu(II) and the excited state transformation of organic matter. Experimental evidence has shown that CIP can create intermediate compounds that include O-O peroxide rings, with or without the presence of Cu(II). When Cu(II) is present, the cyclopropyl group of the CIP molecule is more prone to transformation and so degradation. Finally, the toxicity assessment results indicated that both Cu(II) and SI water increased the toxicity of the degradation products.

Unveiling the fate of metal leaching in bimetal-catalyzed Fenton-like systems: pivotal role of aqueous matrices and machine learning prediction

Metal-based catalytic materials exhibit exceptional properties in degrading emerging pollutants within Fenton-like systems. However, the potential risk of metal leaching has become pressing environmental concern. This study addressed scientific issues pertaining to the leaching behavior and control strategies for metal-based catalytic materials. Innovative cobalt-aluminum hydrotalcite (CoAl-LDH) triggered peroxymonosulfate (PMS) activation system was constructed and achieved near-complete removal of Ciprofloxacin (CIP) across diverse water quality environments. Notably, it was found that the tunable ion exchange and Al3+ stabilization of CoAl-LDH occurred due to the particularity of neutral water quality, resulting in significantly lower Co2+ leaching levels (0.321 mg/L) compared to acidic conditions (5.103 mg/L). In light of this, machine learning technology was then employed for the first time to simulate the dynamic trend of Co2+ leaching and elucidated the critical regulatory roles and mechanisms of Al3+, aqueous matrix, and reaction rate. Furthermore, degradation systems based on different water quality and metal leaching levels regulated the generation levels of SO4.- and O2∙-, and the unique advantages of free radical attack paths were clarified through CIP degradation products and ecotoxicity analysis. These findings introduced novel insights and approaches for engineering application and pollution control in metal-based Fenton-like water treatment.

A Review of the Dissemination of Antibiotic Resistance through Wastewater Treatment Plants: Current Situation in Sri Lanka and Future Perspectives

The emergence of antibiotic resistance (AR) poses a significant threat to both public health and aquatic ecosystems. Wastewater treatment plants (WWTPs) have been identified as potential hotspots for disseminating AR in the environment. However, only a limited number of studies have been conducted on AR dissemination through WWTPs in Sri Lanka. To address this knowledge gap in AR dissemination through WWTP operations in Sri Lanka, we critically examined the global situation of WWTPs as hotspots for transmitting antibiotic-resistant bacteria (ARB) and antibiotic-resistant genes (ARGs) by evaluating more than a hundred peer-reviewed international publications and available national publications. Our findings discuss the current state of operating WWTPs in the country and highlight the research needed in controlling AR dissemination. The results revealed that the impact of different wastewater types, such as clinical, veterinary, domestic, and industrial, on the dissemination of AR has not been extensively studied in Sri Lanka; furthermore, the effectiveness of various wastewater treatment techniques in removing ARGs requires further investigation to improve the technologies. Furthermore, existing studies have not explored deeply enough the potential public health and ecological risks posed by AR dissemination through WWTPs.

The Potential of Cold Atmospheric Pressure Plasmas for the Direct Degradation of Organic Pollutants Derived from the Food Production Industry

Specialized chemicals are used for intensifying food production, including boosting meat and crop yields. Among the applied formulations, antibiotics and pesticides pose a severe threat to the natural balance of the ecosystem, as they either contribute to the development of multidrug resistance among pathogens or exhibit ecotoxic and mutagenic actions of a persistent character. Recently, cold atmospheric pressure plasmas (CAPPs) have emerged as promising technologies for degradation of these organic pollutants. CAPP-based technologies show eco-friendliness and potency for the removal of organic pollutants of diverse chemical formulas and different modes of action. For this reason, various types of CAPP-based systems are presented in this review and assessed in terms of their constructions, types of discharges, operating parameters, and efficiencies in the degradation of antibiotics and persistent organic pollutants. Additionally, the key role of reactive oxygen and nitrogen species (RONS) is highlighted. Moreover, optimization of the CAPP operating parameters seems crucial to effectively remove contaminants. Finally, the CAPP-related paths and technologies are further considered in terms of biological and environmental effects associated with the treatments, including changes in antibacterial properties and toxicity of the exposed solutions, as well as the potential of the CAPP-based strategies for limiting the spread of multidrug resistance.

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.

Hospital wastewater (HWW) treatment in low- and middle-income countries: A systematic review of microbial treatment efficacy

BACKGROUND

Proper treatment of hospital wastewater (HWW) is crucial to minimize the long-term effects on human health and aquatic ecosystems. However, the majority of HWW generated in low and middle-income countries (LMICs), is discharged without adequate treatment. This systematic review aims to fill the knowledge gap in LMICs by examining the efficacy of HWW treatment and the types of technologies used.

METHODS

Studies included in the review offered valuable insights into the current state of HWW management in LMICs. Between 2000 and 2022, only 36 research studies focused on hospital-based wastewater treatment within LMICs. Data were extracted on wastewater treatment technologies in hospitals or healthcare settings in LMICs. Data on sampling techniques, effectiveness, microorganisms and risk of bias of included studies were recorded.

RESULTS

A total of 36 articles met the eligibility criteria: mentioned about 1) hospitals 2) wastewater treatment 3) LMICs and 4) treatment efficacy. Twenty-two studies were conducted in Asia (22/36), 17 were conducted in countries with high Human Development Index. Constructed wetland, and activated sludge process were the most common technologies used in LMICs. A few studies utilized membrane bioreactors and ozone/UV treatment. Fourteen studies reported the concentration reduction to assess the microbial efficacy of the treatment process, 29/36 studies did not meet the national standards for effluent discharge. Reporting on sampling methods, wastewater treatment processes and efficacy of HWW treatment were at high risk of bias. Extreme heterogeneity in study methods and outcomes reporting precluded meta-analysis.

CONCLUSIONS

The existing evidence indicates inadequate microbial treatment in low- and middle-income country hospitals, with this systematic review emphasizing the need for improvement in healthcare waste management. It underscores the importance of long-term studies using innovative treatment methods to better understand waste removal in LMIC hospitals and calls for further research to develop context-specific healthcare waste treatment approaches in these regions.

Wastewater-based surveillance as a tool for public health action: SARS-CoV-2 and beyond

Wastewater-based surveillance (WBS) has undergone dramatic advancement in the context of the coronavirus disease 2019 (COVID-19) pandemic. The power and potential of this platform technology were rapidly realized when it became evident that not only did WBS-measured SARS-CoV-2 RNA correlate strongly with COVID-19 clinical disease within monitored populations but also, in fact, it functioned as a leading indicator. Teams from across the globe rapidly innovated novel approaches by which wastewater could be collected from diverse sewersheds ranging from wastewater treatment plants (enabling community-level surveillance) to more granular locations including individual neighborhoods and high-risk buildings such as long-term care facilities (LTCF). Efficient processes enabled SARS-CoV-2 RNA extraction and concentration from the highly dilute wastewater matrix. Molecular and genomic tools to identify, quantify, and characterize SARS-CoV-2 and its various variants were adapted from clinical programs and applied to these mixed environmental systems. Novel data-sharing tools allowed this information to be mobilized and made immediately available to public health and government decision-makers and even the public, enabling evidence-informed decision-making based on local disease dynamics. WBS has since been recognized as a tool of transformative potential, providing near-real-time cost-effective, objective, comprehensive, and inclusive data on the changing prevalence of measured analytes across space and time in populations. However, as a consequence of rapid innovation from hundreds of teams simultaneously, tremendous heterogeneity currently exists in the SARS-CoV-2 WBS literature. This manuscript provides a state-of-the-art review of WBS as established with SARS-CoV-2 and details the current work underway expanding its scope to other infectious disease targets.

Antibiotic pollution of the Yellow River in China and its relationship with dissolved organic matter: Distribution and Source identification

Understanding the sources of antibiotics is important for managing antibiotic contamination and preventing environmental risks in the aquatic environment. In this study, the distribution of dissolved organic matter (DOM) and 24 antibiotics from four typical classes (quinolones, macrolides, sulfonamides and tetracyclines) in the Yellow River basin containing distinct sources of pollution was investigated. In particular, relationships between the antibiotic concentrations and fluorescent properties of DOM were to be established to identify antibiotic sources. A total of 22 antibiotics were detected, with maximum concentrations ranging from 0.27 to 30.14 ng/L in the mainstream of the Yellow River. Of these antibiotics, only erythromycin (ERY) and sulfamethoxazole (SMX) posed potential risks to aquatic organisms. Spatially, tetracyclines were mainly distributed in the upstream reaches of the river, and quinolones were largely distributed in the midstream. High levels of sulfonamides were present downstream of the investigated river. Only EYR belonging to the macrolide group was detected and had a high downstream concentration. EEM-PARAFAC analysis showed that DOM was composed of visible fulvic acid-like fluorescence fraction (C1), ultraviolet fulvic acid-like fluorescence fraction (C2) and protein-like fraction (C3). Using Pearson correlation analysis, this study demonstrated a close relationship between DOM spectral parameters and antibiotic concentrations in the Yellow River basin. Specifically, r (C3, C2) was significantly and positively correlated with the concentrations of SMX, sulfadoxine (SDX), and ERY, while humification index (HIX) had an opposite relationship with these antibiotics. These results suggested that SMX, SDX and ERY were mainly discharged from wastewater treatment plants into the mainstream of the Yellow River. This work provides a powerful demonstration that DOM plays an important role in indicating the occurrence and sources of antibiotics in the aquatic environment.

Adsorption behaviors and influencing factors of antibiotic norfloxacin on natural kaolinite-humic composite colloids in aquatic environment

Particles are ubiquitous and abundant in natural waters and play a crucial role in the fate and bioavailability of organic pollution. In the present study, natural mineral (kaolinites, KL), organic (humic/fulvic acid, HA/FA) and their composite particles were further separated into particles fractions (PFs, >1 μm) and colloidal fractions (CFs, 1 kDa-1 μm) by cross-flow ultrafiltration (CFUF). This research demonstrated the role of kaolinite-humic composite colloids on the adsorption of fluoroquinolone norfloxacin (NOR). The Freundlich model satisfactory described adsorption curves, showing strong affinity of NOR to CFs, with sorption capacity (K_F) between 8975.50 and 16638.13 for NOR. The adsorption capacities of NOR decreased with the particle size increasing from CFs to PFs. In addition, composite CFs showed excellent adsorption capacity, which was mainly attributed to the larger specific surface area of composite CFs and electronegativity and numerous oxygen-containing functional groups on the surfaces of the complexes, and electrostatic attraction, hydrogen bond and cation exchange could dominate the NOR adsorption onto the composite CFs. The best pH value under adsorption condition of composite CFs varied from weakly acidic to neutral with the increase of load amount of humic and fulvic acids on the surface of inorganic particles. The adsorption decreased with higher cation strength, larger cation radius and higher cation valence, which depended on the surface charge of colloids and the molecular shape of NOR. These results provided insight into the interfacial behaviors of NOR on the surfaces of natural colloids and promoted the understanding of the migration and transport of antibiotics in environmental systems.

Distribution and Characterization of Typical Antibiotics in Water Bodies of the Yellow River Estuary and Their Ecological Risks

A total of 34 antibiotics from five major classes of antibiotics, including macrolides, sulfonamides, quinolones, tetracyclines and chloramphenicol, were considered as contaminants, considering the Yellow River Estuary as the study area. The distribution, sources and ecological risks of typical antibiotics in the Yellow River Estuary were investigated using an optimized solid-phase extraction pre-treatment and an Agilent 6410B tandem triple-quadrupole liquid chromatography-mass spectrometer for antibiotic detection. The results show that antibiotics were widely present in the water bodies of the Yellow River Estuary, with 14 antibiotics detected to varying degrees, including a high detection rate for lincomycin hydrochloride. Farming wastewater and domestic sewage were the primary sources of antibiotics in the Yellow River Estuary. The distribution characteristics of antibiotics in the study area were linked to the development of farming and social activities. The ecological risk evaluation of 14 antibiotics in the Yellow River Estuary watershed showed that clarithromycin and doxycycline hydrochloride were present at medium-risk levels, and lincomycin hydrochloride, sulfamethoxazole, methomyl, oxifloxacin, enrofloxacin, sulfadiazine, roxithromycin, sulfapyridine, sulfadiazine and ciprofloxacin were present at low-risk levels in the samples collected from water bodies of the Yellow River Estuary. This study provides novel, beneficial information for the assessment of the ecological risk presented by antibiotics in the Yellow River Estuary water bodies and provides a scientific basis for future antibiotic pollution control in the Yellow River Basin.

Enhanced purification of kitchen-oil wastewater driven synergistically by surface microelectric fields and microorganisms

The stable structure and toxic effect of refractory organic pollutants in wastewater lead to the problem of high energy consumption in water treatment technology. Herein, we propose a synergistic purification of refractory wastewater driven by microorganisms and surface microelectric fields (SMEF) over a dual-reaction-center (DRC) catalyst HCLL-S8-M prepared by an in situ growth method of carbon nitride on the Cu-Al₂O₃ surface. Characterization techniques demonstrate the successful construction of SMEF with strong electrostatic force over HCLL-S8-M based on cation-π interactions between metal copper ions and carbon nitride rings. With the catalyst as the core filler, an innovative fixed bed bioreactor is constructed to purify the actual kitchen-oil wastewater. The removal efficiency of the wastewater even with a very low biodegradability (BOD₅/COD = 0.33) can reach 60% after passing through this bioreactor. An innovative reaction mechanism is revealed for the first time that under the condition of a small amount of biodegradable organic matter, the SMEF induces the enrichment of electric active microorganisms (Desulfobulbus and Geobacter) in the wastewater, accelerates the interspecies electron transfer of intertrophic metabolism with the biodegradable bacteria through the extracellular electron transfer mechanism such as cytochrome C and self-secreted electron shuttle. The electrons of the refractory organic pollutants adsorbed on the surface of the catalyst are delocalized by the SMEF, which can be directly utilized by microorganisms through EPS conduction. The SMEF generated by electron polarization can maximize the utilization of pollutants and microorganisms in wastewater and further enhance degradation without adding any external energy, which is of great significance to the development of water self-purification technology.

Post-treatment disinfection technologies for sustainable removal of antibiotic residues and antimicrobial resistance bacteria from hospital wastewater

The World Health Organization (WHO) has identified antimicrobial resistance bacteria and its spread as one of the most serious threats to public health and the environment in the twenty-first century. Different treatment scenarios are found in several countries, each with their own regulations and selection criteria for the effluent quality and management practices of hospital wastewater. To prevent the spread of disease outbreaks and other environmental threats, the development of sustainable treatment techniques that remove all antibiotics and antimicrobial resistant bacteria and genes should be required. Although few research based articles published focusing this issues, explaining the drawbacks and effectiveness of post-treatment disinfection strategies for eliminating antibiotic residues and antimicrobial resistance from hospital wastewater is the reason of this review. The application of conventional activated sludge (CAS) in large scale hospital wastewater treatments poses high energy supply needs for aeration, capital and operational costs. Membrane bioreactors (MBR) have also progressively replaced the CAS treatment systems and achieved better treatment potential, but membrane fouling, energy cost for aeration, and membrane permeability loss restrict their performance at large scale operations. In addition, the membrane process alone doesn't completely remove/degrade these micropollutants; as a substitute, the pollutants are being concentrated in a smaller volume, which requires further post-treatment. Therefore, these drawbacks should be solved by developing advanced techniques to be integrated into any of these or other secondary wastewater treatment systems, aiming for the effective removal of these micropollutants. The purpose of this paper is to review the performances of post-treatment disinfection technologies in the removal of antibiotics, antimicrobial resistant bacteria and their gens from hospital wastewater. The performance of advanced disinfection technologies (such as granular and powered activated carbon adsorption, ozonation, UV, disinfections, phytoremediation), and other integrated post-treatment techniques are primarily reviewed. Besides, the ecotoxicology and public health risks of hospital wastewater, and the development, spreading and mechanisms of antimicrobial resistant and the protection of one health are also highlighted.

Arabic Gum-Grafted-Hydrolyzed Polyacrylonitrile@ZnFe2O4 as a Magnetic Adsorbent for Remediation of Levofloxacin Antibiotic from Aqueous Solutions

The Arabic gum-grafted-hydrolyzed polyacrylonitrile/ZnFe₂O₄ (AG-g-HPAN@ZnFe₂O₄) as organic/inorganic adsorbent was obtained in three steps using grafted PAN onto Arabic gum in the presence of ZnFe₂O₄ magnetic nanoparticles and then hydrolysis by alkaline solution. Fourier transform infrared (FT-IR), energy-dispersive X-ray analysis (EDX), field emission scanning electron microscopy (FESEM), X-ray diffraction (XRD), thermogravimetric analysis (TGA), vibrating sample magnetometer (VSM), and the Brunauer-Emmett-Teller (BET) analysis analyses were used to characterize the chemical, morphological, thermal, magnetic, and textural properties of the hydrogel nanocomposite. The obtained result demonstrated that the AG-g-HPAN@ZnFe₂O₄ adsorbent showed acceptable thermal stability with 58% char yields and superparamagnetic property with magnetic saturation (Ms) of 24 emu g^-1. The XRD pattern showed that the semicrystalline structure with the presence of ZnFe₂O₄ has distinct peaks which displayed that the addition of zinc ferrite nanospheres to amorphous AG-g-HPAN increased its crystallinity. The AG-g-HPAN@ZnFe₂O₄ surface morphology exhibits uniform dispersion of zinc ferrite nanospheres throughout the smooth surface of the hydrogel matrix, and its BET surface area was measured at 6.86 m²/g, which was higher than that of AG-g-HPAN as a result of zinc ferrite nanosphere incorporation. The adsorption effectiveness of AG-g-HPAN@ZnFe₂O₄ for eliminating a quinolone antibiotic (levofloxacin) from aqueous solutions was investigated. The effectiveness of adsorption was assessed under several experimental conditions, including solution pH (2-10), adsorbent dose (0.0015-0.02 g) contact duration (10-60 min), and initial concentration (50-500 mg/L). The maximum adsorption capacity (Q _max) of the produced adsorbent for levofloxacin was found to be 1428.57 mg/g (at 298 k), and the experimental adsorption data were well explained by the Freundlich isotherm model. The pseudo-second-order model satisfactorily described the adsorption kinetic data. The levofloxacin was mostly adsorbed onto the AG-g-HPAN@ZnFe₂O₄ adsorbent via electrostatic contact and hydrogen bonding. Adsorption-desorption studies demonstrated that the adsorbent could be efficiently recovered and reused after four consecutive runs with no significant loss in adsorption performance.

Photodegradation of phenylurea herbicides sensitized by norfloxacin and the influence of natural organic matter

The photochemical activity of fluoroquinolone antibiotics (FQs) has gained attention due to the discovery of their phototoxicity and photocarcinogenicity in clinics. This study reveals that norfloxacin (NOR) can sensitize the photodegradation of phenylurea (PU) herbicides. This is attributed to the formation of an excited triplet of norfloxacin (³NOR*) by UV-A irradiation of its quinolone chromophore, which can further react with O₂ to form singlet oxygen (¹O₂). The second-order rate of ³NOR* with PU ranges from 1.54 × 10¹⁰ to 2.76 × 10¹⁰ M^-1s^-1. The steady-state concentrations of ³NOR* were calculated as (4.29-31.2)× 10^-16 M at 10 μM NOR under UV_365nm irradiation. Natural organic matter (NOM) inhibited the degradation of PU induced by ³NOR*. In the presence of 10 mg L^-1 NOM, the pseudo-first-order rate constants (k_obs,NOM) of the degradation of diuron (DIU), isoproturon (IPU), monuron (MOU), and chlorotoluron (CLU) decreased by 65%, 19%, 36%, and 62%, respectively. NOM mainly acts as a reductant which reacted with the radical intermediates of the PU generated by ³NOR*oxidation, thus reversing the oxidation. The inhibitory effect increases with increasing NOM concentration. Results of this study underscore the role of NOR as a photosensitizer in accelerating the abatement of PU pesticides in sunlit surface waters. This study significantly advances the understandings of the behavior of NOR in aquatic environments.

Source-specific ecological risks and critical source identification of PPCPs in surface water: Comparing urban and rural areas

To control the concentrations of pharmaceutical and personal care products (PPCPs) in the surface water of urban and rural areas, it is important to explore the spatial variation in source-specific ecological risks and identify critical sources. Here, we focused on 22 PPCPs found in the effluent from wastewater treatment plants and surface water in Tianjin, and source-specific risk was quantitatively apportioned combining positive matrix factorization with ecological risk assessment. Results showed that rural areas exhibited a more severe contamination level than urban areas. Medical wastewater (30.1 %) accounted for the highest proportion, while domestic sewage posed the greatest threat to aquatic ecosystems. The incidence of potential risks (RQ > 0.01) caused by domestic sewage in urban areas (88.9 %) was higher than that in rural areas (75.9 %). However, PPCP risks caused by farmland drainage, aquaculture, and livestock discharge were mainly distributed in rural areas. The critical source identified in the entire region was domestic sewage (weight, 0.36), and its weight (0.51) in urban areas was greater than that in rural areas (0.32). The impact of aquaculture (weight, 0.16) in rural areas was noteworthy. These findings may contribute to developing environmental management strategies in key areas to help alleviate PPCP contamination worldwide.

Physiological responses and phytoremediation capacity of floating and submerged aquatic macrophytes exposed to ciprofloxacin

Ciprofloxacin (Cipro) water contamination is a global concern, having reached disturbing concentrations and threatening the aquatic ecosystems. We investigated the physiological responses and Cipro-phytoremediation capacity of one floating (Salvinia molesta D.S. Mitchell) and one submerged (Egeria densa Planch.) species of aquatic macrophytes. The plants were exposed to increased concentrations of Cipro (0, 1, 10, and 100 µg.Cipro.L^-1) in artificially contaminated water for 96 and 168 h. Although the antibiotic affected the activities of mitochondrial electron transport chain enzymes, the resulting increases in H₂O₂ concentrations were not associated with oxidative damage or growth reductions, mainly due to the activation of antioxidant systems for both species. In addition to being tolerant to Cipro, after only 96 h, plants were able to reclaim more than 58% of that from the media. The phytoremediation capacity did not differ between the species, however, while S. molesta bioaccumulate, E. densa appears to metabolize Cipro in their tissues. Both macrophytes are indicated for Cipro-phytoremediation projects.

A systematic review and meta-analysis of integrated studies on antimicrobial resistance in Vietnam, with a focus on Enterobacteriaceae, from a One Health perspective

Vietnam is a low- and middle-income country (LMIC), a primary food producer, and an antimicrobial resistance (AMR) hotspot. AMR is recognized as a One Health challenge since it may transfer between humans, animals and the environment. This study aimed to apply systematic review and meta-analysis to investigate the phenotypic profiles and correlations of antimicrobial-resistant Enterobacteriaceae across three compartments: humans, animals and the environment in Vietnam. A total of 89 articles found in PubMed, Science Direct, and Google Scholar databases were retrieved for qualitative synthesis. E. coli and non-typhoidal Salmonella (NTS) were the most common bacterial species in studies of all compartments (60/89 studies). Among antimicrobials classified as critically important, the resistance levels were observed to be highest to quinolones, 3rd generation of cephalosporins, penicillins, and aminoglycosides. Of 89 studies, 55 articles reported the resistance prevalence of E. coli and NTS in healthy humans, animals and the environment against ciprofloxacin, ceftazidime, ampicillin, gentamicin, sulfamethoxazole-trimethoprim, chloramphenicol was used for meta-analysis. The pooled prevalence was found highest in E. coli against ampicillin 84.0% (95% CI 73.0-91.0%) and sulfamethoxazole-trimethoprim 66.0% (95% CI 56.0-75.0%) while in NTS they were 34.0% (95% CI 24.0-46.0%), 33.0% (95% CI 25.0-42.0%), respectively. There were no significant differences in the pooled prevalence of E. coli and NTS to these antimicrobials across healthy humans, animals and the environment, except for ceftazidime-resistant E. coli (χ² = 8.29, p = 0.02), chloramphenicol-resistant E.coli (χ² = 9.65, p < 0.01) and chloramphenicol-resistant NTS (χ² = 7.51, p = 0.02). Findings from the multiple meta-regression models indicated that the AMR levels in E. coli (β = 1.887, p < 0.001) and the North (β = 0.798, p = 0.047) had a higher fraction of AMR than NTS and other regions of Vietnam. The outcomes of this study play an important role as the baseline information for further investigation and follow-up intervention strategies to tackle AMR in Vietnam, and more generally, can be adapted to other LMICs.

Genomic characterisation of multidrug-resistant Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii in two intensive care units in Hanoi, Viet Nam: a prospective observational cohort study

BACKGROUND

Viet Nam has high rates of antimicrobial resistance (AMR) but little capacity for genomic surveillance. This study used whole genome sequencing to examine the prevalence and transmission of three key AMR pathogens in two intensive care units (ICUs) in Hanoi, Viet Nam.

METHODS

A prospective surveillance study of all adults admitted to ICUs at the National Hospital for Tropical Diseases and Bach Mai Hospital was done between June 19, 2017, and Jan 16, 2018. Clinical and environmental samples were cultured on selective media, characterised with MALDI TOF mass spectrometry, and sequenced with Illumina. Phylogenies based on the de-novo assemblies (SPAdes) were constructed with MAFFT (PARsnp), Gubbins, and RAxML. Resistance genes were detected with Abricate against the US National Center for Biotechnology Information database.

FINDINGS

3153 Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii isolates from 369 patients were analysed. Phylogenetic analysis revealed predominant lineages within A baumannii (global clone 2, sequence types ST2 and ST571) and K pneumoniae (ST15, ST16, ST656, ST11, and ST147) isolates. Isolation from stool was most common with E coli (87·0%) followed by K pneumoniae (62·5%). Of the E coli, 85·0% carried a bla_CTX-M variant, while 81·8% of K pneumoniae isolates carried bla_NDM (54·4%), or bla_KPC (45·1%), or both. Transmission analysis with single nucleotide polymorphisms identified 167 clusters involving 251 (68%) of 369 patients, in some cases involving patients from both ICUs. There were no clear differences between the lineages or AMR genes recovered between the two ICUs.

INTERPRETATION

This study represents the largest prospective surveillance study of key AMR pathogens in Vietnamese ICUs. Clusters of closely related isolates in patients across both ICUs suggests recent transmission before ICU admission in other health-care settings or in the community.

FUNDING

UK Medical Research Council Newton Fund, Viet Nam Ministry of Science and Technology, Wellcome Trust, Academy of Medical Sciences, Health Foundation, and UK National Institute for Health and Care Research Cambridge Biomedical Research Centre.

Antimicrobial Resistance and Implications: Impact on Pregnant Women with Urinary Tract Infections

Urinary Tract Infections (UTI) is one of the most common infections, especially among women. Presently accessible antibiotics are a clinician’s first line of defense to treat infections, but antimicrobial resistance menace to reduce their efficacy. The consequences of multi-drug resistance to antibiotics are enhanced morbidity and mortality rates. The yearly death toll is >700,000 population worldwide, rising to ~10 million by 2050. There is a lack of novel antibiotics for UTIs as the return on its investment is poor compared to medicines for lifestyle diseases. The three organisms of utmost worry are methicillin-resistant Staphylococcus aureus (MRSA), Carbapenems and third-generation Cephalosporins resistant Klebsiella pneumoniae, Fluoroquinolones and third-generation Cephalosporins resistant Escherichia coli (E. coli). Among these, Escherichia coli is the foremost cause of community-acquired UTI infections throughout the globe, mainly due to the absence of alertness and inappropriate wastewater treatment. The purpose of this review article is to explore literature on uropathogens, the pattern of their antimicrobial resistance, and the hospital practices concerning the spread, as inadequate studies have been carried out and published on this topic. Hospital personnel are usually familiar with the management of infections, but most do not understand the conditions in their hospital. Implications of hospital practices play a major role in controlling hospital-acquired UTIs and the burden of its antimicrobial resistance. A complete approach involving financial and human resources will improve the infection control practices in hospitals without a doubt. Strict infection control measures in hospitals can help to reduce the number of hospital-acquired infections in pregnant women.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

Phycoremediation integrated approach for the removal of pharmaceuticals and personal care products from wastewater - A review

Pharmaceuticals and personal care products (PPCPs) are of emerging concerns because of their large usage, persistent nature which promised their continuous disposal into the environment, as these pollutants are stable enough to pass through wastewater treatment plants causing hazardous effects on all the organisms through bioaccumulation, biomagnification, and bioconcentration. The available technologies are not capable of eliminating all the PPCPs along with their degraded products but phycoremediation has the advantage over these technologies by biodegrading the pollutants without developing resistant genes. Even though phycoremediation has many advantages, industries have found difficulty in adapting this technology as a single-stage treatment process. To overcome these drawbacks recent research studies have focused on developing technology that integrated phycoremediation with the commonly employed treatment processes that are in operation for treating the PPCPs effectively. This review paper focuses on such research approaches that focused on integrating phycoremediation with other technologies such as activated sludge process (ASP), advanced oxidation process (AOP), Up-flow anaerobic sludge blanket reactor (UASBR), UV irradiation, and constructed wetland (CW) with the advantages and limitations of each integration processes. Furthermore, augmenting phycoremediation by co-metabolic mechanism with the addition of sodium chloride, sodium acetate, and glucose for the removal of PPCPs has been highlighted in this review paper.

Treatment technologies to mitigate the harmful effects of recalcitrant fluoroquinolone antibiotics on the environ- ment and human health

Antibiotic proliferation in the environment and their persistent nature is an issue of global concern as they induce antibiotic resistance threatening both human health and the ecosystem. Antibiotics have therefore been categorized as emerging pollutants. Fluoroquinolone (FQs) antibiotics are an emerging class of contaminants that are used extensively in human and veterinary medicine. The recalcitrant nature of fluoroquinolones has led to their presence in wastewater, effluents and water bodies. Even at a low concentration, FQs can stimulate antibacterial resistance. The main sources of FQ contamination include waste from pharmaceutical manufacturing industries, hospitals and households that ultimately reaches the wastewater treatment plants (WWTPs). The conventional WWTPs are unable to completely remove FQs due to their chemical stability. Therefore, the development and implementation of more efficient, economical, convenient treatment and removal technologies are needed to adequately address the issue. This review provides an overview of the technologies available for the removal of fluoroquinolone antibiotics from wastewater including adsorptive removal, advanced oxidation processes, removal using non-carbon based nanomaterials, microbial degradation and enzymatic degradation. Each treatment technology is discussed on its merits and limitations and a comparative view is presented on the choice of an advanced treatment process for future studies and implementation. A discussion on the commercialization potential and eco-friendliness of each technology is also included in the review. The importance of metabolite identification and their residual toxicity determination has been emphasized. The last section of the review provides an overview of the policy interventions and regulatory frameworks that aid in retrofitting antibiotics as a central key focus contaminant and thereby defining the discharge limits for antibiotics and establishing safe manufacturing practices.

Toxicity of fluoroquinolones on the cladoceran Daphnia magna

This study evaluates the acute and chronic toxicological effects of six fluoroquinolones on the mortality and growth of Daphnia magna. The NOECs calculated with the multivariate Probit regression model for the chronic study were 56 μg/L ciprofloxacin, 63 μg/L enrofloxacin, 78 μg/L levofloxacin, 85 μg/L marbofloxacin, 69 μg/L norfloxacin, and 141 μg/L ofloxacin. The risk quotients were determined using the measure environmental concentrations reported in water sources from different countries. The risks were low and moderate in water samples from rivers and lakes, although concentrations of ciprofloxacin, norfloxacin, and ofloxacin reported in some countries can cause toxicological damage to D. magna. In addition, urban wastewater and hospital wastewater samples constitute a threat to D. magna (high and moderate risks), requiring the treatment of these wastewater. PRACTITIONER POINTS: The NOECs calculated with the multivariate Probit model for the six fluoroquinolonas are between 56 μg/L ciprofloxacin and 141 μg/L ofloxacin. The levels of ciprofloxacin, norfloxacin, and ofloxacin in urban wastewater and hospital wastewater produce moderate and high risks for D. magna. Water and river samples from some countries containing ciprofloxacin, norlfoxacin, and ofloxacin present high risks for D. magna.

Distribution of pharmaceutical and personal care products (PPCPs) in aquatic environment in Hanoi and Metro Manila

Pharmaceutical and personal care products (PPCPs) recently defined as emerging pollutants that widespread in surface water all around the world. This study investigated the distribution, and ecological risk of PPCPs in urban rivers of Hanoi, Vietnam, and Metro Manila, the Philippines. Of the 56 investigated PPCPs, 48 and 33 compounds were detected in the river water in Hanoi and in Metro Manila, respectively. The individual PPCP concentrations ranged from a few ng L^-1 to thousands of ng L^-1_. The total concentration of PPCPs detected in water samples ranged from 7.5 to 20,789 ng L^-1 in Hanoi and 118 to 3,394 ng L^-1 in Manila. The predominant antibiotics was sulfamethoxazole detected in 27/28 samples with a maximum concentration up to 2,778 ng L^-1 in Hanoi and presented in all samples with a maximum concentration up to 261 ng L^-1 in Metro Manila. In Hanoi, the level of PPCPs in urban canals of Kim Nguu and To Lich Rivers was as high as that detected in domestic wastewater. The PPCP concentrations in tributaries and mainstream were lower than those found in urban canals. In rivers of both sites, PPCPs tended to increase along the stream. The concentration ratio of the labile marker caffeine to recalcitrant marker carbamazepine indicated that untreated domestic wastewater is the significant source of PPCPs in river water in Hanoi and Metro Manila. The ecological risk estimated by the risk quotient of the obtained maximum residue of PPCPs in investigated river water predicted a high risk of PPCPs to the aquatic organism in both Hanoi and Manila.

Biochar-Supported TiO2-Based Nanocomposites for the Photocatalytic Degradation of Sulfamethoxazole in Water-A Review

Sulfamethoxazole (SMX) is a frequently used antibiotic for the treatment of urinary tract, respiratory, and intestinal infections and as a supplement in livestock or fishery farming to boost production. The release of SMX into the environment can lead to the development of antibiotic resistance among the microbial community, which can lead to frequent clinical infections. SMX removal from water is usually done through advanced treatment processes, such as adsorption, photocatalytic oxidation, and biodegradation. Among them, the advanced oxidation process using TiO2 and its composites is being widely used. TiO2 is a widely used photocatalyst; however, it has certain limitations, such as low visible light response and quick recombination of e-/h+ pairs. Integrating the biochar with TiO2 nanoparticles can overcome such limitations. The biochar-supported TiO2 composites showed a significant increase in the photocatalytic activities in the UV-visible range, which resulted in a substantial increase in the degradation of SMX in water. The present review has critically reviewed the methods of biochar TiO2 composite synthesis, the effect of biochar integration with the TiO2 on its physicochemical properties, and the chemical pathways through which the biochar/TiO2 composite degrades the SMX in water or aqueous solution. The degradation of SMX using photocatalysis can be considered a useful model, and the research studies presented in this review will allow extending this area of research on other types of similar pharmaceuticals or pollutants in general in the future.

Prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in wastewater: a systematic review and meta-analysis

Wastewater is considered a hotspot niche of multi-drug and pathogenic bacteria such as Enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBL-E). Thus, the aim of this meta-analysis was to evaluate the prevalence of ESBL-E in different wastewater sources. Different databases (Medline, EMBASE, and Cochrane Library) were searched from inception to March 2021. Data were analyzed using random-effects modeling, and subgroup and meta-regression analyses were used to ascertain heterogeneity among the subgroups. Fifty-seven observational studies were selected, and the pooled prevalence of ESBL-E in wastewater was 24.81% (95% CI, 19.28-30.77). Escherichia coli had the highest ESBL prevalence. The blaCTX-M genes were the most prevalent in the selected studies (66.56%). The pooled prevalence of ESBL was significantly higher in reports from America (39.91%, 95% CI, 21.82-59.51) and reports studying hospital and untreated wastewaters (33.98%, 95% CI, 23.82-44.91 and 27.36%, 95% CI, 19.12-36.42). Overall, this meta-analysis showed that the prevalence of ESBL-E in wastewater is increasing over time and that hospital wastewater is the most important repository of ESBL-E. Therefore, there is a need for developing new sewage treatment systems that decrease the introduction of resistant bacteria and antibiotic residues.

Effective removal of levofloxacin drug and Cr(VI) from water by a composed nanobiosorbent of vanadium pentoxide@chitosan@MOFs

Wastewaters is generally polluted with various inorganic and organic contaminants which require effective multipurpose purification technology. In this respect, a novel V₂O₅@Ch/Cu-TMA nanobiosorbent was constructed via encapsulation of nanoscale metal organic frameworks (Cu-TMA) into vanadium pentoxide-imbedded-chitosan matrix to comprehensively investigate its efficiency in removal of levofloxacin drug (LEVO) (e.g., organic pollutant) and chromium (VI) (e.g., inorganic pollutant) from water. Both LEVO drug and Cr(VI) adsorptions were correlated to pseudo-second order (R² = 1) and Langmuir isotherm (R² = 0.9924 for LEVO and R² = 0.9815 for Cr(VI)). Adsorption of Cr(VI) was confirmed to be spontaneous and endothermic reactions, while LEVO was found to proceed via spontaneous and exothermic reactions based on the thermodynamic parameters. The emerged V₂O₅@Ch/Cu-TMA is regarded as an excellent nanobiosorbent for removal of inorganic contaminant as Cr(VI) from all natural water samples (tap, sea and wastewater) with percentages range 92.43%-96.95% and organic contaminant as LEVO drug from tap and wastewater (91.99%-97.20%).

Distribution and ecological risk assessment of typical antibiotics in the surface waters of seven major rivers, China

The consumption and production of antibiotics in China rank highest in the world. As such, the occurrence of antibiotics in environmental media of China has raised significant concerns. Rivers play an important role in the sustainable development of China's economy and society, possibly causing high levels and detection frequencies of antibiotics in the aquatic environment of rivers in China. Therefore, it is necessary to understand the distribution and risk level of antibiotics in rivers. From south to north, China has seven major rivers vertically and horizontally. They are Yangtze River, Yellow River, Hai River, Liao River, Huai River, Songhua River and Pearl River. In this review, we made an extensive literature survey and published all studies on antibiotic concentrations in seven river systems of China from 2010 to 2020 were sorted out to provide a clear draw of the distribution characteristics of antibiotics. We found that 70 antibiotics have been detected in the seven major river systems. 13 typical antibiotics in surface waters of seven river systems were systematically reviewed and ecological risk assessment was conducted. The occurrence frequencies of high-risk antibiotics in surface waters followed the rank order: ETM-H₂O > CIP > OFX > SMX > NOR. The RQ_s values of seven rivers decreased in the order of Hai River (1.58-18 094.3) > Liao River (1.14-290.23) > Pearl River (2.11-118.25) > Yangtze River (0.3-64.78) > Yellow River (7.56-35.45) > Songhua River (0.03-22.26) > Huai River (1.87-20.83).

Typical antibiotics in the receiving rivers of direct-discharge sources of sewage across Shanghai: occurrence and source analysis

In Shanghai, the antibiotics in the receiving rivers of direct-discharge sources of sewage (aquaculture farms, cattle farms and wastewater treatment plants) were investigated. Water and sediment samples from the receiving rivers of these sources were collected, and were screened for 19 typical antibiotics. The concentration of the antibiotics in the water and sediment ranged from not detected (ND) to 530.05 ng L⁻¹ and ND to 1039.53 ng g⁻¹, respectively, and sulfonamides and fluoroquinolones were identified as the main antibiotics in the water and sediment, respectively. According to principal component analysis with multiple linear regression (PCA-MLR), source contributions were estimated: wastewater treatment plants (66.8%) > aquaculture farms and cattle farms (21.2%), indicating that the contribution of human antibiotics was higher than veterinary antibiotics. Based on the risk quotients, ciprofloxacin was identified as the main antibiotic that causes medium risk in the aquatic ecosystem. This work systematically reflected the profile and source apportionment of antibiotics in Shanghai, which is helpful for antibiotic contamination control and environmental management.

In Shanghai, the antibiotics in the receiving rivers of direct-discharge sources of sewage (aquaculture farms, cattle farms and wastewater treatment plants) were investigated.

Environmental hotspots for antibiotic resistance genes

Bacterial resistance toward broad-spectrum antibiotics has become a major concern in recent years. The threat posed by the infectious bacteria and the pace with which resistance determinants are transmitted needs to be deciphered. Soil and water contain unique and diverse microbial communities as well as pools of naturally occurring antibiotics resistant genes. Overuse of antibiotics along with poor sanitary practices expose these indigenous microbial communities to antibiotic resistance genes from other bacteria and accelerate the process of acquisition and dissemination. Clinical settings, where most antibiotics are prescribed, are hypothesized to serve as a major hotspot. The predisposition of the surrounding environments to a pool of antibiotic-resistant bacteria facilitates rapid antibiotic resistance among the indigenous microbiota in the soil, water, and clinical environments via horizontal gene transfer. This provides favorable conditions for the development of more multidrug-resistant pathogens. Limitations in detecting gene transfer mechanisms have likely left us underestimating the role played by the surrounding environmental hotspots in the emergence of multidrug-resistant bacteria. This review aims to identify the major drivers responsible for the spread of antibiotic resistance and hotspots responsible for the acquisition of antibiotic resistance genes.

Antibiotics in surface water of East and Southeast Asian countries: A focused review on contamination status, pollution sources, potential risks, and future perspectives

This review provides focused insights into the contamination status, sources, and ecological risks associated with multiple classes of antibiotics in surface water from the East and Southeast Asia based on publications over the period 2007 to 2020. Antibiotics are ubiquitous in surface water of these countries with concentrations ranging from <1 ng/L to hundreds μg/L and median values from 10 to 100 ng/L. Wider ranges and higher maximum concentrations of certain antibiotics were found in surface water of the East Asian countries like China and South Korea than in the Southeast Asian nations. Environmental behavior and fate of antibiotics in surface water is discussed. The reviewed occurrence of antibiotics in their sources suggests that effluent from wastewater treatment plants, wastewater from aquaculture and livestock production activities, and untreated urban sewage are principal sources of antibiotics in surface water. Ecological risks associated with antibiotic residues were estimated for aquatic organisms and the prevalence of antibiotic resistance genes and antibiotic-resistant bacteria were reviewed. Such findings underline the need for synergistic efforts from scientists, engineers, policy makers, government managers, entrepreneurs, and communities to manage and reduce the burden of antibiotics and antibiotic resistance in water bodies of East and Southeast Asian countries.

Review on the Visible Light Photocatalysis for the Decomposition of Ciprofloxacin, Norfloxacin, Tetracyclines, and Sulfonamides Antibiotics in Wastewater

Antibiotics are chemical compounds that are used to kill or prevent bacterial growth. They are used in different fields, such as the medical field, agriculture, and veterinary. Antibiotics end up in wastewater, which causes the threat of developing antibacterial resistance; therefore, antibiotics must be eliminated from wastewater. Different conventional elimination methods are limited due to their high cost and effort, or incomplete elimination. Semiconductor-assisted photocatalysis arises as an effective elimination method for different organic wastes including antibiotics. A variety of semiconducting materials were tested to eliminate antibiotics from wastewater; nevertheless, research is still ongoing due to some limitations. This review summarizes the recent studies regarding semiconducting material modifications for antibiotic degradation using visible light irradiation.

Occurrence, Distribution, and Ecological Risk Assessment of Antibiotics in Selected Urban Lakes of Hanoi, Vietnam

Residue concentrations of fifteen antibiotics including sulfonamides, quinolones, macrolides, β-lactams, and trimethoprim in lakes from Hanoi metropolitan area, Vietnam, were analyzed using ultra-performance liquid chromatography coupled with tandem mass spectrometry (UPLC/MS-MS) to elucidate their occurrence and behavior in urban environment. For surface water, the average concentrations of five antibiotic classes decreased in the order: sulfonamides (117.9 ng/L) > β-lactams (31.28 ng/L) > quinolones (20.19 ng/L) > macrolides (17.74 ng/L) > trimethoprim (8.93 ng/L). While the highest concentration of SMX was detected at 806.5 ng/L in surface water, those obtained in sediment were only at 1.35 ng/g because of their high solubility in water. Quinolones were found at a maximal concentration of 158.7 ng/L for OFL in water phase whereas those in sediment phase were 4,017 ng/g due to their great affinity in sediment. These findings revealed the different fate and release mechanisms of each antibiotic group in the environment. The ecological risk assessment implied some targeted compounds, and in particular, OFL and AZM could pose high risks to algae in the aquatic ecosystem.

Occurrence of pharmaceutical and personal care products in Cau River, Vietnam

This study evaluated the occurrence of PPCPs in Cau River (Vietnam). Surface water and sediment samples were collected to determine PPCP concentrations. The analysis results showed the presence of 36 out of 56 investigated PPCPs in samples. The total concentration of PPCPs in water samples ranged from 8.21 to 529 ng/L and the value observed in sediment was from 17.4 to 172.8 μg/kg. Along the Cau River, there was a trend of accumulation of PPCPs at the downstream. The highest level of PPCP was observed after the river flows through Thai Nguyen and Bac Ninh provinces. Among detected PPCPs, the ones detected with high frequency (over 70%) and high concentration were caffeine, sulfamethoxazole, and lincomycin in water and triclocarban, levofloxacin, and griseofulvin in sediment. The water-sediment partition coefficient (K_d) was estimated to explore the fate of PPCP in the river, and the observed K_d mean values for lincomycin, sulfamethoxazole, and griseofulvin were 223.0, 7.6, and 997.0 kg/L, respectively. Risk assessment was initially conducted by applying a semi-quantitative assessment risk quotient (RQ); the potential ecological risk to the aquatic organism of PPCPs posed a moderate risk.

Antibiotic and antiparasitic residues in surface water of urban rivers in the Red River Delta (Hanoi, Vietnam): concentrations, profiles, source estimation, and risk assessment

Antibiotic residues and antimicrobial resistance in surface water are issues of global concern, especially in developing countries. In this study, the occurrence of seven antibiotics and one antiparasitic agent was determined in surface water samples collected from four rivers running through Hanoi urban area in the Red River Delta, northern Vietnam. The pharmaceuticals in water samples were analyzed by solid-phase extraction combined with liquid chromatography-tandem mass spectrometry method. The concentrations of pharmaceuticals in our samples ranged from 3050 to 16,700 (median 7800) ng/L, which were generally higher than levels found in river water from many other locations in the world. Amoxicillin, oxfendazole, and lincomycin were the most dominant and frequently detected compounds (detection rate 100%), which together accounted for 76 ± 14% of total concentrations. Sulfacetamide and sulfamethoxazole were detected at moderate concentrations in more than two-thirds of the analyzed samples. The remaining antibiotics (i.e., azithromycin, ciprofloxacin, and ofloxacin) were found at lower detection frequency and concentrations. Antibiotic concentrations in the water samples were not significantly different between the investigated rivers. Meanwhile, levels of pharmaceuticals in the samples collected in February 2020 were higher than those found in the remaining samples, largely due to the sharp decrease in sulfamethoxazole and azithromycin concentrations of the samples collected in March and April. Considerable ecological risks of antibiotics in surface water were estimated for some compounds such as amoxicillin, ciprofloxacin, and ofloxacin.

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.

Investigating the impact of hospital antibiotic usage on aquatic environment and aquaculture systems: A molecular study of quinolone resistance in Escherichia coli

Quinolones are one of the most important classes of antibacterials available for the treatment of infectious diseases in humans. However, there is a growing concern about bacterial resistance to antimicrobials including quinolones. The spread of antibiotic-resistant bacteria in the aquatic environment has been recognized as a growing threat to public health and hospitals appear to be a major contributor to this. The objective of this study was to investigate the prevalence of quinolone resistance in Escherichia coli from selected water bodies receiving direct hospital effluents in Kerala, India. Standard disc diffusion and E-test were used for antibiotic susceptibility testing. As antibiotic resistance can develop in bacterial isolates by different means, EtBr Agar Cartwheel method was used to detect the efflux pump activity and presence of resistant genes was detected by PCR. The mechanism of transfer of plasmid mediated resistance was confirmed by conjugation experiments. A total of 209 multidrug-resistant Escherichia coli were isolated from different hospital effluent discharge sites and aquaculture farms located in their vicinity. Among them, qnrB was found to be most prevalent followed by qnrS, OqxAB, qnrA and aac (6')-Ib-cr. The results suggested that the antibiotics present at sub-inhibitory concentrations in direct hospital effluents increases the selection pressure impacting the cell function of even normal microorganisms in the aquatic environment to change the genetic expression of virulence factors or acquire resistance genes by different transfer mechanisms, posing a serious threat to public health.

Effects of prescription antibiotics on soil- and root-associated microbiomes and resistomes in an agricultural context

The use of treated wastewater for crop irrigation is rapidly increasing to respond to the ever-growing demands for water and food resources. However, this practice may contribute to the spread of antibiotic resistant bacteria (ARB) and antibiotic resistant genes (ARGs) in agricultural settings. To evaluate this potential risk, we analyzed microbiomes and resistomes of soil and Lactuca sativa L. (lettuce) root samples from pots irrigated with tap water spiked with 0, 20, or 100 μg L^-1 of a mixture of three antibiotics (Trimethoprim, Ofloxacin, Sulfamethoxazole). The presence of antibiotics induced changes in bacterial populations, particularly in soil, as revealed by 16S rDNA sequence analysis. Parallel shotgun sequencing identified a total of 56 different ARGs conferring resistance against 14 antibiotic families. Antibiotic -treated samples showed increased loads of ARGs implicated in mutidrug resistance or in both direct and indirect acquired resistance. These changes correlated with the prevalence of Xantomonadales species in the root microbiomes. We interpret these data as indicating different strategies of soil and root microbiomes to cope with the presence of antibiotics, and as a warning that their presence may increase the loads of ARBs and ARGs in edible plant parts, therefore constituting a potential risk for human consumers.

Ecotoxicological risk assessment and source apportionment of antibiotics in the waters and sediments of a peri-urban river

Antibiotics have been widely used in the past decades and caused global public health concerns due to the growing problems of antimicrobial resistance. The peri-urban rivers are always receiving massive wastes containing antibiotics and appear to be a reservoir of antibiotics and antibiotic resistance genes in the environment. To prevent and control the pollution of antibiotics, it is essential to correctly identify the potential sources of antibiotics in peri-urban rivers. Currently, systematic knowledge on risk characteristics and source apportionment of antibiotics in peri-urban rivers is still lacking. In the study, we addressed this problem and focused on exploring the ecotoxicological risk and potential sources of antibiotics in a peri-urban river in Beijing (Chaobai River). To this end, the waters and sediments were collected from the river, as well as the potential source types including domestic sewage, WWTP effluent, chicken manure, pig manure and cattle manure. The occurrence and concentration levels of 16 antibiotics in the waters and sediments of the river were comprehensively characterized, as well as the correlation of antibiotics with environmental factors. Then, risk quotients and mixture risk quotients were used to assess the ecotoxicological risk of single compound and the mixture toxicity of antibiotics, respectively. The synergistic effects of antibiotic mixtures were also analyzed. Further, positive matrix factorization was employed to apportion the potential sources of antibiotics based on the multilinear engine (ME-2) algorithm. The target antibiotics were widely detected in the peri-urban river and several antibiotics posed moderate ecotoxicological risks on aquatic organisms. Apportionment analysis identified four potential sources of antibiotics in the waters of Chaobai River, including domestic sewage (31.5%), chicken waste (26.4%), WWTP effluent (22.2%) and a mix source (20.0%). Additionally, WWTP effluent (~58%) and sewage effluent (41%) were apportioned as the main contributors of antibiotics in the sediments.

Antimicrobial Resistance of Staphylococcus aureus Isolated from Hospital Wastewater in Kermanshah, Iran

Introduction

Hospital wastewater contains highly resistant and virulent bacteria that can spread into the environment. This study was conducted to investigate the antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in raw and treated hospital wastewater.

Methods

During a three-month period, 40 sewage samples were collected from the hospital sewage (Kermanshah, Iran), and S. aureus were identified using culture and biochemical tests. MRSA was detected by resistance to cefoxitin. Antibiotic resistance (AR) was determined using disk diffusion according to the Clinical and Laboratory Standards Institute (CLSI) in 20 MSSA (10 raw and 10 treated sewage) and 40 MRSA isolates (20 raw and 20 treated sewage). The antimicrobial resistance genes (ARGs) were determined by PCR.

Results

Eleven and eight percent of the isolates were MRSA in raw and treated sewage samples, respectively. Out of 60 isolates, 59 (98%) were multidrug resistant (MDR). The most common ARGs were mecA (raw=100%, treated=100%), aacA-D (raw=100%, treated=85%) and tetK (raw =95%, treated =45%) in MRSA, while the tetM gene was the most abundant gene (raw=50%, treated=80%) in MSSA. None of isolates (n=60) was positive for the vanB gene. MSSR (n=20) had the highest level of resistance against penicillin (100%), clindamycin (raw=90%, treated=90%), azithromycin (raw=80%, treated=90%). All MRSA isolates (n=40,100%) in both raw and treated sewage samples were non-susceptible to penicillin, oxacillin and azithromycin. There was no significant difference in the frequency AR and ARGs between raw and treated sewage samples (p>0.05).

Conclusion

The results indicated a high frequency of MDR and ARGs in both raw and treated sewage isolates which could be released into the environment through sewage system and pose a serious threat to public health. Hospital wastewater treatment processes should be improved in order to prevent the dissemination of the most resistant strains of S. aureus.

Effects of clay colloids on ciprofloxacin transport in saturated quartz sand porous media under different solution chemistry conditions

Antibiotics, a highly prevalent class of environmental organic pollutants, are becoming a matter of global concern. Clay minerals that are ubiquitous in subsurface environments may play an important role in the fate and transport of antibiotics. Taking ciprofloxacin (CIP) as a model antibiotic, this work explored the role of clay colloids (kaolinite and montmorillonite) on the adsorption and transport of CIP under different chemical solution conditions. The adsorption isotherms showed that montmorillonite colloids had a larger CIP sorption capacity than kaolinite colloids. The results of transport experiments indicated that montmorillonite colloids could promote CIP transport in saturated sand columns, but the addition of kaolinite colloids affected CIP mobility to a much smaller extent. The much stronger transport-enhancement effect of montmorillonite colloids was due to CIP adsorbed strongly to the colloids and desorption hysteresis of colloid-adsorbed CIP, likely stemming from the intercalation of this antibiotic in the interlayer of montmorillonite. Interestingly, transport of clay colloids increased with the increasing pH from 5.0 to 9.0; however, CIP transport decreased with the increasing pH in the presence of clay colloids. The observations were likely attributable to pH-dependent ciprofloxacin adsorption/desorption to clay minerals. Increasing the concentrations of NaCl and CaCl₂ generally decreased the contaminant-mobilizing ability of montmorillonite colloids, mainly by increasing the aggregation of colloids and thus, decreasing the transport of colloid-adsorbed CIP. Moreover, under the test conditions (1 mM NaCl and pH 7.0), the presence of CIP inhibited the transport of clay colloids due to the increase in aggregate size of clay colloids with the addition of CIP. Overall, these findings suggest that clay colloids with high adsorption abilities for antibiotics in the subsurface environment may act as a carrier for certain antibiotic compounds.

Assessing the Photocatalytic Degradation of Fluoroquinolone Norfloxacin by Mn:ZnS Quantum Dots: Kinetic Study, Degradation Pathway and Influencing Factors

Norfloxacin (NOFX), a broadly used fluoroquinolone antibiotic, has been a subject of great concern in the past few years due to its undesirable effect on human beings and aquatic ecosystems. In this study, novel Mn doped ZnS (Mn:ZnS) quantum dots (QDs) were prepared through a facile chemical precipitation method and used as photocatalysts for NOFX degradation. Prior to photodegradation experiments, morphological and optical parameters of the QDs were examined through transmission electron microscopy, scanning electron microscopy, energy dispersive X-ray analysis, Fourier transform infrared spectroscopy, ultraviolet-visible spectroscopy, fluorescence spectroscopy, Brunauer-Emmett-Teller analysis, and differential thermal and thermogravimetric analyses. Mn:ZnS QDs exhibited excellent properties of photodegradation, not only under UV irradiation but also in sunlight, which induced NOFX to photodegrade. The utmost photodegradation efficiency was obtained under optimal conditions (25 mL of NOFX, 15 mg/L, pH 10, 60 min UV irradiation, 60 mgs QDs), adopting first order kinetics. In addition, hydroxyl radicals produced by the conduction band electrons were found to be the primary reason dominating the transformation of NOFX in basic conditions, while holes, oxygen atoms, as well as the doped metal (Mn) enhanced the degradation. The QDs showed excellent reusability and stability in four repeated cycles. Finally, four different pathways were predicted, derived from the identified intermediates, with piperazinyl ring transformation being the primary one. It is expected that the synthesized Mn:ZnS QDs could be utilized as efficient photocatalytic materials for energy conversion and ecological remediation.

Treatment enhances the prevalence of antibiotic-resistant bacteria and antibiotic resistance genes in the wastewater of Sri Lanka, and India

Wastewater treatment plants (WWTPs) are being debated for being the hot spots for the development of antibiotic resistance in pathogenic microbial communities. We observed the prevalence of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARG), and multidrug resistance (MDR) in two municipal WWTPs and one hospital WWTP in Western and Southern Sri Lanka, and compared the results with particular reference to Indian and the World scenario to trace the imprints of treatment on ARB and ARG. Result suggests that although wastewater treatment resulted in higher than 1.06 log Escherichia coli (E. coli) reduction at all WWTPs, yet the percent of E. coli resistant to most of the antibiotics increased from influent to effluent. Higher prevalence of ARB, ARG, and MDR were noted in hospital WWTP owing to the higher antibiotic concentrations used and excreted by the patients. With reference to India, the WWTPs in Sri Lanka showed more ARB and a consistent increase in its percentages after the treatment but were less resistant to Fluoroquinolone (FQ). E. coli strains isolated from each location of both countries showed multidrug resistance, which has increased after the treatment and was strongly correlated with FQ in every WWTP. Resistant genes for Fluoroquinolone (FQ) (aac-(6')-1b-cr, qnrB, qnrS), β-lactams (ampC), and sulphonamides (sul1) were common in all the wastewaters except additional parC gene in the hospital effluent of Sri Lanka, implying much higher resistance for quinolones, especially for Ciprofloxacin. Multivariate statistical treatments suggest that effluent showed higher loadings and association for MDR/ARB, where pH change and more extensive interaction with metals during the treatment processes seem to have profound effects.