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

Septic tanks as a pathway for emerging contaminants to the aquatic environment-Need for alternative rural wastewater treatment?

Septic tanks (STs) as a decentralised approach to community wastewater treatment were investigated as a pathway for emerging contaminants (ECs) entering the aquatic environment. A broad range of ECs were examined in five community STs (population equivalents 217-475) and receiving rivers in Scotland over 12 months. All 68 studied ECs were detected at least once in ST influent or effluent at a broad concentration range from ng L-1 - μg L-1 which can surpass freshwater predicted no-effect concentrations. Pharmaceuticals with acute use, such as antibiotics and antifungals, had high monthly variability and concentrations can exceed those previously found in centralised wastewater treatment works. Differences between the STs demonstrate the impact of localised prescription and population behaviour on EC concentrations. The similarities in concentrations between influent and effluent, suggest limited or no removal of ECs in STs. Hence, dilution of the discharges is required to mitigate environmental risk. Although the contribution of ECs sorbed to suspended solids to the total EC concentration was generally small (<10%), higher contributions (>30%) were observed for fluoroquinolone antibiotics (ofloxacin and ciprofloxacin), antidepressants (fluoxetine), and antifungals (clotrimazole). A wide range of ECs were also detected in rivers upstream and downstream of the ST discharge points, and concentrations increased by up to 95% downstream. In general, risk quotients (RQs) in the rivers were low, indicating small risk for the environment. However, higher RQs (>1) were found for ibuprofen, diclofenac and ciprofloxacin in a few samples. Therefore, reducing their concentration by improving ST performance or through sustainable medicines use may be needed at low dilution locations to mitigate any risk.

Wastewater reuse and pharmaceutical pollution in agriculture: Uptake, transport, accumulation and metabolism of pharmaceutical pollutants within plants

The presence of pharmaceutical pollutants in water sources has become a growing concern due to its potential impacts on human health and other organisms. The physicochemical properties of pharmaceuticals based on their intended therapeutical application, which include antibiotics, hormones, analgesics, and antidepressants, is quite diverse. Their presence in wastewater, sewerage water, surface water, ground water and even in drinking water is reported by many researchers throughout the world. Human exposure to these pollutants through drinking water or consumption of aquatic and terrestrial organisms has raised concerns about potential adverse effects, such as endocrine disruption, antibiotic resistance, and developmental abnormalities. Once in the environment, they can persist, undergo transformation, or degrade, leading to a complex mixture of contaminants. Application of treated wastewater, compost, manures or biosolids in agricultural fields introduce pharmaceutical pollutants in the environment. As pharmaceuticals are diverse in nature, significant differences are observed during their uptake and accumulation in plants. While there have been extensive studies on aquatic ecosystems, the effect on agricultural land is more disparate. As of now, there are few reports available on the potential of plant uptake and transportation of pharmaceuticals within and between plant organs. This review summarizes the occurrence of pharmaceuticals in aquatic water bodies at a range of concentrations and their uptake, accumulation, and transport within plant tissues. Research gaps on pharmaceutical pollutants' specific effect on plant growth and future research scopes are highlighted. The factors affecting uptake of pharmaceuticals including hydrophobicity, ionization, physicochemical properties (pKa, logKow, pH, Henry's law constant) are discussed. Finally, metabolism of pharmaceuticals within plant cells through metabolism phase enzymes and plant responses to pharmaceuticals are reviewed.

Evaluation of pharmaceutical consumption between urban and suburban catchments in China by wastewater-based epidemiology

Wastewater-based epidemiology (WBE) is amply used for estimating human consumption of chemicals, yet information on regional variation of pharmaceuticals and their environmental fate are scarce. Thus, this study aims to estimate the consumption of three cardiovascular, four non-steroidal anti-inflammatory pharmaceuticals (NSAIDs), and four psychoactive pharmaceuticals between urban and suburban catchments in China by WBE, and to explore their removal efficiencies and ecological risks. Eleven analytes were detected in both influent and effluent samples. The estimated consumptions ranged from Collapse

Key Words

• Ecological risks
• Pharmaceutical usage
• Regional variation
• Removal efficiency
• Wastewater treatment plant

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MESH Headings

• China
• Water Pollutants, Chemical/analysis
• Wastewater/analysis
• Wastewater/chemistry
• Pharmaceutical Preparations/analysis
• Cities
• Humans
• Risk Assessment
• Anti-Inflammatory Agents, Non-Steroidal/analysis
• Environmental Monitoring
• Wastewater-Based Epidemiological Monitoring
• Psychotropic Drugs/analysis

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Affiliation(s)

Zongrui Li State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Jincheng Li State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Yongxia Hu West Center, Guangzhou Institute of Chemistry, Chinese Academy of Sciences, Chongqing, 400714, China
Yile Yan State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Shaoyu Tang Research Center for Eco-Environmental Engineering, School of Environment and Civil Engineering, Dongguan University of Technology, Dongguan, 523808, China
Ruixue Ma State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China
Liangzhong Li State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Ecology and Environment, Guangzhou, 510655, China; CAS Key Laboratory of Renewable Energy, Guangdong Provincial Key Laboratory of New and Renewable Energy Research and Development, Guangzhou Institute of Energy Conversion, Chinese Academy of Sciences, Guangzhou, 510640, China.

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Wastewater surveillance for antibiotics and resistance genes in a river catchment: Spatiotemporal variations and the main drivers

Wastewater-based epidemiology (WBE) is used for mining information about public health such as antibiotics resistance. This study investigated the distribution profiles of six types of antibiotic resistance genes (ARGs) in wastewater and rivers in Wuhu City, China. The levels of ARGs found in the Qingyijiang River were significantly higher than other rivers, and were comparable to effluent levels. Among the ARGs, sulfonamides ARGs and intI1 were the predominant in both wastewaters and rivers. Additionally, the concentrations of ARGs were higher on weekends as opposed to weekdays. Their distribution patterns remained consistent inter-week and inter-season using linear regression analysis (p < 0.001). Interestingly, the occurrence levels of ARGs in wastewaters during spring were significantly higher than in autumn, although insignificant in rivers. The apparent removal rate of ARGs in domestic wastewater sources ranged from 61.52-99.29%, except for qepA (-1.91% to 81.09%), whereas the removal rates in mixed domestic and industrial wastewaters showed a marked decrease (-92.94% to 76.67%). A correlation network analysis revealed that azithromycin and erythromycin were key antibiotics, while blaNDM-1, tetM, tetB, and ermB were identified as key ARGs. Sulfonamide and fluoroquinolone antibiotics, and tetracycline and macrolide ARGs were the primary contributors. Linear mixed models demonstrated that socio-economic variables positively impacted the occurrence levels of ARGs, whereas wastewater flow and river runoff were the negative drivers for their concentrations in wastewaters and surface waters, respectively. Overall, this WBE study contributes to the understanding of spatiotemporal profiles and main drivers of the occurrence of ARGs in wastewater and receiving water.

Fate of fluoroquinolones in field soil environment after incorporation of poultry litter from a farm with enrofloxacin administration via drinking water

The practice of incorporating animal manure into soil is supported within the European Circular economy as a possible substitute for mineral fertilizers and will become crucial for the sustainability of agriculture. However, this practice may indirectly contribute to the dissemination of antibiotics, resistance bacteria, and resistance genes. In this study, medicated drinking water and poultry litter samples were obtained from a broiler-chick farm. The obtained poultry litter was incorporated into the soil at the experimental field site. The objectives of this research project were first to develop analytical methods able to quantify fluoroquinolones (FQs) in medicated drinking water, poultry litter, and soil samples by LC-MS; second to study the fate of these FQs in the soil environment after incorporation of poultry litter from flock medicated by enrofloxacin (ENR); and third to screen the occurrence of selected fluoroquinolone resistance encoding genes in poultry litter and soil samples (PCR analysis). FQs were quantified in the broiler farm's medicated drinking water (41.0 ± 0.3 mg∙L-1 of ENR) and poultry litter (up to 70 mg∙kg-1 of FQs). The persistence of FQs in the soil environment over 112 days was monitored and evaluated (ENR concentrations ranged from 36 μg∙kg-1 to 9 μg∙kg-1 after 100 days). The presence of resistance genes was confirmed in both poultry litter and soil samples, in agreement with the risk assessment for the selection of AMR in soil based on ENR concentrations. This work provides a new, comprehensive perspective on the entry and long-term fate of antimicrobials in the terrestrial environment and their consequences after the incorporation of poultry litter into agricultural fields.

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

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

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

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

Occurrence, environmental impact and fate of pharmaceuticals in groundwater and surface water: a critical review

In many nations and locations, groundwater serves as the population's primary drinking water supply. However, pharmaceuticals found in groundwater and surface waters may affect aquatic ecosystems and public health. As a result, their existence in natural raw waters are now more widely acknowledged as a concern. This review summarises the evidence of research on pharmaceuticals' occurrence, impact and fate, considering results from different water bodies. Also, various analytical techniques were reviewed to compare different pharmaceuticals' detection frequencies in water bodies. These include liquid chromatography-mass spectrometry (LC-MS), high-performance liquid chromatography (HPLC), ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), and gas chromatography-mass spectrometry (GC-MS). However, owing to LC-MS's high sensitivity and specification, it is the most reported instrument used for analysis. The PRISMA reviewing methodology was adopted based on relevant literature in order to focus on aim of the review. Among other pharmaceuticals reviewed, sulfamethoxazole was found to be the most frequently detected drug in wastewater (up to 100% detection frequency). The most reported pharmaceutical group in this review is antibiotics, with sulfamethoxazole having the highest concentration among the analysed pharmaceuticals in groundwater and freshwater (up to 5600 ng/L). Despite extensive study and analysis on the occurrence and fate of pharmaceuticals in the environment, appropriate wastewater management and disposal of pharmaceuticals in the water environment are not still monitored regularly. Therefore, there is a need for mainstream studies tailored to the surveillance of pharmaceuticals in water bodies to limit environmental risks to human and aquatic habitats in both mid and low-income nations.

Recent advances in the biological treatment of wastewater rich in emerging pollutants produced by pharmaceutical industrial discharges

Pharmaceuticals and personal care products present potential risks to human health and the environment. In particular, wastewater treatment plants often detect emerging pollutants that disrupt biological treatment. The activated sludge process is a traditional biological method with a lower capital cost and limited operating requirements than more advanced treatment methods. In addition, the membrane bioreactor combines a membrane module and a bioreactor, widely used as an advanced method for treating pharmaceutical wastewater with good pollution performance. Indeed, the fouling of the membrane remains a major problem in this process. In addition, anaerobic membrane bioreactors can treat complex pharmaceutical waste while recovering energy and producing nutrient-rich wastewater for irrigation. Wastewater characterizations have shown that wastewater's high organic matter content facilitates the selection of low-cost, low-nutrient, low-surface-area, and effective anaerobic methods for drug degradation and reduces pollution. However, to improve the biological treatment, researchers have turned to hybrid processes in which all physical, chemical, and biological treatment methods are integrated to remove various emerging contaminants effectively. Hybrid systems can generate bioenergy, which helps reduce the operating costs of the pharmaceutical waste treatment system. To find the most effective treatment technique for our research, this work lists the different biological treatment techniques cited in the literature, such as activated sludge, membrane bioreactor, anaerobic treatment, and hybrid treatment, combining physicochemical and biological techniques.

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.

Fate and ecological risks of antibiotics in water-sediment systems with cultivated and wild Phragmites australis in a typical Chinese shallow lake

River carrying antibiotics from upstream posed serious threats to receiving lake, and plants might had effects on antibiotics. Therefore, samples of waters, sediments and tissues of cultivated and wild Phragmites australis were collected to analyse antibiotics fate and ecological risks (RQs) in Zaozhadian Lake. Our results revealed that the total antibiotics showed an increasing tendency in surface/pore water and P. australis tissues and a decreasing tendency in overlying water and sediments from the lake entrance to the centre. The bioaccumulation factors (BAFs) of two sulfonamides (SAs) and three quinolones (QNs) increased in sediments and decreased in those of erythromycin in pore water from Site 1 to Site 11. Three QNs and two tetracyclines (TCs) were dominant antibiotics in pore water/sediment and surface/overlying water respectively. Higher levels of two SAs in surface/pore water and two macrolides (MAs) in overlying/pore water and sediments were observed in the wild P. australis region, while higher values of two TCs in overlying/pore water and three QNs in sediment were observed in the cultivated P. australis region. Higher BAFs of SAs and QNs in sediments were observed in the cultivated and wild P. australis region respectively. The RQs of oxytetracycline and two MAs posed moderate risks in surface/overlying water from more than 50% of sampling sites. Norfloxacin exhibited moderate RQ and low ∑RQ levels in sediments, and showed high risk in pore water. Our findings imply that much more attention should be given to the antibiotics from river inputs and management normatives to control antibiotic pollution.

Distribution and characteristics of carbapenem-resistant and extended-spectrum β-lactamase (ESBL) producing Escherichia coli in hospital effluents, sewage treatment plants, and river water in an urban area of Japan

Occurrence of profiles of the carbapenem-resistant Escherichia coli (CRE-E) and extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E) in an urban river in a sub-catchment of the Yodo River Basin, one of the representative water systems of Japan was investigated. We conducted seasonal and year-round surveys for the antimicrobial-resistant bacteria (AMRB) and antimicrobial-resistance genes (AMRGs) in hospital effluents, sewage treatment plant (STP) wastewater, and river water; subsequently, contributions to wastewater discharge into the rivers were estimated by analyses based on the mass flux. Furthermore, the characteristics of AMRB in the water samples were evaluated on the basis of antimicrobial susceptibility tests. CRE-E and ESBL-E were detected in all water samples with mean values 11 and 1900 CFU/mL in the hospital effluent, 58 and 4550 CFU/mL in the STP influent, not detected to 1 CFU/mL in the STP effluent, and 1 and 1 CFU/mL in the STP discharge into the river, respectively. Contributions of the pollution load derived from the STP effluent discharged into the river water were 1 to 21%. The resistome profiles for bla_IMP, bla_TEM, and bla_CTX-M genes in each water sample showed that AMRGs were not completely removed in the wastewater treatment process in the STP, and the relative abundances of bla_IMP, bla_TEM, and bla_CTX-M genes were almost similar (P<0.05). Susceptibility testing of antimicrobial-resistant E. coli isolates showed that CRE-E and ESBL-E detected in wastewaters and river water were linked to the prevalence of AMRB in clinical settings. These results suggest the importance of conducting environmental risk management of AMRB and AMRGs in the river environment. To our knowledge, this is the first detailed study that links the medical environment to CRE-E and ESBL-E for evaluating the AMRB and AMRGs in hospital effluents, STP wastewater, and river water at the basin scale on the basis of mass flux as well as the contributions of CRE-E and ESBL-E to wastewater discharge into the river.

Anionic surfactants monitoring in healthcare facilities - a case of Belo Horizonte City, Brazil

Surfactants are substances that when in aquatic environments can cause negative impacts. Hospital effluents carry numerous chemicals daily, including surfactants, used in sanitization and disinfection procedures. These chemicals are found in the effluents and reach water bodies due to a lack of proper removal in the wastewater treatment plants. The present study investigated data about wastewater monitored from healthcare facilities located in the city of Belo Horizonte, Brazil, focusing on anionic surfactants. The results showed 72 establishments monitoring this parameter, resulting in a median concentration of 1 mg L-1 and 2.49 mg L-1 mean value of anionic surfactants, between 2007 and 2019. It is also observed in the correlation between surfactants and oils in all healthcare establishment sizes, except for the medium-sized. Although anionic surfactants are the most used in cleaning product formulations, cationic surfactants still do not have specific legislation in the studied country that dictates a limit for discharge into sewage; consequently, they are not routinely monitored in effluents. However, these compounds are used in the formulation of routine hospital products.

Spatiotemporal trends and annual fluxes of pharmaceuticals in a Scottish priority catchment

Pharmaceuticals (a class of emerging contaminants) are continuously introduced into effluent-receiving surface waters due to their incomplete removal within wastewater treatment plants (WWTPs). This work investigated the presence and distribution of eight commonly used human pharmaceuticals in the River Dee (Scotland, UK), a Scottish Environment Protection Agency priority catchment that is a conservation site and important raw water source. Grab sampling and passive sampling (Polar Organic Chemical Integrative Sampler, POCIS) was performed over 12 months, targeting: paracetamol, ibuprofen, and diclofenac (analgesics/anti-inflammatories); clarithromycin and trimethoprim (antibiotics); carbamazepine and fluoxetine (psychoactive drugs); and 17α-ethynylestradiol (estrogen hormone). Sampling sites spanned from the river's rural source to the heavily urbanised estuary into the North Sea. Ibuprofen (ranging 0.8-697 ng/L), paracetamol (ranging 4-658 ng/L), trimethoprim (ranging 3-505 ng/L), diclofenac (ranging 2-324 ng/L) and carbamazepine (ranging 1-222 ng/L) were consistently detected at the highest concentrations through grab sampling, with concentrations generally increasing down river with increasing urbanisation. However, POCIS revealed trace contamination of most compounds throughout the river (commonly <0.5 ng/L), indicating pollution may be related to diffuse sources. Analysis of river flows revealed that low flow and warm seasons corresponded to statistically significantly higher concentrations of diclofenac and carbamazepine, two compounds of environmental and regulatory concern. Below the largest WWTP, annual average fluxes ranged 0.1 kg/yr (clarithromycin) to 143.8 kg/yr (paracetamol), with 226.2 kg/yr for total target compounds. It was estimated that this source contributed >70% of the total mass loads (dissolved phase) of the target compounds in the river. As the River Dee is an important raw water source and conservation site, additional catchment monitoring is warranted to safeguard water quality and assess environmental risk of emerging contaminants, particularly in relation to unusual weather patterns, climate change and population growth.

Innovate to secure the future: the future of modern medicine

As drug-resistant pathogens emerge and spread globally, antimicrobial (especially antibiotic) treatments are becoming less effective. As infections become more complex and costly to treat in humans and animals, antimicrobial resistance (AMR) is a global challenge of real and increasing scale and complexity. If we do not act for the long term and with sustainability in mind, the annual deaths we see currently, numbering 700,000 globally, will rise each year to 10 million by 2050. To effectively contain and mitigate AMR, we need more evidence of the drivers and impacts of AMR on human, animal and environmental health, and the links between them. We also need to turn evidence into action and tailored, sustainable approaches for countries and communities, which put clinicians and patients at the centre. Excellent research is underway across the world into innovation (including new treatments, diagnostics and vaccines), infection prevention and behavioural interventions. In this article, we explore how, where and why research should be intensified, with increased collaboration and transparency, to strengthen global health security and secure the future of modern medicine for patients globally.

Pharmaceuticals in farms and surrounding surface water bodies: Hazard and ecotoxicity in a swine production area in Costa Rica

The presence of pharmaceuticals in the environment is known to have multiple origins; livestock activities comprise one scarcely studied source, both globally and specially in Latin-America. This work aims to study the occurrence of pharmaceuticals in wastewater from swine farms and their surrounding surface waters, in a highland livestock production area of Costa Rica. The monitoring of 70 pharmaceutical active compounds resulted in the detection of 10 molecules in farm wastewater (influents and effluents of the on-farm treatment system), including compounds of animal and human use. A 57% of effluents showed high hazard (ΣHQ > 1), mainly due to the compounds risperidone, ketoprofen, ibuprofen and naproxen. Additionally, ecotoxicological tests with Daphnia magna and Microtox classified at least 21% of the effluents as very toxic (10 < TU ≤ 100); likewise, 86% of effluents exhibited germination index (GI) inhibition values over 90% for Lactuca sativa. Seven molecules were detected in surface water, six of them of human use (1,7-dimethylxanthine, caffeine, cephalexin, carbamazepine, gemfibrozil, ibuprofen) and one (acetaminophen) of dual (human and veterinary) use; nonetheless, most of the detections were found in sampling points closer to human settlements than animal farms. Considering the set of molecules and their distribution, the livestock influence on surface water seems minimal in comparison with the urban influence. Only 16% of surface water samples showed high risk, mainly due to ibuprofen, gemfibrozil and caffeine; similarly, 45% samples presented GI inhibition >20% (no toxicity was determined towards Daphnia magna or Microtox). These findings in surface water suggest an incipient environmental risk in the area.

Removal behaviour of NSAIDs from wastewater using a P-functionalised microporous carbon

Diclofenac (DCF), naproxen (NPX) and ibuprofen (IBF) are three of the most commonly used non-steroidal anti-inflammatory drugs (NSAIDs) worldwide. They are widely detected in natural waters due to their persistence in wastewater treatment, and their removal is desirable in future wastewater management worldwide. In this study, "acid catalyst" functionalisation and subsequent carbonisation were adopted to synthesise a P-doped microporous carbonous adsorbent (CScPA) for NSAID removal. The CScPA was evaluated in depth for its adsorption performance (i.e., isotherms, kinetics and thermodynamics of adsorption at lab-scale). The CScPA had a large surface area (791.1 m²/g) and good porosity (0.392 cm³/g), which facilitated a high maximum adsorption capacity of 62.02 mg/g for a NSAID mixture. Thermodynamic data indicated that the adsorption of these NSAIDs was an endothermic process determined by physisorption (low-energy interactions). XPS analysis revealed the specific interactions involved in the adsorption process, including π-π and n-π electron donor-acceptor (EDA) interactions and hydrogen (H-) bonding. The Freundlich isotherm and Elovich kinetic model provided the best fit to the experimental results, which indicated surface heterogeneity (of the CScPA) and cooperative adsorption mechanisms. The adsorption process was shown to have potential to be applied to real wastewater effluent containing NSAIDs at low environmentally relevant concentrations (removal reached > 90% at 10 μg/L). Analysis of different implementation and cost related factors suggested that the CScPA has the potential for use with "real-world" water matrices, offering a sustainable treatment process for pharmaceutical remediation in wastewater.

Trends, new insights and perspectives in the treatment of hospital effluents

Recently, investigations of hospital effluent management and treatment have not only interested research groups with acquired experience in the field, but have also attracted the interest of new groups over the world. The most recent literature provides new insights into the occurrence of pharmaceuticals and other contaminants of emerging concern, pathogens, viruses, and antibiotic-resistant bacteria and genes in hospital effluent in various new developing and developed countries. It also provides information on the effective removal of key compounds (mainly antibiotics, analgesics, beta-blockers and chemotherapy drugs) by means of enhanced biological treatments and advanced oxidation processes. The current debate among the scientific community is mainly about the proper treatment to reduce the spread of antibiotic-resistant bacteria and genes and about the feasibility (from a technical and economic point of view) of treatment trains tested at lab and pilot scales.