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

European fluxes of medical gadolinium to the ocean: A model based on healthcare databases

Marine ecosystems are exposed to a multitude of stresses, including emerging metals as Rare Earth Elements. The management of these emerging contaminants represents a significant environmental issue. For the past three decades, the increasing medical use of gadolinium-based contrast agents (GBCAs) has contributed to their widespread dispersion in hydrosystems, raising concerns for ocean conservation. In order to control GBCA contamination pathways, a better understanding of the cycle of these elements is needed, based on the reliable characterization of fluxes from watersheds. Our study proposes an unprecedented annual flux model for anthropogenic gadolinium (Gd_anth) based on GBCA consumption, demographics and medical uses. This model enabled the mapping of Gd_anth fluxes for 48 European countries. The results show that 43 % of Gd_anth is exported to the Atlantic Ocean, 24 % to the Black Sea, 23 % to the Mediterranean Sea and 9 % to the Baltic Sea. Together, Germany, France and Italy contribute 40 % of Europe's annual flux. Our study was therefore able to identify the current and future major contributors to Gd_anth flux in Europe and identify abrupt changes related to the COVID-19 pandemic.

Predicted occurrence, ecotoxicological risk and environmentally acquired resistance of antiviral drugs associated with COVID-19 in environmental waters

Antiviral drugs have been used to treat the ever-growing number of coronavirus disease, 2019 (COVID-19) patients. Consequently, unprecedented amounts of such drug residues discharging into ambient waters raise concerns on the potential ecotoxicological effects to aquatic lives, as well as development of antiviral drug-resistance in wildlife. Here, we estimated the occurrence, fate and ecotoxicological risk of 11 therapeutic agents suggested as drugs for COVID-19 treatment and their 13 metabolites in wastewater and environmental waters, based on drug consumption, physical-chemical property, and ecotoxicological and pharmacological data for the drugs, with the aid of quantitative structure-activity relationship (QSAR) modelling. Our results suggest that the removal efficiencies at conventional wastewater treatment plants will remain low (<20%) for half of the substances, and consequently, high drug residues (e.g. 7402 ng/L ribavirin, 4231 ng/L favipiravir, 730 ng/L lopinavir, 319 ng/L remdesivir; each combined for both unchanged forms and metabolites; and when each drug is administered to 100 patients out of 100,000 populations on a day) can be present in secondary effluents and persist in the environmental waters. Ecotoxicological risk in receiving river waters can be high (risk quotient >1) by a use of favipiravir, lopinavir, umifenovir and ritonavir, and medium (risk quotient >0.1) by a use of chloroquine, hydroxychloroquine, remdesivir, and ribavirin, while the risk will remain low (risk quotient <0.1) for dexamethasone and oseltamivir. The potential of wild animals acquiring antiviral drug resistance was estimated to be low. Our prediction suggests a pressing need for proper usage and waste management of antiviral drugs as well as for improving removal efficiencies of drug residues in wastewater.

Evaluating sewer exfiltration in groundwater by pharmaceutical tracers after the 2016 Kumamoto earthquakes, Japan

In April 2016, a series of earthquakes (M 7.3 on the Japan Meteorological Agency scale) occurred in Kumamoto, Japan causing serious damage to underground sewerage networks. In this study, we evaluated sewer exfiltration in groundwater in the Kumamoto area after the earthquakes by using multiple tracers. We used 14 pharmaceuticals, including carbamazepine and crotamiton, and anthropogenic Gd as tracers, and we measured concentrations of these tracers from September 2016 to November 2017 seasonally. The detection frequency of caffeine, carbamazepine, crotamiton, ibuprofen, and anthropogenic Gd ranged from 29% to 45%, and the concentrations of the pharmaceuticals in the groundwater were lower than those in previous studies. The median of all pharmaceutical concentrations did not decrease, whereas the median of the sum of crotamiton and carbamazepine concentrations, which are quantitative sewage markers, decreased with time. The sewer exfiltration rates in September 2016 estimated using carbamazepine, crotamiton, and anthropogenic Gd were 0.59 ± 0.27%, 0.66 ± 0.47%, and 0.11 ± 0.18% of sewage dry weather flow, respectively, indicating that the effect of the earthquakes on sewer exfiltration was small, probably because the damaged sewers were quickly repaired. This study demonstrated that a multiple-tracer approach is useful for evaluating sewer exfiltration after major earthquakes.

Geo-referenced simulation of pharmaceuticals in whole watersheds: application of GREAT-ER 4.1 in Germany

The geo-referenced regional exposure assessment tool for European rivers (GREAT-ER) is designed to support river basin management or the implementation process within the EU Water Framework Directive by predicting spatially resolved exposure concentrations in whole watersheds. The usefulness of the complimentary application of targeted monitoring and GREAT-ER simulations is demonstrated with case studies for three pharmaceuticals in selected German watersheds. Comparison with monitoring data corroborates the capability of the probabilistic model approach to predict the expected range of spatial surface water concentrations. Explicit consideration of local pharmaceutical emissions from hospitals or private doctor's offices (e.g., for X-ray contrast agents) can improve predictions on the local scale without compromising regional exposure assessment. Pharmaceuticals exhibiting low concentrations hardly detectable with established analytical methods (e.g., EE2) can be evaluated with model simulations. Management scenarios allow for a priori assessment of risk reduction measures. In combination with targeted monitoring approaches, the GREAT-ER model can serve as valuable support tool for exposure and risk assessment of pharmaceuticals in whole watersheds.

Impact of industrial waste water treatment plants on Dutch surface waters and drinking water sources

Direct industrial discharges of Chemicals of Emerging Concern (CEC) to surface water via industrial wastewater treatment plants (IWTP) gained relatively little attention compared to discharges via municipal sewage water treatment plants. IWTP effluents may however seriously affect surface water quality. Here we modelled direct industrial emissions of all 182 Dutch IWTP from 19 different industrial classes, and derived their impact on Dutch surface water quality and drinking water production. We selected industrial chemicals relevant for drinking water production, however a lack of systematic information on concentrations in IWTP effluents for many chemicals of interest was found. Therefore, we used data from the European Pollutant Release and Transfer Register and data on Dutch IWTP as surrogate. We coupled these to a detailed hydrological model under two extreme river discharge conditions, and compared the predicted and measured concentrations. We derived relative impact factors for the IWTP based on their contribution to concentrations at surface water locations with a drinking water function. In total, a third of the abstracted water for drinking water production is influenced by the IWTP. From all Dutch 182 IWTP, only a limited number has - based on the model approach using surrogate parameters - a high impact on surface waters with a drinking water function. Mitigation measures can be taken cost-efficiently, by placing extra treatment technologies at the IWTP with high impact. Finally, we propose recommendations for licensing and controlling industrial aqueous emissions and give suggestions to fill the currently existing knowledge gaps and diminish uncertainties in the approach.

Quantification of Element Fluxes in Wastewaters: A Nationwide Survey in Switzerland

The number and quantities of trace elements used in industry, (high-tech) consumer products, and medicine are rapidly increasing, but the resulting emissions and waste streams are largely unknown. We assessed the concentrations of 69 elements in digested sewage sludge and effluent samples from 64 municipal wastewater treatment plants as well as in major rivers in Switzerland. This data set, representative of an entire industrialized country, presents a reference point for current element concentrations, average per-capita fluxes, loads discharged to surface waters, and economic waste-stream values. The spatial distribution of many individual elements could be attributed either to predominant geogenic or to anthropogenic inputs. Per-capita element fluxes ranged from <10 μg day^-1 (e.g., Au, In, and Lu) to >1 mg day^-1 (e.g., Zn, Sc, Y, Nb, and Gd) and >1 g day^-1 (e.g., for P, Fe, and S). Effluent loads of some elements contributed significantly to riverine budgets (e.g., 24% for Zn, 50% for P, and 83% for Gd), indicating large anthropogenic inputs via the wastewater stream. At various locations, precious metal concentrations in sludge were similar to those in profitable mining ores, with total flux values of up to 6.8 USD per capita per year or 15 USD per metric ton of dry sludge.

Less-studied TCE: are their environmental concentrations increasing due to their use in new technologies?

The possible environmental impact of the recent increase in use of a group of technology-critical elements (Nb, Ta, Ga, In, Ge and Te) is analysed by reviewing published concentration profiles in environmental archives (ice cores, ombrotrophic peat bogs, freshwater sediments and moss surveys) and evaluating temporal trends in surface waters. No increase has so far been recorded. The low potential direct emissions of these elements, resulting from their absolute low production levels, make it unlikely that the increasing use of these elements in modern technology has any noticeable effect on their environmental concentrations on a global scale. This holds particularly true for those of these elements that are probably emitted in relatively high amounts from other human activities (i.e., coal combustion and non-ferrous smelting), such as In, the most studied element of the group.

Removal of Antibiotics in Biological Wastewater Treatment Systems-A Critical Assessment Using the Activated Sludge Modeling Framework for Xenobiotics (ASM-X)

Many scientific studies present removal efficiencies for pharmaceuticals in laboratory-, pilot-, and full-scale wastewater treatment plants, based on observations that may be impacted by theoretical and methodological approaches used. In this Critical Review, we evaluated factors influencing observed removal efficiencies of three antibiotics (sulfamethoxazole, ciprofloxacin, tetracycline) in pilot- and full-scale biological treatment systems. Factors assessed include (i) retransformation to parent pharmaceuticals from e.g., conjugated metabolites and analogues, (ii) solid retention time (SRT), (iii) fractions sorbed onto solids, and (iv) dynamics in influent and effluent loading. A recently developed methodology was used, relying on the comparison of removal efficiency predictions (obtained with the Activated Sludge Model for Xenobiotics (ASM-X)) with representative measured data from literature. By applying this methodology, we demonstrated that (a) the elimination of sulfamethoxazole may be significantly underestimated when not considering retransformation from conjugated metabolites, depending on the type (urban or hospital) and size of upstream catchments; (b) operation at extended SRT may enhance antibiotic removal, as shown for sulfamethoxazole; (c) not accounting for fractions sorbed in influent and effluent solids may cause slight underestimation of ciprofloxacin removal efficiency. Using tetracycline as example substance, we ultimately evaluated implications of effluent dynamics and retransformation on environmental exposure and risk prediction.