Dynamics of active pharmaceutical ingredients loads in a Swiss university hospital wastewaters and prediction of the related environmental risk for the aquatic ecosystems

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

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

Ketoprofen products induced photosensitization of sulfonamide antibiotics: The cocktail effects of pharmaceutical mixtures on their photodegradation

Indirect photolysis induced by naturally occurring sensitizers constitutes an important pathway accounting for the transformation and fate of many recalcitrant micropollutants in sunlit surface waters. However, the photochemical transformation of micropollutants by photosensitizing pharmaceuticals has been less investigated. In this study, we demonstrated that the non-steroidal anti-inflammatory drug ketoprofen (KTF) and its photoproducts, 3-acetylbenzophenone (AcBP) and 3-ethylbenzophenone (EtBP), could sensitize the photodegradation of coexisting sulfonamide antibiotics, e.g., sulfamethoxazole (SMX), under artificial 365 nm ultraviolet (UV) and sunlight irradiation. Key reactive species including triplet excited state and singlet oxygen (1O2) responsible for photosensitization were identified by laser flash photolysis (LFP) and electron paramagnetic resonance (EPR) techniques, respectively. High-resolution mass spectrometry (HRMS) and structure-related reactivity analyses revealed that the sensitized photolysis of SMX occurred mainly through single electron transfer. The rate constants of sulfonamides sensitized by AcBP photolysis followed the order of sulfisoxazole (SIX)＞sulfathiazole (STZ)＞SMX＞sulfamethizole (SMT). Exposure to sunlight also enhanced the photolysis of SMX in the presence of KTF or AcBP, and water matrix had limited impact on such process. Overall, our results reveal the feasibility and mechanistic aspects of photosensitization of coexisting contaminants by pharmaceuticals (or their photoproducts) and provide new insights into the cocktail effects of pharmaceutical mixtures on their photochemical behaviors in aqueous environment.

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

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

[Disposal of drugs and the ensuing environmental impacts: an integrative review of the literature]

The scope of this article is to investigate the national and international evidence available on the forms of drug disposal and the presence of drugs in environmental matrices. It involved an integrative review of the literature conducted in the PubMed, SciELO and Virtual Health Library (VHL) databases, which included articles in English, Spanish and Portuguese published between 2010 and 2020. Twenty-six articles were selected, which revealed the incorrect disposal of medicines by professionals and consumers due mainly to the lack of knowledge about the environmental impacts that they may cause. Studies have highlighted the contamination of water, sewage and sediments by incorrectly discarded drugs. Furthermore, it was observed that aquatic living creatures can be impacted by the presence of drugs in environmental matrices. The incorrect disposal of drugs continues to be a reality in the evidence assessed, which leads to the contamination of environmental matrices and is often not removed by wastewater treatment plants and interferes with the equilibrium of environmental life.

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.

Strategies for safe management of hospital wastewater during the COVID-19 pandemic

Management of hospital wastewater is a challenging task, particularly during the situations like coronavirus 2019 (COVID-19) pandemic. The hospital effluent streams are likely to contain many known and unknown contaminants including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along with a variety of pollutants arising from pharmaceuticals, life-style chemicals, drugs, radioactive species, and human excreta from the patients. The effluents are a mixed bag of contaminants with some of them capable of infecting through contact. Hence, it is essential to identify appropriate treatment strategies for hospital waste streams. In this work, various pollutants emerging in the context of COVID-19 are examined. A methodical review is conducted on the occurrence and disinfection methods of SARS-CoV-2 in wastewater. An emphasis is given to the necessity of addressing the challenges of handling hospital effluents dynamically involved during the pandemic scenario to ensure human and environmental safety. A comparative evaluation of disinfection strategies makes it evident that the non-contact methods like ultraviolet irradiation, hydrogen peroxide vapor, and preventive approaches such as the usage of antimicrobial surface coating offer promise in reducing the chance of disease transmission. These methods are also highly efficient in comparison with other strategies. Chemical disinfection strategies such as chlorination may lead to further disinfection byproducts, complicating the treatment processes. An overall analysis of various disinfection methods is presented here, including developing methods such as membrane technologies, highlighting the merits and demerits of each of these processes. Finally, the wastewater surveillance adopted during the COVID-19 outbreak is discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-023-04803-1.

Occurrence of pharmaceuticals in the wastewater of a Greek hospital: Combining consumption data collection and LC-QTOF-MS analysis

In this article we applied drug consumption approach and chemical analysis in parallel to investigate the concentrations of a large number of pharmaceuticals in different streams of a General Hospital. Drugs consumption data was collected during two periods (Period 1, 2) and the predicted environmental concentrations (PECs) were estimated for the wastewater of a building housing specific medical services (Point A) and for the entire hospital (Point B). Hospital wastewater samples (HWW) samples were also collected from these points and periods and the measured environmental concentrations (MEC) were determined using UHPLC-ESI-QTOF-MS/MS. According to consumption data, the highest number of drugs was consumed in the departments of Hematology, Intensive Care Unit, Cardiology, Internal Medicine, and Oncology, while the number of active substances used in the hospital was 413 (Period 1) and 362 (Period 2). For most substances, much higher PEC and MEC values were found at the HWW of Point A indicating that on-site treatment of this stream could be examined in the future. The application of wide-scope target analysis allowed the quantification of 122 compounds, while 21 additional substances were identified using suspect screening. The highest mean concentrations in Period 1 were found for acetaminophen (1100 μg/L) and rifaximin (723 μg/L), while in Period 2 for iopromide (458 μg/L) and acyclovir (408 μg/L). Among the detected compounds, 19 metabolites were determined. Atenolol acid, 1-hydroxy-midazolam and clopidogrel carboxylic acid were quantified at concentrations much higher than parent compounds indicating the importance of metabolites' monitoring in HWW. Calculation of PEC/MEC ratio for 36 pharmaceuticals showed sufficient correlation of these values for 19 % to 33 % of the substances depending on the examined period and sampling point. The parallel collection of drugs consumption data and chemical analysis give a thorough picture of the substances present in HWW and their main sources, facilitating decision-making for their better management.

Efficient and Reusable Sorbents Based on Nanostructured BN Coatings for Water Treatment from Antibiotics

Increasing contamination of wastewater with antibiotics used in agriculture, animal husbandry, and medicine is a serious problem for all living things. To address this important issue, we have developed an efficient platform based on a high specific surface area hexagonal boron nitride (BN) coating formed by numerous nanopetals and nanoneedles. The maximum sorption capacity of 1 × 1 cm² BN coatings is 502.78 µg/g (tetracycline, TET), 315.75 µg/g (ciprofloxacin, CIP), 400.17 µg/g (amoxicillin, AMOX), and 269.7 µg/g (amphotericin B, AMP), which exceeds the sorption capacity of many known materials. Unlike nanoparticles, BN-coated Si wafers are easy to place in and remove from antibiotic-contaminated aqueous solutions, and are easy to clean. When reusing the adsorbents, 100% efficiency was observed at the same time intervals as in the first cleaning cycle: 7 days (TET) and 14 days (CIP, AMOX, AMP) at 10 µg/mL, 14 days (TET, CIP, and AMOX) and 28 days (AMP) at 50 µg/mL, and 14 days (TET) and 28 days (CIP, AMOX and AMP) at 100 µg/mL. The results obtained showed that TET and CIP are best adsorbed on the surface of BN, so TET was chosen as an example for further theoretical modeling of the sorption process. It was found that adsorption is the main mechanism, and this process is spontaneous and endothermic. This highlights the importance of a high specific surface area for the efficient removal of antibiotics from aqueous solutions.

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.

Exposure to trace levels of metals and fluoroquinolones increases inflammation and tumorigenesis risk of zebrafish embryos

Exposure to trace-level heavy metals and antibiotics may elicit metabolic disorder, alter protein expression, and then induce pathological changes in zebrafish embryos, despite negligible physiological and developmental toxicity. This study investigated the single and combined developmental toxicity of fluoroquinolones (enrofloxacin [ENR] and ciprofloxacin [CIP]) (≤0.5 μM) and heavy metals (Cu and Cd) (≤0.5 μM) to zebrafish embryos, and molecular responses of zebrafish larvae upon exposure to the single pollutant (0.2 μM) or a binary metal-fluoroquinolone mixture (0.2 μM). In all single and mixture exposure groups, no developmental toxicity was observed, but oxidative stress, inflammation, and lipid depletion were found in zebrafish embryos, which was more severe in the mixture exposure groups than in the single exposure groups, probably due to increased metal bioaccumulation in the presence of ENR or CIP. Metabolomics analysis revealed the up-regulation of amino acids and down-regulation of fatty acids, corresponding to an active response to oxidative stress and the occurrence of inflammation. The up-regulation of antioxidase and immune proteins revealed by proteomics analysis further confirmed the occurrence of oxidative stress and inflammation. Furthermore, the KEGG pathway enrichment analysis showed a significant disturbance of pathways related to immunity and tumor, indicating the potential risk of tumorigenesis in zebrafish larvae. The findings provide molecular-level insights into the adverse effects of heavy metals and antibiotics (especially in chemical mixtures) on zebrafish embryos, and highlight the potential ecotoxicological risks of trace-level heavy metals and antibiotics in the environment.

Advanced bio-oxidation of fungal mixed cultures immobilized on rotating biological contactors for the removal of pharmaceutical micropollutants in a real hospital wastewater

Hospital wastewater represents an important source of pharmaceutical active compounds (PhACs) as contaminants of emerging concern for urban wastewater treatment plants. This work evaluates a fungal biological treatment of a hospital effluent before discharging in the municipal sewer system. This treatment was performed in rotating biological contactors (RBCs) covered with wooden planks in order to promote the attachment of the fungal biomass. These bioreactors, initially inoculated with Trametes versicolor as white rot fungi, have created biofilms of a diversified population of fungal (wood-decaying fungi belonging to Basidiomycota and Ascomycetes) and bacterial (Beta-proteobacteria, Firmicutes, and Acidobacteria) microorganisms. The mixed fungal/bacterial community achieved a stable performance in terms of carbon, nitrogen, and phosphorous reductions for 75 days of continuous operation. Moreover, a remarkable removal of pharmaceutical micropollutants was accomplished especially for antibiotics (98.4 ± 0.7, 83 ± 8% and 76 ± 10 for azithromycin, metronidazole and sulfamethoxazole, respectively). Previous studies have proven a high efficiency of fungi for the removal of microcontaminants as a result of advanced bio-oxidation processes mediated by oxidizing hydroxyl radicals. This study evidences the development of a stable fungal-bacterial mixed culture over wooden-modified RBCs for in-situ removal of pharmaceutical compounds of hospital wastewater under non-sterile conditions and non-strict temperature control, avoiding periodical fungal inoculation due to destabilization and displacement of fungal cultures by indigenous wastewater bacteria.

Occurrence, source apportionment and source-specific risk assessment of antibiotics in a typical tributary of the Yellow River basin

The spatial distributions, sources, and source-specific risk apportionments of 26 antibiotics (5 categories) in the Fenhe River basin were determined based on sample data. The results showed that antibiotics were widely distributed in the surface water. There were significant differences between the different types of antibiotics, and the highest mean concentration was that of the sulfonamide category (33.74 ng/L), accounting for 36% of the total antibiotic concentration. Spatially, all antibiotics were mainly detected in the middle and downstream areas. The ecological risk assessment results showed that the significant risk rate of antibiotics accounted for 70% and was mainly distributed in the downstream area; however, the risks differed between the 5 categories. Quinolone antibiotics exhibited the highest significant risk rate, reaching 100%. The ecological risk associated with sulfamethoxazole was the highest among all detected antibiotics. The following five main factors influenced the antibiotic concentrations: aquaculture, pharmaceutical wastewater, livestock discharges, domestic sewage, and sewage treatment plants. Among these, pharmaceutical wastewater sources contributed the most (35%) to the total antibiotic concentration, and were distributed throughout the river. Although livestock discharges were not the main reason for the high level of ecological risk, these discharges were highest at certain sites in the midstream region. Different pollution sources posed different levels of ecological risk to the Fenhe River basin, the highest of which was pharmaceutical wastewater with a significant risk rate of 58%.

Degradation of Anti-Inflammatory Drugs in Synthetic Wastewater by Solar Photocatalysis

Due to the high number of anti-inflammatory drugs (AIMDs) used by the public health sector in Iraq and distributed all over the country and due to their toxicity, there is a need for an environmental-friendly technique to degrade any wasted (AIMD) present in aquatic ecosystem. The degradation of diclofenac sodium (DCF), ibuprofen (IBN), and mefenamic acid (MFA) in synthetic hospital wastewater were investigated utilizing locally-made Cu-coated TiO2 nanoparticles in a solar-irradiated reactor. Different key variables were studied for their effects on process efficiency, such as loadings of catalyst (C CU-TiO2 = 100–500 mg/L), AIMDs (100 µg/L), pH (4–9), and hydrogen peroxide (CH2O2 = 200–800 mg/L). The results revealed that degradation percentages of 96.5, 94.2, and 82.3%, were obtained for DCF, IBN, and MFA, respectively, using our Cu-coated TiO2 catalyst within 65 min at pH = 9, while other parameters were C CU-TiO2 = 300 mg/L, and CH2O2 = 400 mg/L. The experimental results revealed coupling photocatalysis with solar irradiation as a clean energy source could be utilized for the degradation of toxic pollutants in surface water.

A comparative study among catalytic wet air oxidation, Fenton, and Photo-Fenton technologies for the on-site treatment of hospital wastewater

The feasibility of catalytic wet air oxidation, intensified homogeneous Fenton and heterogeneous Photo-Fenton systems for the treatment of real hospital wastewater has been investigated. Wastewater samples were collected from a hospital sewer, during a weekly monitoring program, and fully characterized. Up to seventy-nine pharmaceuticals, including mostly parent compounds and some of their transformation products, were analyzed. Catalytic wet air oxidation allowed the complete removal of several pharmaceutical groups, but it did not allow to eliminate analgesics/anti-inflammatories and antibiotics, whose average removal was around 85%. Intensified Fenton oxidation was the most efficient process for all the drugs removal with an almost complete reduction of the initial pharmaceutical load (99.8%). The heterogeneous Photo-Fenton system reached a 94.5% reduction of the initial pharmaceutical load. The environmental risk of the treated samples by the hazard quotient (HQ) method was also evaluated. Fenton oxidation was the most effective system with a final ∑HQ of 5.4. Catalytic wet air oxidation and Photo-Fenton systems achieved total ∑HQ values of 895 and 88, respectively. This fact was related to the presence of refractory antibiotics in the treated catalytic wet air oxidation samples. On the opposite, the Photo-Fenton system provided the elimination of most pharmaceutical pollutants that pose a high environmental risk such as antibiotics. Simplified cost estimation was finally performed as a preliminary approach of the economy of the three oxidation processes for the hospital wastewater treatment.

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.

Pharmaceuticals Market, Consumption Trends and Disease Incidence Are Not Driving the Pharmaceutical Research on Water and Wastewater

Pharmaceuticals enhance our quality of life; consequently, their consumption is growing as a result of the need to treat ageing-related and chronic diseases and changes in the clinical practice. The market revenues also show an historic growth worldwide motivated by the increase on the drug demand. However, this positivism on the market is fogged because the discharge of pharmaceuticals and their metabolites into the environment, including water, also increases due to their inappropriate management, treatment and disposal; now, worldwide, this fact is recognized as an environmental concern and human health risk. Intriguingly, researchers have studied the most effective methods for pharmaceutical removal in wastewater; however, the types of pharmaceuticals investigated in most of these studies do not reflect the most produced and consumed pharmaceuticals on the market. Hence, an attempt was done to analyze the pharmaceutical market, drugs consumption trends and the pharmaceutical research interests worldwide. Notwithstanding, the intensive research work done in different pharmaceutical research fronts such as disposal and fate, environmental impacts and concerns, human health risks, removal, degradation and development of treatment technologies, found that such research is not totally aligned with the market trends and consumption patterns. There are other drivers and interests that promote the pharmaceutical research. Thus, this review is an important contribution to those that are interested not only on the pharmaceutical market and drugs consumption, but also on the links, the drivers and interests that motivate and determine the research work on certain groups of pharmaceuticals on water and wastewater.

Ciprofloxacin-degrading Paraclostridium sp. isolated from sulfate-reducing bacteria-enriched sludge: Optimization and mechanism

Ciprofloxacin (CIP), one of the most widely used fluoroquinolone antibiotics, is frequently detected in the effluents of wastewater treatment plants and aquatic environments. In this study, a CIP-degrading bacterial strain was isolated from the sulfate reducing bacteria (SRB)-enriched sludge, identified as Paraclostridium sp. (i.e., strain S2). The effects of critical operational parameters on CIP removal by the strain S2 were systematically studied and these parameters were optimized via response surface methodology to maximize CIP removal. Furthermore, the pathway and kinetics of CIP removal were investigated by varying the initial CIP concentrations (from 0.1 to 20 mg/L). The CIP removal was characterized by rapid sorption followed by biotransformation with a specific biotransformation rate of 1975.7 ± 109.1 µg/g-cell dry weight/h at an initial CIP concentration of 20 mg/L. Based on the main transformation products, several biotransformation pathways have been proposed including piperazine ring cleavage, OH/F substitution, decarboxylation, and hydroxylation as the major transformation reactions catalyzed by cytochrome P450 and dehydrogenases. Acute toxicity assessment apparently shows that CIP biotransformation by strain S2 resulted in the formation of less toxic intermediates. To the best of our knowledge, this is the very first study in which a key functional microbe, Paraclostridium sp., highly effective in CIP biotransformation, was isolated from SRB-enriched sludge. The findings of this study could facilitate in developing appropriate bioaugmentation strategy, and in designing and operating an SRB-based engineered process for treating CIP-laden wastewater.

Determination of antimicrobial concentration and associated risk in water sources in West Bengal state of India

The presence of antimicrobials in wastewater (WW), surface water (SW), groundwater (GW), and even in potable water from treatment plants has been reported from many countries. Their presence in the water sources is causing the rise and spread of antimicrobial resistance (AMR), thereby threatening our public health, global economy, and development. This necessitates the constant monitoring of these compounds along with the evaluation of their associated risk to aquatic organisms. In this study, GW, WW, and SW samples from different parts of West Bengal (India) were analyzed using the SPE-HPLC-DAD method for detecting two frequently used fluoroquinolones (ciprofloxacin, CIP and ofloxacin, OFL). The highest concentration of CIP and OFL was 5.75 μg/L (GW) and 17.84 μg/L (WW), respectively. The antimicrobial activity was determined against Escherichia coli and Staphylococcus aureus isolates from WW against CIP, which showed that Escherichia coli and Staphylococcus aureus had developed ~ 69 and ~ 12 times resistance compared to their respective pure strains. The risk assessment showed that CIP poses an insignificant threat to fish and Daphnia (RQ < 1) but a significant threat to green algae and Microcystis aeruginosa (RQ> > 1). OFL concentration also poses a great threat to all the organisms for which the assessment was made (RQ> > 1). Moreover, risk assessment in terms of AMR showed that the present level of these antimicrobials in different water sources could cause the development of resistance among the microbial community (RQ > 1). These results emphasize the need for constant monitoring of pharmaceutical compounds, especially antimicrobials, to be kept under check.

Prioritizing pharmaceuticals based on environmental risks in the aquatic environment in China

In last two decades, the number of detected activated pharmaceutical ingredients (APIs) in the natural environment worldwide has increased due to their widespread use in daily life. However, given the large number of APIs that are currently in use (approximate 850 are on the market in China), it is impractical to investigate the occurrence, ecotoxicological effects, and perform environmental risk assessment for all drugs. Therefore, it is crucial to rank and prioritize APIs in the environment to identify the compounds of high concern. In China, since information on API usage is not available, an attempt was made to use the number of products per API (the number of pharmaceutical commodities that contain a particular API) on the market multiplied by its daily dose (average daily dose of medication for adults used for the primary therapeutic purpose) to replace the usage in the exposure modeling. Coupled with the hazard assessment, including acute and chronic toxicity of aquatic ecological effects and potential effects related to the therapeutic mode of action, risk scores were estimated and used for ranking. Application of the approach was illustrated for 259 APIs with product number no less than 4. A list of 20 APIs was finally identified as a potential priority, including drugs of cardiovascular, nervous system, respiratory system, musculoskeletal system and antibiotics. In the future, this approach could be applied to prioritize APIs in other countries/regions where information on API usage are limited or non-existent.

A comprehensive study of COVID-19 in wastewater

The COVID-19 pandemic has had an adverse effect on human health, economy, and diverse environments. Besides the general transmission of the virus through air droplets and human-to-human contact; it is also transmitted while infecting the digestive system, which subsequently is defecated through the feces. Such fecal transmission can cause a major environmental distress, causing community transmission. This chapter attempts to investigate thoroughly the types of aquatic water bodies and addresses their role in the viral dissemination to combat SARS-CoV-2. It further enlightens the need for wastewater-based epidemiology (WBE) studies for surveillance as well as for early warning signal. The study could provide a comprehensive approach for designing effective strategies in the context of COVID-19 to counter the viral transmission and its deactivation. It also serves as a working paper for scholars and strategy regulators for planning and development of a new set-up from the global to the local level.

Liquid chromatography/mass spectrometry analytical determination of gabapentin transformation products by heterogeneous photocatalysis and environmental evaluation

RATIONALE

Gabapentin is a drug used to treat epilepsy and peripheral neuropathic pain. It is an analog of gamma-aminobutyric acid, and it is a selective blocker of voltage-gated calcium channels. The drug is excreted unmetabolized; it is stable in the environment and is classified as a persistent mobile organic contaminant. Because wastewater treatment plants (WWTPs) are not completely efficient, some bioactive molecules may be released unaltered into the environment. The aim of this study was to provide information about degradation pathways of gabapentin in water by studying its photoinduced transformation products (TPs) through laboratory simulation experiments. Gabapentin and its TPs were monitored in influent and effluent water samples from WWTPs in Germany and Italy.

METHODS

The laboratory simulation used heterogeneous photodegradation mediated by titanium dioxide (TiO₂ ). Chromatographic separation was achieved using a C18 reverse-phase column, and the structural identification of TPs was performed using high-resolution electrospray ionization high-resolution mass spectrometry (ESI-HRMS) and multistage MSⁿ experiments.

RESULTS

Several TPs were observed during TiO₂ photodegradation. Nine new compounds were detected, and potential structures were assigned by studying the fragmentation pathways of the [M + H]⁺ ions of these TPs and gabapentin. Gabapentin and some of the newly identified TPs were found in environmental samples from WWTPs.

CONCLUSIONS

The developed high-performance liquid chromatography/high-resolution mass spectrometry method was used to identify TPs from gabapentin. It was then successfully applied to real environmental samples to monitor the TPs as potential environmental pollutants.

Assessing hospital impact on pharmaceutical levels in a rural 'source-to-sink' water system

It is widely recognised that inadequate removal of pharmaceuticals in wastewater may lead to their presence in surface waters. Hospitals are key point-sources for pharmaceuticals entering municipal waterways, and rural hospitals are of concern as receiving wastewater treatment plants (WWTPs) may be smaller, less advanced and thus less efficient. While most research has focused on urban settings, here we present results from a rural ''source-to-sink'' study around a hospital. The aim was to determine the contribution of pharmaceuticals discharged to a municipal wastewater system, and, to assess pharmaceutical removal efficiency in the WWTP. Samples were collected daily for one month to assess water quality and pharmaceuticals in the broader water cycle: (i) raw water supply; (ii) treated hospital tap water; (iii) hospital wastewater discharge; (iv) combined WWTP influent; and (v) final WWTP effluent. Target compounds included analgesics/antiinflammatories, antibiotics, psychiatric drugs, and a synthetic estrogen hormone. Concentrations ranged from: 3 ng/L (carbamazepine) to 105,910 ng/L (paracetamol) in hospital discharge; 5 ng/L (ibuprofen) to 105,780 ng/L (paracetamol) in WWTP influent; and 60 ng/L (clarithromycin) to 36,201 ng/L (paracetamol) in WWTP effluent. WWTP removal ranged from 87% (paracetamol) to <0% (carbamazepine and clarithromycin), and significant correlations with water quality characteristics and WWTP flow data were observed for some compounds. Results suggested that the hospital is an important source of certain pharmaceuticals entering municipal wastewater, and associated water quality parameters are impacted. Pharmaceutical persistence in the WWTP effluent highlighted the direct pathway these compounds have into receiving surface water, where their impact remains uncharacterised. Rural regions may face future challenges mitigating environmental risk as WWTP infrastructure ages, populations grow and pharmaceutical use and diversity continue to increase.

A critical evaluation of comparative regulatory strategies for monitoring pharmaceuticals in recycled wastewater

Pharmaceuticals are a subset of micropollutants, present in the environment in trace concentrations. Because of their persistent nature, these chemicals are of particular concern. Little is known about how mixtures of pharmaceutical residues, found in WWTP effluents, affect the environment or public health. Yet, numerous studies show negative outcomes for both aquatic and terrestrial organisms, suggesting that they are given both to bioaccumulation and uptake in plants. Israel leads the world in effluent reuse (86%), almost exclusively utilized for purposes of agricultural irrigation. Pharmaceuticals, however, are not included in Israel's water regulatory oversight or management, essentially creating an epidemiological experiment among its citizens and environment. Globally, these compounds also are not commonly subject to monitoring or regulation. This study reviews and analyzes water policies and regulation worldwide that address the presence of pharmaceuticals in water resources, with a particular focus on Australia, Singapore, Switzerland, and the USA. Furthermore, the study investigates the reasons why these chemicals are not yet regulated in Israel. Based on a comprehensive evaluation of the data and analysis of the regulatory rationale in other countries, a list of recommended pharmaceutical standards that should be measured and monitored in Israel's wastewater treatment system is proposed. The suggested prioritization criteria should be at the heart of a new regulatory agenda for controlling pharmaceutical contamination in wastewater.

Monitoring the release of anti-inflammatory and analgesic pharmaceuticals in the receiving environment

The occurrence of anti-inflammatory and analgesic pharmaceuticals (AIAPs) in the effluents of 16 hospitals, influent and effluent of wastewater treatment plant (WWTP), the contribution and mass load of each hospital to WWTP influent, and the removal efficiencies in WWTP were investigated. Environmental risk was also evaluated by toxicity tests using organisms from three different trophic levels. Acetaminophen had the highest concentration in summer and winter samples, followed by ketoprofen, ibuprofen, and naproxen. The total daily load of AIAPs detected in influent of WWTP was 1677 mg/day/1000 inhabitants in summer and 5074 mg/day/1000 inhabitants in winter. The contribution of 16 hospitals to the total AIAP load in influent of WWTP was 11.30% in summer and 7.09% in winter. The highest mass loads were calculated as 203 mg/bed.day in general hospital in summer and 300 mg/bed.day in pediatric hospital in winter. The removal efficiencies of AIAPs in WWTP ranged between 13% and 100% in summer and 0.88% and 99% in winter. WWTP is not sufficient to remove all the AIAPs. Diclofenac (in summer), mefenamic acid, indomethacin, and phenylbutazone exhibited poor removal below 50%. The effluents of the WWTP exhibited a low risk for fish and Daphnia magna and an insignificant risk for algae.

Occurrence, removal and environmental risk of markers of five drugs of abuse in urban wastewater systems in South Australia

The occurrence and fate of five drugs of abuse in raw influent and treated effluent wastewater were investigated over a period of 1 year in the Adelaide region of South Australia. Four wastewater treatment plants were chosen for this study and monitored for five drugs which included cocaine in the form of its metabolite benzoylecgonine (BE), methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and two opioids (codeine and morphine) during the period April 2016 to February 2017. Alongside concentrations in raw sewage, the levels of drugs in the treated effluent were assessed and removal efficiencies were calculated. Drug concentrations were measured by mixed-mode solid phase extraction and liquid chromatography coupled to a quadrupole mass spectrometer. Drug concentrations detected in the raw wastewater ranged from 7 to 6510 ng/L and < LOD to 4264 ng/L in treated effluent samples. Drug removal rates varied seasonally and spatially. The mass loads of drugs discharged into the environment were in descending order: codeine > methamphetamine > morphine > MDMA > BE. Results showed that all the targeted drugs were on average incompletely removed by wastewater treatment, with removal performance highest for morphine (94%) and lowest for MDMA (58%). A screening-level environmental risk assessment was subsequently performed for the drugs based on effluent wastewater concentrations. Based on calculated risk quotients, overall environmental risk for these compounds appears low, with codeine and methamphetamine likely to pose the greatest potential risk to receiving environments. Given the recognised limitations of current ecotoxicological models and risk assessment methods for these and other pharmaceutical drugs, the potential for environmental impacts associated with the continuous discharge of these compounds in wastewater effluents should not be overlooked.

Insights into the Fate and Removal of Antibiotics in Engineered Biological Treatment Systems: A Critical Review

Antibiotics, the most frequently prescribed drugs of modern medicine, are extensively used for both human and veterinary applications. Antibiotics from different wastewater sources (e.g., municipal, hospitals, animal production, and pharmaceutical industries) ultimately are discharged into wastewater treatment plants. Sorption and biodegradation are the two major removal pathways of antibiotics during biological wastewater treatment processes. This review provides the fundamental insights into sorption mechanisms and biodegradation pathways of different classes of antibiotics with diverse physical-chemical attributes. Important factors affecting sorption and biodegradation behavior of antibiotics are also highlighted. Furthermore, this review also sheds light on the critical role of extracellular polymeric substances on antibiotics adsorption and their removal in engineered biological wastewater treatment systems. Despite major advancements, engineered biological wastewater treatment systems are only moderately effective (48-77%) in the removal of antibiotics. In this review, we systematically summarize the behavior and removal of different antibiotics in various biological treatment systems with discussion on their removal efficiency, removal mechanisms, critical bioreactor operating conditions affecting antibiotics removal, and recent innovative advancements. Besides, relevant background information including antibiotics classification, physical-chemical properties, and their occurrence in the environment from different sources is also briefly covered. This review aims to advance our understanding of the fate of various classes of antibiotics in engineered biological wastewater treatment systems and outlines future research directions.

Aqueous photochemical degradation of mefenamic acid and triclosan: role of wastewater effluent matrices

In this study, photochemical degradation of two emerging pharmaceutical chemicals, mefenamic acid (MF) and triclosan (TCS), was investigated to clarify the role of treated wastewater effluent matrices on their environmental photolysis. Target compounds were individually exposed to simulated sunlight in different media: ultrapure buffered water and synthetic field water with treated municipal wastewater effluent. The results in ultrapure buffered water showed that the direct photolysis processes in aquatic environments are not relevant to the elimination of MF. However, in samples containing treated wastewater effluent, photochemical degradation of MF was clearly enhanced. Our results indicate that MF undergoes indirect photolysis by reactive intermediates produced in an effluent matrix. Further quenching experiments suggested that photochemically produced hydroxyl radicals and excited triplet state dissolved organic matter drive the degradation of MF. In contrast to MF, TCS photochemical degradation proceeds through rapid direct photolysis. TCS was quickly degraded in ultrapure buffered water but it is considerably hampered in samples containing wastewater effluent. The declined degradation of TCS in the synthetic field water was discussed in terms of underlying optical filter effects by coexisting chromophoric substances. Results emphasize the importance of taking local water chemistry into consideration when predicting natural attenuation of pharmaceutical chemicals in receiving areas.

Pharmaceutical manufacturing facility discharges can substantially increase the pharmaceutical load to U.S. wastewaters

Discharges from pharmaceutical manufacturing facilities (PMFs) previously have been identified as important sources of pharmaceuticals to the environment. Yet few studies are available to establish the influence of PMFs on the pharmaceutical source contribution to wastewater treatment plants (WWTPs) and waterways at the national scale. Consequently, a national network of 13 WWTPs receiving PMF discharges, six WWTPs with no PMF input, and one WWTP that transitioned through a PMF closure were selected from across the United States to assess the influence of PMF inputs on pharmaceutical loading to WWTPs. Effluent samples were analyzed for 120 pharmaceuticals and pharmaceutical degradates. Of these, 33 pharmaceuticals had concentrations substantially higher in PMF-influenced effluent (maximum 555,000 ng/L) compared to effluent from control sites (maximum 175 ng/L). Concentrations in WWTP receiving PMF input are variable, as discharges from PMFs are episodic, indicating that production activities can vary substantially over relatively short (several months) periods and have the potential to rapidly transition to other pharmaceutical products. Results show that PMFs are an important, national-scale source of pharmaceuticals to the environment.

Fast quantification of fluoroquinolones in environmental water samples using molecularly imprinted polymers coupled with internal extractive electrospray ionization mass spectrometry

A simple, fast and high-sensitivity method for quantification of fluoroquinolones in environmental water samples using MIPs-iEESI-MS.

Implementing ecopharmacovigilance (EPV) from a pharmacy perspective: A focus on non-steroidal anti-inflammatory drugs

Environmental experts have made great efforts to control pharmaceutical pollution. However, the control of emerged environmental problems caused by medicines should draw more attention of pharmacy and pharmacovigilance researchers. Ecopharmacovigilance (EPV) as a kind of pharmacovigilance for the environment is recognized worldwide as crucial to minimize the environmental risk of pharmaceutical pollutants. But continuing to treat the pollution of pharmaceuticals as a group of substances instead of targeting individual pharmaceuticals on a prioritized basis will lead to a significant waste of resources. Considering vulture population decline caused by non-steroidal anti-inflammatory drugs (NSAIDs) residues, we presented a global-scale analysis of 139 reports of NSAIDs occurrence across 29 countries, in order to provide a specific context for implementing EPV. We found a heavy regional bias toward research in Europe, Asia and America. The top 5 most frequently studied NSAIDs included ibuprofen, diclofenac, naproxen, acetaminophen and ketoprofen. The profile of NSAIDs was dominated by acetaminophen in wastewater influents and effluents. Ibuprofen was the most abundant NSAID in surface water. Only 9 NSAIDs were reported in groundwater samples. And majority of NSAIDs were detected in solid matrices at below 1μg/g except for ketoprofen, diclofenac and ibuprofen. From a pharmacy perspective, we get some implication and propose some management practice options for EPV implementation. These include: Further popularizing and applying the concept of EPV, together with developing relevant regulatory guidance, is necessary; More attention should be paid to how to implement EPV for the pollution control of older established drugs; Triggering "a dynamic watch-list mechanism" in conjunction with "source control"; Implementing targeted sewage treatment technologies and strengthening multidisciplinary collaboration; Pharmaceutical levels in aquatic organisms as biological indicators for monitoring pharmaceutical pollution within the water environment; Upgrading drinking water treatment plants with the aim of removing pharmaceutical residues; Paying more attention to EPV for pharmaceuticals in solid matrices.

Multi-class of endocrine disrupting compounds in aquaculture ecosystems and health impacts in exposed biota

Fishes are a major protein food source for humans, with a high economic value in the aquaculture industry. Because endocrine disrupting compounds (EDCs) have been introduced into aquatic ecosystems, the exposure of humans and animals that depend on aquatic foods, especially fishes, should be seriously considered. EDCs are emerging pollutants causing global concern because they can disrupt the endocrine system in aquatic organisms, mammals, and humans. These pollutants have been released into the environment through many sources, e.g., wastewater treatment plants, terrestrial run-off (industrial activities, pharmaceuticals, and household waste), and precipitation. The use of pharmaceuticals, pesticides, and fertilizers for maintaining and increasing fish health and growth also contributes to EDC pollution in the water body. Human and animal exposure to EDCs occurs via ingestion of contaminated matrices, especially aquatic foodstuffs. This paper aims to review human EDC exposure via fish consumption. In respect to the trace concentration of EDCs in fish, types of instrument and clean-up method are of great concerns.

Rapid determination of the emerging contaminant oxypurinol in surface water using solid phase extraction followed by ultra high-performance liquid chromatography with fluorescence detection

A method has been developed for the trace analysis of oxypurinol that is considered as an active pharmaceutical ingredient and an emerging environmental contaminant. The method achieved the identification and quantification of oxypurinol in surface water samples utilizing solid phase extraction and ultra high-performance liquid chromatography with diode array and fluorescence detection for the first time. Four principal parameters of solid phase extraction were optimized to obtain maximum extraction efficiency. Under the isocratic elution of methanol/water (5:95, v/v) and the excitation/emission wavelength of 254/359 nm, a rapid determination was achieved in 2.0 min with good linearity of 1.05-351 μg/L (coefficient of determination above 0.9998). The limit of detection and method detection limit were 0.210 μg/L and 1.34 ng/L, respectively. Precision of the method was evaluated and a relative standard deviation value of 3.3% was obtained for analyses of six replicate spiking blank samples (200 mL, 176 ng/L) according to the overall proposed procedure. The method showed a great anti-interference ability and average spiked recoveries of oxypurinol in five surface water samples were in the range of 94.5-111%. The ability of the method to detect and correctly identify oxypurinol can significantly promote investigation on the occurrence of oxypurinol in water and its potential (eco-)toxicological effects. Graphical abstract Quantification of the emerging contaminant oxypurinol in s urface water using SPE/UHPLC-FLD.

Modeling in-sewer transformations at catchment scale - implications on drug consumption estimates in wastewater-based epidemiology

To which extent illicit drugs are transformed during in-sewer transport, depends on a number of factors: i) substance-specific transformation rates, ii) environmental conditions, iii) point of discharge (location of drug user) and iv) sewer network properties, primarily hydraulic residence time (HRT) and the ratio of biofilm contact area to wastewater volume (A/V_eq). Assessing associated uncertainties typically requires numerous simulations. Therefore, we propose a new two-step modeling framework: 1) Quantify hydrodynamic conditions. This computationally demanding step was performed once in SWMM to derive HRT and A/V_eq for each potential point of discharge (node) in three catchments of different size. 2) Estimate biomarker loss. In this step, Monte Carlo simulations were performed for defined scenarios. Depending on assumptions about drug user distribution and prevalence, a number of nodes was sampled. For each node an empirical first-order transformation model was applied with flow-path-corresponding HRT and A/V_eq from step 1. Biotic and abiotic transformation rates were sampled from distributions combining variability of different biofilms. In our modeling study, median losses were >30% for amphetamine, 6-monoacetylmorphine and 6-acetylcodeine in all three catchments with high uncertainty (5%-100% loss), which would imply a systematic underestimation of consumption when neglecting in-sewer processes. Median losses for 21 other investigated biomarkers were <10% with different uncertainty ranges - "no substantial transformation" was confirmed for nine substances in a real sewer segment with a 2-h residence time. Transferability of these results must be tested for other catchments. To further reduce uncertainty, mainly additional knowledge on transformation rates, particularly in biofilm, and their distribution across a sewer network is needed to update model input objectively. Our approach allows efficient testing and, furthermore, can be expanded for many other human biomarkers. Accounting for biomarker stability during in-sewer transport will avoid biased estimates and further improve wastewater-based epidemiology.

Monitoring, sources, receptors, and control measures for three European Union watch list substances of emerging concern in receiving waters - A 20year systematic review

Pollution of European receiving waters with contaminants of emerging concern (CECs), such as with 17-beta-estradiol (a natural estrogenic hormone, E2), along with pharmaceutically-active compounds diclofenac (an anti-inflammatory drug, DCL) and 17-alpha-ethynylestradiol (a synthetic estrogenic hormone, EE2)) is a ubiquitous phenomenon. These three CECs were added to the EU watch list of emerging substances to be monitoring in 2013, which was updated in 2015 to comprise 10 substances/groups of substances in the field of water policy. A systematic literature review was conducted of 3952 potentially relevant articles over period 1995 to 2015 that produced a new EU-wide database consisting of 1268 publications on DCL, E2 and EE2. European surface water concentrations of DCL are typically reported below the proposed annual average environmental quality standard (AA EQS) of 100ng/l, but that exceedances frequently occur. E2 and EE2 surface water concentrations are typically below 50ng/l and 10ng/l respectively, but these values greatly exceed the proposed AA EQS values for these compounds (0.04 and 0.035ng/l respectively). However, levels of these CECs are frequently reported to be disproportionately high in EU receiving waters, particularly in effluents at control points that require urgent attention. Overall it was found that DCL and EE2 enter European aquatic environment mainly following human consumption and excretion of therapeutic drugs, and by incomplete removal from influent at urban wastewater treatment plants (WWTPs). E2 is a natural hormone excreted by humans which also experiences incomplete removal during WWTPs treatment. Current conventional analytical chemistry methods are sufficiently sensitive for the detection and quantification of DCL but not for E2 and EE2, thus alternative, ultra-trace, time-integrated monitoring techniques such as passive sampling are needed to inform water quality for these estrogens. DCL appears resistant to conventional wastewater treatment while E2 and EE2 have high removal efficiencies that occur through biodegradation or sorption to organic matter. There is a pressing need to determine fate and behaviour of these CECs in European receiving waters such as using GIS-modelling of river basins as this will identify pressure points for informing priority decision making and alleviation strategies for upgrade of WWTPs and for hospital effluents with advanced treatment technologies. More monitoring data for these CECs in receiving waters is urgently needed for EU legislation and effective risk management.

Predicted and measured concentrations of pharmaceuticals in hospital effluents. Examination of the strengths and weaknesses of the two approaches through the analysis of a case study

This study deals with the chemical characterization of hospital effluents in terms of the predicted and measured concentrations of 38 pharmaceuticals belonging to 11 different therapeutic classes. The paper outlines the strengths and weaknesses of the two approaches through an analysis of a case study referring to a large hospital. It highlights the observed (and expected) ranges of variability for the parameters of the adopted model, presents the results of an uncertainty analysis of direct measurements (due to sampling mode and frequency and chemical analysis) and a sensitivity analysis of predicted concentrations (based on the annual consumption of pharmaceuticals, their excretion rate and annual wastewater volume generated by the hospital). Measured concentrations refer to two sampling campaigns carried out in summer and winter in order to investigate seasonal variability of the selected compounds. Predicted concentrations are compared to measured ones in the three scenarios: summer, winter and the whole year. It was found that predicted and measured concentrations are in agreement for a limited number of compounds (namely atenolol, atorvastatin and hydrochlorothiazide), and for most compounds the adoption of the model leads to a large overestimation in all three periods. Uncertainties in predictions are mainly due to the wastewater volume and excretion factor, whereas for measured concentrations, uncertainties are mainly due to sampling mode.

Ciprofloxacin residue and antibiotic-resistant biofilm bacteria in hospital effluent

Discharge of antimicrobial residues and resistant bacteria in hospital effluents is supposed to have strong impacts on the spread of antibiotic resistant bacteria in the environment. This study aimed to characterize the effluents of the Gabriel Montpied teaching hospital, Clermont-Ferrand, France, by simultaneously measuring the concentration of ciprofloxacin and of biological indicators resistant to this molecule in biofilms formed in the hospital effluent and by comparing these data to ciprofloxacin consumption and resistant bacterial isolates of the hospital. Determination of the measured environmental concentration of ciprofloxacin by spot sampling and polar organic chemical integrative (POCIS) sampling over 2 weeks, and comparison with predicted environmental concentrations produced a hazard quotient >1, indicating a potential ecotoxicological risk. A negative impact was also observed with whole hospital effluent samples using the Tetrahymena pyriformis biological model. During the same period, biofilms were formed within the hospital effluent, and analysis of ciprofloxacin-resistant isolates indicated that Gamma-Proteobacteria were numerous, predominantly Aeromonadaceae (69.56%) and Enterobacteriaceae (22.61%). Among the 115 isolates collected, plasmid-mediated fluoroquinolone-resistant genes were detected, with mostly aac(6')-lb-cr and qnrS. In addition, 60% of the isolates were resistant to up to six antibiotics, including molecules mostly used in the hospital (aminosides and third-generation cephalosporins). In parallel, 1247 bacteria isolated from hospitalized patients and resistant to at least one of the fluoroquinolones were collected. Only 5 of the 14 species identified in the effluent biofilm were also found in the clinical isolates, but PFGE typing of the Gram-negative isolates found in both compartments showed there was no clonality among the strains. Altogether, these data confirm the role of hospital loads as sources of pollution for wastewater and question the role of environmental biofilms communities as efficient shelters for hospital-released resistance genes.

Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use-A One Year Study from Vietnam

Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital's wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital's wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001).

Hospital-Use Pharmaceuticals in Swiss Waters Modeled at High Spatial Resolution

A model to predict the mass flows and concentrations of pharmaceuticals predominantly used in hospitals across a large number of sewage treatment plant (STP) effluents and river waters was developed at high spatial resolution. It comprised 427 geo-referenced hospitals and 742 STPs serving 98% of the general population in Switzerland. In the modeled base scenario, domestic, pharmaceutical use was geographically distributed according to the population size served by the respective STPs. Distinct hospital scenarios were set up to evaluate how the predicted results were modified when pharmaceutical use in hospitals was allocated differently; for example, in proportion to number of beds or number of treatments in hospitals. The hospital scenarios predicted the mass flows and concentrations up to 3.9 times greater than in the domestic scenario for iodinated X-ray contrast media (ICM) used in computed tomography (CT), and up to 6.7 times greater for gadolinium, a contrast medium used in magnetic resonance imaging (MRI). Field measurements showed that ICM and gadolinium were predicted best by the scenarios using number of beds or treatments in hospitals with the specific facilities (i.e., CT and/or MRI). Pharmaceuticals used both in hospitals and by the general population (e.g., cyclophosphamide, sulfamethoxazole, carbamazepine, diclofenac) were predicted best by the scenario using the number of beds in all hospitals, but the deviation from the domestic scenario values was only small. Our study demonstrated that the bed number-based hospital scenarios were effective in predicting the geographical distribution of a diverse range of pharmaceuticals in STP effluents and rivers, while the domestic scenario was similarly effective on the scale of large river-catchments.