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Esmaeili-Khoshmardan M, Dabiri H, Rafiee M, Eslami A, Yazdanbakhsh A, Amereh F, Jahangiri-Rad M, Hashemi A. Dynamics of antimicrobial resistance and susceptibility profile in full-scale hospital wastewater treatment plants. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2024; 90:103-123. [PMID: 39007309 DOI: 10.2166/wst.2024.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/14/2024] [Indexed: 07/16/2024]
Abstract
Drug resistance has become a matter of great concern, with many bacteria now resist multiple antibiotics. This study depicts the occurrence of antibiotic-resistant bacteria (ARB) and resistance patterns in five full-scale hospital wastewater treatment plants (WWTPs). Samples of raw influent wastewater, as well as pre- and post-disinfected effluents, were monitored for targeted ARB and resistance genes in September 2022 and February 2023. Shifts in resistance profiles of Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii antimicrobial-resistant indicators in the treated effluent compared to that in the raw wastewater were also worked out. Ceftazidime (6.78 × 105 CFU/mL) and cefotaxime (6.14 × 105 CFU/mL) resistant species showed the highest concentrations followed by ciprofloxacin (6.29 × 104 CFU/mL), and gentamicin (4.88 × 104 CFU/mL), in raw influent respectively. WWTP-D employing a combination of biological treatment and coagulation/clarification for wastewater decontamination showed promising results for reducing ARB emissions from wastewater. Relationships between treated effluent quality parameters and ARB loadings showed that high BOD5 and nitrate levels were possibly contributing to the persistence and/or selection of ARBs in WWTPs. Furthermore, antimicrobial susceptibility tests of targeted species revealed dynamic shifts in resistance profiles through treatment processes, highlighting the potential for ARB and ARGs in hospital wastewater to persist or amplify during treatment.
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Affiliation(s)
- Maedeh Esmaeili-Khoshmardan
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Dabiri
- Department of Medical Microbiology, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Rafiee
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Air Quality and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail:
| | - Akbar Eslami
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Yazdanbakhsh
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Amereh
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Jahangiri-Rad
- Water Purification Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali Hashemi
- Department of Medical Microbiology, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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Perez-Bou L, Gonzalez-Martinez A, Gonzalez-Lopez J, Correa-Galeote D. Promising bioprocesses for the efficient removal of antibiotics and antibiotic-resistance genes from urban and hospital wastewaters: Potentialities of aerobic granular systems. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 342:123115. [PMID: 38086508 DOI: 10.1016/j.envpol.2023.123115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/07/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
The use, overuse, and improper use of antibiotics have resulted in higher levels of antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs), which have profoundly disturbed the equilibrium of the environment. Furthermore, once antibiotic agents are excreted in urine and feces, these substances often can reach wastewater treatment plants (WWTPs), in which improper treatments have been highlighted as the main reason for stronger dissemination of antibiotics, ARB, and ARGs to the receiving bodies. Hence, achieving better antibiotic removal capacities in WWTPs is proposed as an adequate approach to limit the spread of antibiotics, ARB, and ARGs into the environment. In this review, we highlight hospital wastewater (WW) as a critical hotspot for the dissemination of antibiotic resistance due to its high level of antibiotics and pathogens. Hence, monitoring the composition and structure of the bacterial communities related to hospital WW is a key factor in controlling the spread of ARGs. In addition, we discuss the advantages and drawbacks of the current biological WW treatments regarding the antibiotic-resistance phenomenon. Widely used conventional activated sludge technology has proved to be ineffective in mitigating the dissemination of ARB and ARGs to the environment. However, aerobic granular sludge (AGS) technology is a promising technology-with broad adaptability and excellent performance-that could successfully reduce antibiotics, ARB, and ARGs in the generated effluents. We also outline the main operational parameters involved in mitigating antibiotics, ARB, and ARGs in WWTPs. In this regard, WW operation under long hydraulic and solid retention times allows better removal of antibiotics, ARB, and ARGs independently of the WW technology employed. Finally, we address the current knowledge of the adsorption and degradation of antibiotics and their importance in removing ARB and ARGs. Notably, AGS can enhance the removal of antibiotics, ARB, and ARGs due to the complex microbial metabolism within the granular biomass.
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Affiliation(s)
- Lizandra Perez-Bou
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain; Microbial Biotechnology Group, Microbiology and Virology Department, Faculty of Biology, University of Havana, Cuba
| | - Alejandro Gonzalez-Martinez
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain
| | - Jesus Gonzalez-Lopez
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain
| | - David Correa-Galeote
- Microbiology Department, Faculty of Pharmacy, University of Granada, Granada, Andalucía, Spain; Microbiology and Environmental Technology Section, Institute of Water Research, University of Granada, Granada, Andalucía, Spain.
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Perez-Bou L, Muñoz-Palazon B, Gonzalez-Lopez J, Gonzalez-Martinez A, Correa-Galeote D. Deciphering the Role of WWTPs in Cold Environments as Hotspots for the Dissemination of Antibiotic Resistance Genes. MICROBIAL ECOLOGY 2023; 87:14. [PMID: 38091083 DOI: 10.1007/s00248-023-02325-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023]
Abstract
Cold environments are the most widespread extreme habitats in the world. However, the role of wastewater treatment plants (WWTPs) in the cryosphere as hotspots in antibiotic resistance dissemination has not been well established. Hence, a snapshot of the resistomes of WWTPs in cold environments, below 5 °C, was provided to elucidate their role in disseminating antibiotic resistance genes (ARGs) to the receiving waterbodies. The resistomes of two natural environments from the cold biosphere were also determined. Quantitative PCR analysis of the aadA, aadB, ampC, blaSHV, blaTEM, dfrA1, ermB, fosA, mecA, qnrS, and tetA(A) genes indicated strong prevalences of these genetic determinants in the selected environments, except for the mecA gene, which was not found in any of the samples. Notably, high abundances of the aadA, ermB, and tetA(A) genes were found in the influents and activated sludge, highlighting that WWTPs of the cryosphere are critical hotspots for disseminating ARGs, potentially worsening the resistance of bacteria to some of the most commonly prescribed antibiotics. Besides, the samples from non-disturbed cold environments had large quantities of ARGs, although their ARG profiles were highly dissimilar. Hence, the high prevalences of ARGs lend support to the fact that antibiotic resistance is a common issue worldwide, including environmentally fragile cold ecosystems.
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Affiliation(s)
- Lizandra Perez-Bou
- Department of Microbiology and Virology, Faculty of Biology, University of Havana, Havana, Cuba
- Microbiology and Environmental Technologies Section, Water Research Institute, University of Granada, Granada, Spain
| | - Barbara Muñoz-Palazon
- Microbiology and Environmental Technologies Section, Water Research Institute, University of Granada, Granada, Spain
- Department of Microbiology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Jesus Gonzalez-Lopez
- Microbiology and Environmental Technologies Section, Water Research Institute, University of Granada, Granada, Spain
- Department of Microbiology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Alejandro Gonzalez-Martinez
- Microbiology and Environmental Technologies Section, Water Research Institute, University of Granada, Granada, Spain
- Department of Microbiology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - David Correa-Galeote
- Microbiology and Environmental Technologies Section, Water Research Institute, University of Granada, Granada, Spain.
- Department of Microbiology, Faculty of Pharmacy, University of Granada, Granada, Spain.
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Li C, Du X, Huang C, Zhang Z. Effects of High Pharmaceutical Concentrations in Domestic Wastewater on Membrane Bioreactor Treatment Systems: Performance and Microbial Community. MEMBRANES 2023; 13:650. [PMID: 37505016 PMCID: PMC10383461 DOI: 10.3390/membranes13070650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
Despite pharmaceuticals being widely detected in water-bodies worldwide, what remain unclear are the effects of high pharmaceutical concentrations on the treatment efficiency of biological wastewater treatment processes, such as membrane bioreactor (MBR) systems. This study investigated the efficiency of MBR technology in the treatment of synthetic wastewater containing a mixture of five typical pharmaceuticals (ofloxacin, sulfamethoxazole, sulfamethylthiadiazole, carbamazepine and naproxen) with a total concentration of 500 µg/L. Both the control MBR (MBRc) without pharmaceutical dosing and the MBR operated with high influent pharmaceutical concentrations (MBRe) were operated under room temperature with the same hydraulic retention time of 11 h and the same sludge retention time of 30 d. The removal efficiency rates of total nitrogen and total phosphorus were 83.2% vs. 90.1% and 72.6% vs. 57.8% in the MBRc vs. MBRe systems, and both MBRs achieved >98% removal of organics for a 180-day period. The floc size decreased, and membrane fouling became more severe in the MBRe system. Microbial diversity increased in the MBRe system and the relative abundances of functional microbe differed between the two MBRs. Furthermore, the total relative abundances of genes involved in glycolysis, assimilating nitrate reduction and nitrification processes increased in the MBRe system, which could account for the higher organics and nitrogen removal performance. This work provides insights for MBR operation in wastewater treatment with high pharmaceutical concentrations.
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Affiliation(s)
- Chengyue Li
- Membrane & Nanotechnology-Enabled Water Treatment Center, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Guangdong Provincial Engineering Research Centre for Urban Water Recycling and Environmental Safety, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Xin Du
- Membrane & Nanotechnology-Enabled Water Treatment Center, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Guangdong Provincial Engineering Research Centre for Urban Water Recycling and Environmental Safety, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Chuyi Huang
- Membrane & Nanotechnology-Enabled Water Treatment Center, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Guangdong Provincial Engineering Research Centre for Urban Water Recycling and Environmental Safety, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Zhenghua Zhang
- Membrane & Nanotechnology-Enabled Water Treatment Center, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Guangdong Provincial Engineering Research Centre for Urban Water Recycling and Environmental Safety, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- School of Environment, Tsinghua University, Beijing 100084, China
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Liu A, Zhao Y, Cai Y, Kang P, Huang Y, Li M, Yang A. Towards Effective, Sustainable Solution for Hospital Wastewater Treatment to Cope with the Post-Pandemic Era. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2854. [PMID: 36833551 PMCID: PMC9957062 DOI: 10.3390/ijerph20042854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread across the globe since the end of 2019, posing significant challenges for global medical facilities and human health. Treatment of hospital wastewater is vitally important under this special circumstance. However, there is a shortage of studies on the sustainable wastewater treatment processes utilized by hospitals. Based on a review of the research trends regarding hospital wastewater treatment in the past three years of the COVID-19 outbreak, this review overviews the existing hospital wastewater treatment processes. It is clear that activated sludge processes (ASPs) and the use of membrane bioreactors (MBRs) are the major and effective treatment techniques applied to hospital wastewater. Advanced technology (such as Fenton oxidation, electrocoagulation, etc.) has also achieved good results, but the use of such technology remains small scale for the moment and poses some side effects, including increased cost. More interestingly, this review reveals the increased use of constructed wetlands (CWs) as an eco-solution for hospital wastewater treatment and then focuses in slightly more detail on examining the roles and mechanisms of CWs' components with respect to purifying hospital wastewater and compares their removal efficiency with other treatment processes. It is believed that a multi-stage CW system with various intensifications or CWs incorporated with other treatment processes constitute an effective, sustainable solution for hospital wastewater treatment in order to cope with the post-pandemic era.
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Affiliation(s)
- Ang Liu
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
| | - Yaqian Zhao
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
| | - Yamei Cai
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
| | - Peiying Kang
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
| | - Yulong Huang
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
| | - Min Li
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
| | - Anran Yang
- State Key Laboratory of Eco-Hydraulics in Northwest Arid Region, Xi’an University of Technology, Xi’an 710048, China
- Department of Municipal and Environmental Engineering, School of Water Resources and Hydroelectric Engineering, Xi’an University of Technology, Xi’an 710048, China
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Klatt M, Beyer F, Einfeldt J. Hospital wastewater treatment and the role of membrane filtration - removal of micropollutants and pathogens: A review. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2022; 86:2213-2232. [PMID: 36378176 DOI: 10.2166/wst.2022.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Dissemination of multiresistant bacteria and high concentrations of micropollutants by hospitals and other medical facilities can be significantly reduced by a wide variety of on-site treatment approaches. Membrane filtration technologies, ranging from microfiltration to reverse osmosis, have been adapted in many studies and offer multiple purposes in advanced wastewater treatment configurations. While the direct rejection of pharmaceutical compounds and pathogens can only be achieved with nanofiltration and reverse osmosis processes, porous membranes are known for their pathogen removal capabilities and can be used in combination with other advanced treatment approaches, such as oxidation and adsorption processes. This review was conducted to systematically assess studies with membrane filtration technologies that are used as either stand-alone or hybrid systems for the treatment of hospital wastewater. In this review, four different databases were screened with a pre-set of search strings to thoroughly investigate the application of membrane filtration technology in hospital wastewater treatment. Hybrid systems that combine multiple treatment technologies seem to be the most promising way of consistently removing micropollutants and pathogens from hospital wastewater, but additional economic assessments are needed for an extensive evaluation.
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Affiliation(s)
- Marten Klatt
- Department of Environmental Engineering, Hamburg University of Applied Sciences, Hamburg, Germany E-mail: ; ; Institute of Wastewater Management and Water Protection, Hamburg University of Technology, Hamburg, Germany
| | - Falk Beyer
- Department of Process Engineering, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Jörn Einfeldt
- Department of Environmental Engineering, Hamburg University of Applied Sciences, Hamburg, Germany E-mail: ;
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