Occurrence and abundance of antibiotics and resistance genes in rivers, canal and near drug formulation facilities--a study in Pakistan

Epigenetic modifications and metabolic gene mutations drive resistance evolution in response to stimulatory antibiotics

The antibiotic resistance crisis, fueled by misuse and bacterial evolution, is a major global health threat. Traditional perspectives tie resistance to drug target mechanisms, viewing antibiotics as mere growth inhibitors. New insights revealed that low-dose antibiotics may also serve as signals, unexpectedly promoting bacterial growth. Yet, the development of resistance under these conditions remains unknown. Our study investigated resistance evolution under stimulatory antibiotics and uncovered new genetic mechanisms of resistance linked to metabolic remodeling. We documented a shift from a fast, reversible mechanism driven by methylation in central metabolic pathways to a slower, stable mechanism involving mutations in key metabolic genes. Both mechanisms contribute to a metabolic profile transition from glycolysis to rapid gluconeogenesis. In addition, our findings demonstrated that rising environmental temperatures associated with metabolic evolution accelerated this process, increasing the prevalence of metabolic gene mutations, albeit with a trade-off in interspecific fitness. These findings expand beyond the conventional understanding of resistance mechanisms, proposing a broader metabolic mechanism within the selective window of stimulatory sub-MIC antibiotics, particularly in the context of climate change.

Mixtures of toxic organic micropollutants compromise the safety of water resources in urban agglomerations in low- and medium-income countries: The example of Lahore, Pakistan

Contamination of water resources with mixtures of organic micropollutants (OMP) including pesticides, pharmaceuticals, and industrial chemicals is a serious threat to aquatic organisms and human health. Long-term exposure to such pollutants may cause detrimental effects even at very low concentrations. Water resources in urban agglomerations in low- and medium-income countries may be under particular pressure due to high population densities, significant industrial activities, and limited water treatment and management resources. In these areas, many inhabitants directly rely on healthy urban water resources. Using the agglomeration of Lahore, Pakistan, as a case, we studied the occurrence, spatial distribution, and toxic risks of OMP mixtures in different urban water resources using target screening with liquid chromatography high-resolution mass spectrometry. In total, 266 of 576 target analytes were detected in at least one of the 200 samples taken from groundwater, canals, River Ravi and drains within the urban agglomeration. Notably, very high concentrations ranging from 10 to over 100 μg L-1 were found for highly toxic pesticides including several fungicides such as picoxystrobin, the transformation product phthalamic acid, and imazalil, the insecticide etofenprox but also industrial chemicals stemming for example from traffic such as 2-naphthalene sulfonic acid. Our study revealed high toxic risks particularly for invertebrates, fish and algae, with etofenprox as a dominant risk driver. This compound is extensively used in Lahore to control insect vectors of malaria and dengue fever in the urban agglomeration. Mixture risks were assessed using a toxic unit (TU) approach based on organism group specific effect concentrations, complemented with a risk quotient (RQ) approach using the lowest predicted no effect concentrations (PNECs). Acute and chronic risk thresholds were frequently exceeded, often by many orders of magnitude. These very high mixture risks strongly exceed those with previous studies in Europe, Africa and South America.

Pharmaceuticals and personal care product modelling: Unleashing artificial intelligence and machine learning capabilities and impact on one health and sustainable development goals

The presence of pharmaceutical and personal care products (PPCPs) in the environment poses a significant threat to environmental resources, given their potential risks to ecosystems and human health, even in trace amounts. While mathematical modelling offers a comprehensive approach to understanding the fate and transport of PPCPs in the environment, such studies have garnered less attention compared to field and laboratory investigations. This review examines the current state of modelling PPCPs, focusing on their sources, fate and transport mechanisms, and interactions within the whole ecosystem. Emphasis is placed on critically evaluating and discussing the underlying principles, ongoing advancements, and applications of diverse multimedia models across geographically distinct regions. Furthermore, the review underscores the imperative of ensuring data quality, strategically planning monitoring initiatives, and leveraging cutting-edge modelling techniques in the quest for a more holistic understanding of PPCP dynamics. It also ventures into prospective developments, particularly the integration of Artificial Intelligence (AI) and Machine Learning (ML) methodologies, to enhance the precision and predictive capabilities of PPCP models. In addition, the broader implications of PPCP modelling on sustainability development goals (SDG) and the One Health approach are also discussed. GIS-based modelling offers a cost-effective approach for incorporating time-variable parameters, enabling a spatially explicit analysis of contaminant fate. Swin-Transformer model enhanced with Normalization Attention Modules demonstrated strong groundwater level estimation with an R2 of 82 %. Meanwhile, integrating Interferometric Synthetic Aperture Radar (InSAR) time-series with gravity recovery and climate experiment (GRACE) data has been pivotal for assessing water-mass changes in the Indo-Gangetic basin, enhancing PPCP fate and transport modelling accuracy, though ongoing refinement is necessary for a comprehensive understanding of PPCP dynamics. The review aims to establish a framework for the future development of a comprehensive PPCP modelling approach, aiding researchers and policymakers in effectively managing water resources impacted by increasing PPCP levels.

Prevalence, virulence potential, antibiotic resistance profile, heavy metal resistance genes of Listeria innocua: A first study in consumed foods for assessment of human health risk in Northern Turkey

Listeria (L.) innocua is typically considered a non-pathogenic bacterium that can sometimes act as an opportunistic pathogen in severely immunocompromised patients. However, it plays an important role in food safety because it acts as an indicator organism for potential contamination and the effectiveness of sanitation methods. The aim of this study was to determine the prevalence, virulence genes, antibiotic resistance profiles, heavy metal and disinfectant resistance genes of L. innocua isolates from animal-derived foods. In this study, we isolated and characterized 39 L. innocua strains recovered from commonly 400 consumed beef meat, fresh fish meat, raw cow milk, and traditional cheese samples collected in Giresun, Turkey. The occurrence of virulence-associated genes was detected, such as plcA (97.4%), iap (35.8%), and hlyA (15.3%). A high incidence of resistance was recorded for fusidic acid (100%), followed by oxacillin (97.4%), clindamycin (82%), trimethoprim/sulfamethoxazole (69.2%), benzylpenicillin (41%), nitrofurantoin (35.8%), and fosfomycin (35.8%). Overall, 100% (39/39) of the isolates were resistant to at least one antibiotic, while 92.3% (36/39) of the isolate strains were multidrug resistant in the antimicrobial susceptibility tested. Among the L. innocua isolates (n = 39), 51.2%, 38.4%, 20.5%, 7.6%, 5.1%, 2.5%, and 2.5% were positive for qacH, cadA1, qacE, qacEΔ1-sul, qacJ, qacF, and qacG heavy metal and disinfectant resistance genes, respectively. The results highlight the need for more comprehensive studies to understand the monitoring and surveillance of L. innocua and their potential hazards to both humans and animals.

Presence of emerging organic contaminants and microbial indicators in surface water and groundwater in urban India

This study presents a first combined assessment of emerging organic contaminants (EOC) and antimicrobial resistance (AMR) indicators in the South Indian city of Bengaluru from multiple sources, addressing a knowledge gap on EOCs and AMR occurrences and relationships in different water sources in urban India. A unique approach in this study was to combine the detection of EOCs with an assessment of the AMR-indicating class 1 integron-integrase gene, intI1. Twenty-five samples collected from groundwater, local surface waters, and tap water imported from the Cauvery Basin were screened for 1499 EOCs. A total of 125 EOCs were detected at concentrations per compound of up to 314 μg/L. Concentrations for a range of contaminants were higher than those previously detected in Indian groundwaters. High concentrations of Per- and polyfluoroalkyl substances (PFAS) were detected with up to 1.8 μg/L in surface water and up to 0.9 μg/L in groundwater. Calculated risk quotients indicated potential AMR development caused by high concentrations of azithromycin, fluconazole, and sulfanilamide in surface waters that have little protection against sewage inflows. Surface waters that have recently undergone environmental restoration (e.g., removing silted bottom layers and enhancing protection against encroachments and sewage inflows) had lower EOC detections and risk of AMR development. Specific EOC detections, e.g., the ubiquitous detection of the sweetener sucralose (in use since ∼2000), indicated recent groundwater recharge and a contribution of imported Cauvery River water for recharge. This study highlights the need for monitoring and water protection, the role of EOCs as potential drivers of AMR, and the success of surface water protection measures to improve freshwater quality.

Metabolomics combined with proteomics reveals phytotoxic effects of norfloxacin under drought stress on Oryza sativa

In recent decades, plants enduring abiotic stresses such as drought and chemical stresses. Currently, the mechanism of combined antibiotic and drought stress response and its impact on crop growth and food security remains poorly understood. Here, the mechanism of stress responses under the exposure of norfloxacin (NF) and drought (D) individually and in combination (DNF) were explored on rice (Oryza sativa) cultivar Hanyou73 through proteomics and metabolomic analysis. All treatments adversely affected chlorophyll fluorescence kinetics, antioxidant enzyme activities, rice grain composition and yield. The results showed that in DNF the antibiotic was accumulated 627% more than NF treatment in rice grains while in leaves there was no significant difference under both treatments. The proteomic revealed that differentially expressed identified proteins were involved in carbohydrate metabolism, amino acid metabolism, photosynthesis and mRNA binding. However, the metabolomics results showed that the abundance of metabolites related to RNA biosynthesis and amino acid metabolism were more affected. The disruptions caused in rice plant under DNF treatment become more severe, this makes it more susceptible than individual D and NF treatment. These findings improve our knowledge about the response of rice plant to cope with antibiotic contamination alone and in combination with drought.

Insights on aggregation-algae consortium based removal of sulfamethoxazole: Unraveling removal effect, enhanced method and toxicological evaluation

The escalating occurrence of the antibiotic Sulfamethoxazole (SMX) in the environment presents a significant global threat to ecological systems and human health. Despite the growing interest in using microalgae for antibiotic biodegradation, strategies to enhance SMX elimination remain underexplored. In this study, we isolated a novel aggregation-algae consortium (AAC) from a municipal wastewater treatment plant (WWTP) and examined its potential for SMX removal, optimized culture conditions, SMX metabolite fate and the physicochemical impact on microalgal cells. The findings revealed that the AAC demonstrated remarkable resistance to SMX, even at concentrations as high as 10 mg/L, and could degrade SMX via free radical reactions. Although ion repulsion limited the biodegradation of AAC, the addition of peptone and yeast extract resulted in a significant enhancement, increased by 16.71%, 39.12% and 46.77% of three SMX groups. Moreover, AAC exhibited exceptional adaptability in real wastewater, achieving removal of 87.05%, 97.39% and 20.80% for total dissolved nitrogen, total dissolved phosphorus and SMX, respectively. The decreased degradation toxicity of SMX following AAC treatment was further validated by ECOSAR software and in vitro tests using Caenorhabditis elegans. This study advanced our understanding of SMX biodegradation and provided a novel approach for treating wastewater contaminated with SMX.

Occurrence and distribution of antibiotic resistance genes in urban rivers with black-odor water of Harbin, China

Antibiotic resistance gene contamination in polluted rivers remains a widely acknowledged environmental issue. This study focused on investigating the contamination conditions of antibiotic resistance genes (ARGs) in Harbin's urban black-odor rivers, specifically Dongfeng Ditch and Hejia Ditch. The research employed a SmartChip Real-Time PCR System to explore the types, abundance, and distribution of ARGs in diverse habitats, such as surface water and sediment. Additionally, the study examined the correlation of ARGs with mobile genetic elements (MGEs) and various environmental factors. It was found that antibiotic resistance genes were prevalent in both water and sediment within the black-odor ditches. The dominant types of ARGs identified included aminoglycoside, sulfonamide, multidrug-resistant, and β-lactam ARGs. Notably, the top four ARGs, in terms of relative abundance, were sul1, fox5, qacEdelta1-01 and aadA1. Most categories of ARGs have significant positive connections with MGEs, indicating that the enrichment and spreading of ARGs in rivers are closely related to MGEs. Based on the correlation analysis, it is found that environmental factors such as dissolved oxygen (DO), ammonia nitrogen (NH4-N), and phosphate (PO4-P) played a substantial role in influencing the variations observed in ARGs. By employing a risk assessment framework based on the human association, host pathogenicity, and mobility of ARGs, the identification of seven high-risk ARGs was achieved. In addition, it is important to assess the environmental risk of ARGs from multiple perspectives (abundance,detection rateand mobility). This study provides a significant reference regarding the presence of ARGs contamination in urban inland black-odor rivers, essential for assessing the health risks associated with ARGs and devising strategies to mitigate the threat of antibiotic resistance.

Analyzing Antibiotic Resistance in Bacteria from Wastewater in Pakistan Using Whole-Genome Sequencing

Background: Wastewater is a major source of Antibiotic-Resistant Bacteria (ARB) and a hotspot for the exchange of Antibiotic-Resistant Genes (ARGs). The occurrence of Carbapenem-Resistant Bacteria (CRB) in wastewater samples is a major public health concern. Objectives: This study aimed to analyze Antibiotic resistance in bacteria from wastewater sources in Pakistan. Methods: We analyzed 32 bacterial isolates, including 18 Escherichia coli, 4 Klebsiella pneumoniae, and 10 other bacterial isolates using phenotypic antibiotic susceptibility assay and whole-genome sequencing. This study identified the ARGs, plasmid replicons, and integron genes cassettes in the sequenced isolates. One representative isolate was further sequenced using Illumina and Oxford nanopore sequencing technologies. Results: Our findings revealed high resistance to clinically important antibiotics: 91% of isolates were resistant to cefotaxime, 75% to ciprofloxacin, and 62.5% to imipenem, while 31% showed non-susceptibility to gentamicin. All E. coli isolates were resistant to cephalosporins, with 72% also resistant to carbapenems. Sequence analysis showed a diverse resistome, including carbapenamases (blaNDM-5, blaOXA-181), ESBLs (blaCTX-M-15, blaTEM), and AmpC-type β-lactamases (blaCMY). Key point mutations noticed in the isolates were pmrB_Y358N (colistin) and ftsI_N337NYRIN, ftsI_I336IKYRI (carbapenem). The E. coli isolates had 11 different STs, with ST410 predominating (28%). Notably, the E. coli phylogroup A isolate 45EC1, (ST10886) is reported for the first time from wastewater, carrying blaNDM-5, blaCMY-16, and pmrB_Y358N with class 1 integron gene cassette of dfrA12-aadA2-qacEΔ1 on a plasmid-borne contig. Other carbapenamase, blaNDM-1 and blaOXA-72, were detected in K. pneumoniae 22EB1 and Acinetobacter baumannii 51AC1, respectively. The integrons with the gene cassettes encoding antibiotic resistance, and the transport and bacterial mobilization protein, were identified in the sequenced isolates. Ten plasmid replicons were identified, with IncFIB prevalent in 53% of isolates. Combined Illumina and Oxford nanopore sequencing revealed blaNDM-5 on an IncFIA/IncFIC plasmid and is identical to those reported in the USA, Myanmar, and Tanzania. Conclusions: These findings highlight the environmental prevalence of high-risk and WHO-priority pathogens with clinically important ARGs, underscoring the need for a One Health approach to mitigate ARB isolates.

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.

Sustainable application of modified Luffa cylindrica biomass for removal of trimethoprim in water by adsorption with process optimization

The present study describes a set of methodological procedures (seldom applied together), including (i) development of an alternative adsorbent derived from abundant low-cost plant biomass; (ii) use of simple low-cost biomass modification techniques based on physical processing and chemical activation; (iii) design of experiments (DoE) applied to optimize the removal of a pharmaceutical contaminant from water; (iv) at environmentally relevant concentrations, (v) that due to initial low concentrations required determination by ultra-performance liquid phase chromatography coupled to mass spectrometry (UPLC-MS/MS). A central composite rotational design (CCRD) was employed to investigate the performance of vegetable sponge biomass (Luffa cylindrica), physically processed (crushing and sieving) and chemically activated with phosphoric acid, in the adsorption of the antibiotic trimethoprim (TMP) from water. The optimized model identified pH as the most significant variable, with maximum drug removal (91.1 ± 5.7%) achieved at pH 7.5, a temperature of 22.5 °C, and an adsorbent/adsorbate ratio of 18.6 mg µg-1. The adsorption mechanisms and surface properties of the adsorbent were examined through characterization techniques such as scanning electron microscopy (SEM), point of zero charge (pHpzc) measurement, thermogravimetric analysis (TGA), specific surface area, and Fourier-transform infrared spectroscopy (FTIR). The best kinetic fit was obtained by the Avrami fractional-order model. The hypothesis of a hybrid behavior of the adsorbent was suggested by the equilibrium results presented by the Langmuir and Freundlich models and reinforced by the Redlich-Peterson model, which achieved the best fit (R2 = 0.982). The thermodynamic study indicated an exothermic, spontaneous, and favorable process. The maximum adsorption capacity of the material was 2.32 × 102 µg g-1 at an equilibrium time of 120 min. Finally, a sustainable and promising adsorbent for the polishing of aqueous matrices contaminated by contaminants of emerging concern (CECs) at environmentally relevant concentrations is available for future investigations.

The IncC and IncX1 resistance plasmids present in multi-drug resistant Escherichia coli strains isolated from poultry manure in Poland

The study describes the whole-genome sequencing of two antibiotic-resistant representative Escherichia coli strains, isolated from poultry manure in 2020. The samples were obtained from a commercial chicken meat production facility in Poland. The antibiotic resistance profile was characterized by co-resistance to β-lactam antibiotics, aminoglycosides, and fluoroquinolones. The three identified resistance plasmids (R-plasmids), pECmdr13.2, pECmdr13.3, and pECmdr14.1, harbored various genes conferring resistance to tetracyclines (tetR[A]) for, aminoglycoside (aph, aac, and aad families), β-lactam (blaCMY-2, blaTEM-176), sulfonamide (sul1, sul2), fluoroquinolone (qnrS1), and phenicol (floR). These plasmids, which have not been previously reported in Poland, were found to carry IS26 insertion elements, the intI1-integrase gene, and conjugal transfer genes, facilitating horizontal gene transfer. Plasmids pECmdr13.2 and pECmdr14.1 also possessed a mercury resistance gene operon related to transposon Tn6196; this promotes plasmid persistence even without antibiotic selection pressure due to co-selection mechanisms such as co-resistance. The chicken manure-derived plasmids belonged to the IncX1 (narrow host range) and IncC (broad host range) incompatibility groups. Similar plasmids have been identified in various environments, clinical isolates, and farm animals, including cattle, swine, and poultry. This study holds significant importance for the One Health approach, as it highlights the potential for antibiotic-resistant bacteria from livestock and food sources, particularly E. coli, to transfer through the food chain to humans and vice versa.

Ecological impact of pharmaceutical pollutants and options of river health improvements - A risk analysis-based approach

Pharmaceuticals are one of the emerging pollutants (EPs) in river waters across the world. Due to their toxic effects on aquatic organisms, they have drawn the global attention of the scientific community concerned with river ecosystems. This paper reviews the existing occurrence data for various pharmaceutical pollutants (PPs) reported in river waters in some part of the world and their ecological impacts. Using algae, macroinvertebrates (MI), and fish as biotic indicator groups in water to reflect river health conditions, an attempt has been made to assess the ecological risk due to the presence of PPs in the water environment. After ascertaining the predicted no-effect concentration (PNEC) of PPs for selected groups of aquatic organisms, the risk quotient (RQ) is estimated based on their measured environmental concentration (MEC). When MEC > PNEC and RQ > 1 for any of the biotic indicator, ecologically it is 'high risk' condition. The determination of PNEC uses a minimum assessment factor (AF) of 10 due to uncertainty in data over the no observed effect level (NOEL) or lowest observed effect level (LOEL). Accordingly, MEC 10 times higher than PNEC, (RQ = 10) represents a threshold risk concentration (RCT) beyond which adverse effects may start showing observable manifestations. In the present study, a new classification system of 'high risk' conditions for RQ = 1-10 has been proposed, starting from 'moderately high' to 'severely high'. For RQ > 10, the ecological condition of the river is considered 'impaired'. For river health assessment, in the present study, the whole range of physico-chemical characteristics of river water quality has been divided into three groups based on their ease of measurement and frequency of monitoring. Dissolved oxygen related parameters (DORPs), nutrients (NTs), and EPs. PPs represent EPs in this study. A framework for calculating separate indicator group score (IGS) and the overall river health index (RHI) has been developed to predict indicator group condition (IGC) and river health condition (RHC), respectively. Color-coded hexagonal pictorial forms representing IGC and RHC provide a direct visible perception of the existing aquatic environment and a scientific basis for prioritization of corrective measures in terms of treatment technology selection for river health improvements. The analyses indicate that many rivers across the world are under 'high risk' conditions due to PPs having MEC > PNEC and RQ > 1. Up to RCT, (where RQ = 10), the 'high risk' condition varies from 'moderately high' to 'severely high'. In many instances, RQ is found much more higher than 10, indicating that the ecological condition of river may be considered as 'impaired'. Algae is the most frequently affected group of biotic indicators, followed by MI and fish. A review of treatment methods for selection of appropriate technology to reduce the pollution load, especially PPs from the wastewater streams has been summarized. It appears that constructed wetlands (CWs) are at present the most suitable nature-based solutions, particularly for the developing economies of the world, to reduce the concentrations of PPs within limits to minimize the ecological impacts of pharmaceutical compounds on biotic indicators and restore the river health condition. Some suggestive design guidelines for the CWs have also been presented to initiate the process.

Antibiotic resistance genes and mobile genetic elements in different rivers: The link with antibiotics, microbial communities, and human activities

Rivers as a critical sink for antibiotic resistance genes (ARGs), and the distribution and spread of ARGs are related to environmental factors, human activities, and biotic factors (e.g. mobile genetic elements (MGEs)). However, the potential link among ARGs, microbial community, and MGEs in rivers under different antibiotic concentration and human activities remains unclear. In this study, 2 urban rivers (URs), 1 rural-urban river (RUR), and 2 rural rivers (RRs) were investigated to identify the spatial-temporal variation and driving force of ARGs. The total concentration of quinolones (QNs) was 160.1-2151 ng·g-1 in URs, 23.34-1188 ng·g-1 in RUR, and 16.39-85.98 ng·g-1 in RRs. Total population (TP), gross domestic production (GDP), sewage, industrial enterprise (IE), and IEGDP appeared significantly spatial difference in URs, RUR, and RRs. In terms of ARGs, 145-161 subtypes were detected in URs, 59-61 subtypes in RURs, and 46-79 subtypes in RRs. For MGEs, 55-60 MGEs subtypes were detected in URs, 29-30 subtypes in RUR, and 29-35 subtypes in RRs. Significantly positive correlation between MGEs and ARGs were found in these rivers. More ARGs subtypes were related to MGEs in URs than those in RUR and RRs. Overall, MGEs and QNs showed significantly direct positive impact on the abundance of ARGs in all rivers, while microbial community was significantly positive impact on the ARGs abundance in URs and RUR. The ARGs abundance in URs/RUR were directly positive influenced by microbial community/MGEs/socioeconomic elements (SEs)/QNs, while those in RRs were directly positive influenced by QNs/MGEs and indirectly positive impacted by SEs. Most QNs resistance risk showed significantly positive correlation with the abundance of ARGs types. Therefore, not only need to consider the concentration of antibiotics, but also should pay more attention to SEs and MGEs in antibiotics risk management and control.

Occurrence of selected antibiotics in urban rivers in northwest Pakistan and assessment of ecotoxicological and antimicrobial resistance risks

Antibiotics in aquatic systems of developing countries are a growing concern, particularly with the potential ecological risks and emergence of antimicrobial resistance. In Pakistan, antibiotics are widely consumed and released untreated into rivers, however, there is little information on their occurrence and potential risks. In this study, the concentrations and risk assessment of three commonly consumed antibiotics, ciprofloxacin (CIP), amoxicillin (AMX), and cefixime (CFM) belonging to different classes of fluoroquinolone, penicillin, and cephalosporin respectively were investigated in the Kabul River and its two tributaries, Bara River and Shah Alam River in the northwest region of the country. Composite samples were collected in different sampling campaigns and analyzed using the LC-ESI-MS/MS technique. All three antibiotics were found in higher concentrations ranging from 410 to 1810 ng/L, 180-850 ng/L, and 120-600 ng/L for CIP, AMX, and CFM respectively. The Friedman and Wilcoxon signed-ranked tests revealed insignificant differences in average concentrations of each antibiotic in the three rivers and the Pearson Correlation showed a significant positive correlation of CIP with both AMX and CFM indicating their similar pollution sources. Ecotoxicological risk assessment showed a higher risk to algae and bacteria (P. putida) in the rivers with CIP posing a greater risk. The potential risk of antimicrobial resistance development (ARD) was higher in all the three rivers, particularly in Kabul River where maximum risk quotients (RQARD) of 28.3, 9.4 and 3.4 were noted for CIP, CFM and AMX respectively. The human health (HH) risk was insignificant, though the RQHH was higher for the lower age groups (0-3 months). In addition, the combined flux of the antibiotics in the Kabul River was estimated as 59 tons/year with CIP having a significant flux relative to the other antibiotics.

Occurrence of Trace-Level Antibiotics in the Msunduzi River: An Investigation into South African Environmental Pollution

The presence of antibiotics in the environmental matrix has raised concerns regarding their risk to the aquatic ecosystem and human health. Surface water, such as rivers, plays a pivotal role in the dispersion and transport of antibiotic residues. The effective monitoring of these contaminants requires investigating their sources and distribution. While numerous studies have been conducted globally to comprehend the emergence, prevalence, and management of these substances, the investigation of therapeutic antibiotics in Africa remains notably underrepresented. Consequently, data regarding these emerging contaminants in the African aquatic environments are scarce, warranting further exploration. This study aims to investigate the occurrence of four specific therapeutic antibiotics-tetracycline, sulfathiazole, penicillin g, and erythromycin-across different seasons in the Msunduzi River, Eastern South Africa. Three sampling campaigns were conducted during spring, autumn, and winter to assess the presence of these antibiotics in the river. Analyte extraction from water samples was achieved through solid-phase extraction, and quantification was performed using liquid chromatography-mass spectrometry. The findings reveal notable concentrations of these antibiotics in the river at locations closest to a wastewater treatment discharge point. Among the antibiotics studied, tetracycline (158.42-1290.43 ng/L) and sulfathiazole (112.68-1151.25 ng/L) were the most frequently detected compounds across the majority of the sampling sites and tributaries of the river. Erythromycin was less frequently detected in the surface water and wastewater effluent but was found to be a risk to algal species within the river. While wastewater effluents represent a significant source of antibiotic contamination in the river, tributaries from industrial areas and informal settlements were identified as continuous sources of antibiotic pollution. Thus, it is imperative to implement appropriate monitoring protocols to mitigate antibiotic pollution in the aquatic environment.

Occurrence of antibiotics and antibiotic-resistant bacteria in the Lebanese polluted Litani River

Antibiotic contamination in polluted rivers is well recognized as an environmental and public health challenge. In this study, the occurrence, distribution, and ecological risk assessment of three commonly used antibiotics (amoxicillin, ciprofloxacin, and azithromycin) were assessed in the Litani River, the most important and highly polluted river in Lebanon. Physicochemical and microbiological water quality parameters including the antibiotic-resistant ones were in parallel determined in the same sites. Water samples from five sites stretching across the river upper basin were analyzed for the antibiotics under study using high-performance liquid chromatography, with both fluorometric and UV detectors post-extraction using a solid-phase method with a hydrophilic-lipophilic balance cartridges. The disc diffusion method and standardized water quality methods were used for antibiotic-resistant bacteria and water quality assessment, respectively. Amoxicillin and ciprofloxacin were found at concentrations of 250 ng/L and 107.2 ng/L, while azithromycin was not detected in any of the sites under study. Varying levels of antibiotic resistance were detected with the isolated Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa) while the total coliforms showed resistance to multiple antibiotics. COD, TP, PO43-, TN, NO3-, NH4 + , E. coli, total coliform, P. aeruginosa, and Cd levels surpassed permissible levels. Correlation analysis with water quality parameters (COD, total phosphate, phosphate, total nitrogen, and cadmium) showed a significant positive correlation with ciprofloxacin (r > 0.5, p value < 0.05). Also, the resistant P. aeruginosa showed a significant positive correlation with cadmium (r > 0.5, p value < 0.05) while the resistant E. coli was positively correlated with total nitrogen, nitrate, and lead levels (r > 0.5, p value < 0.05). The ecological risk assessment revealed that all the tested antibiotics pose low risks (ecological risk quotient RQ < 0.1) except ciprofloxacin, which could pose a medium risk (0.1 < RQ < 1). Future research concerning the long-term assessment of antibiotics' residues and the identification of resistance genes in the river is recommended.

Antibiotic persistence and its impact on the environment

From boon molecules to molecules contributing to rising concern has been the sojourn of antibiotics. The problem of antibiotic contamination has gotten worse due to antibiotics' pervasive use in every aspect of the environment. One such consequence of pollution is the increase in infections with antibiotic resistance. All known antimicrobials being used for human benefit lead to their repetitive and routine release into the environment. The misuse of antibiotics has aggravated the situation to a level that we are short of antibiotics to treat infections as organisms have developed resistance against them. Overconsumption is not just limited to human health care, but also occurs in other areas such as aquaculture, livestock, and veterinary applications for the purpose of improving feed and meat products. Due to their harmful effects on non-target species, the trace level of antibiotics in the aquatic ecosystem presents a significant problem. Since the introduction of antibiotics into the environment is more than their removal, they have been given the status of persistent pollutants. The buildup of antibiotics in the environment threatens aquatic life and may lead to bacterial strains developing resistance. As newer organisms are becoming resistant, there exists a shortage of antibiotics to treat infections. This has presented a very critical problem for the health-care community. Another rising concern is that the development of newer drug molecules as antibiotics is minimal. This review article critically explains the cause and nature of the pollution and the effects of this emerging trend. Also, in the latter sections, why we need newer antibiotics is questioned and discussed.

Selection of priority emerging contaminants in surface waters of India, Pakistan, Bangladesh, and Sri Lanka

The challenge of emerging contaminants (ECs) in global surface water bodies and particularly in low- and middle-income countries such as India, Pakistan, Bangladesh, and Sri Lanka, is evident from the literature. The complexity arises from the high costs involved in EC analysis and the extensive list of ECs, which complicates the selection of essential compounds for scientific and regulatory investigations. Consequently, monitoring programs often include ECs that may have minimal significance within a region and do not pose known or suspected ecological or human health risks. This study aims to address this issue by employing a multi-risk assessment approach to identify priority ECs in the surface waters of the aforementioned countries. Through an analysis of occurrence levels and frequency data gathered from published literature, an optimized risk quotient (RQ) was derived. The findings reveal a priority list of 38 compounds that exhibit potential environmental risks and merit consideration in future water quality monitoring programs. Furthermore, the majority of antibiotics in India (12 out of 17) and Pakistan (7 out of 17) exhibit a risk quotient for antimicrobial resistance selection (RQAMR) greater than 1, highlighting the need for devising effective strategies to mitigate the escalation of antibiotic resistance in the environment.

Bacteria exposed to antiviral drugs develop antibiotic cross-resistance and unique resistance profiles

Antiviral drugs are used globally as treatment and prophylaxis for long-term and acute viral infections. Even though antivirals also have been shown to have off-target effects on bacterial growth, the potential contributions of antivirals to antimicrobial resistance remains unknown. Herein we explored the ability of different classes of antiviral drugs to induce antimicrobial resistance. Our results establish the previously unrecognized capacity of antivirals to broadly alter the phenotypic antimicrobial resistance profiles of both gram-negative and gram-positive bacteria Escherichia coli and Bacillus cereus. Bacteria exposed to antivirals including zidovudine, dolutegravir and raltegravir developed cross-resistance to commonly used antibiotics including trimethoprim, tetracycline, clarithromycin, erythromycin, and amoxicillin. Whole genome sequencing of antiviral-resistant E. coli isolates revealed numerous unique single base pair mutations, as well as multi-base pair insertions and deletions, in genes with known and suspected roles in antimicrobial resistance including those coding for multidrug efflux pumps, carbohydrate transport, and cellular metabolism. The observed phenotypic changes coupled with genotypic results indicate that bacteria exposed to antiviral drugs with antibacterial properties in vitro can develop multiple resistance mutations that confer cross-resistance to antibiotics. Our findings underscore the potential contribution of wide scale usage of antiviral drugs to the development and spread of antimicrobial resistance in humans and the environment.

Resistome profiling reveals transmission dynamics of antimicrobial resistance genes from poultry litter to soil and plant

Poultry farming is a major livelihood in South and Southeast Asian economies where it is undergoing rapid intensification to meet the growing human demand for dietary protein. Intensification of poultry production systems is commonly supported by increased antimicrobial drug use, risking greater selection and dissemination of antimicrobial resistance genes (ARGs). Transmission of ARGs through food chains is an emerging threat. Here, we investigated transmission of ARGs from chicken (broiler and layer) litter to soil and Sorghum bicolor (L.) Moench plants based on field and pot experiments. The results demonstrate ARGs transmission from poultry litter to plant systems under field as well as experimental pot conditions. The most common ARGs could be tracked for transmission from litter to soil to plants were identified as detected were cmx, ErmX, ErmF, lnuB, TEM-98 and TEM-99, while common microorganisms included Escherichia coli, Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Vibrio cholerae. Using next generation sequencing and digital PCR assays we detected ARGs transmitted from poultry litter in both the roots and stems of S. bicolor (L.) Moench plants. Poultry litter is frequently used as a fertiliser because of its high nitrogen content; our studies show that ARGs can transmit from litter to plants and illustrates the risks posed to the environment by antimicrobial treatment of poultry. This knowledge is useful for formulating intervention strategies that can reduce or prevent ARGs transmission from one value chain to another, improving understanding of impacts on human and environmental health. The research outcome will help in further understanding the transmission and risks posed by ARGs from poultry to environmental and human/animal health.

Molecular Evidence for Occurrence of Heavy Metal and Antibiotic Resistance Genes Among Predominant Metal Tolerant Pseudomonas sp. and Serratia sp. Prevalent in the Teesta River

Riverine ecosystems polluted by pharmaceutical and metal industries are potential incubators of bacteria with dual resistance to heavy metals and antibiotics. The processes of co-resistance and cross resistance that empower bacteria to negotiate these challenges, strongly endorse dangers of antibiotic resistance generated by metal stress. Therefore, investigation into the molecular evidence of heavy metal and antibiotic resistance genes was the prime focus of this study. The selected Pseudomonas and Serratia species isolates evinced by their minimum inhibitory concentration and multiple antibiotic resistance (MAR) index showed significant heavy metal tolerance and multi-antibiotic resistance capability, respectively. Consequently, isolates with higher tolerance for the most toxic metal cadmium evinced high MAR index value (0.53 for Pseudomonas sp., and 0.46 for Serratia sp.) in the present investigation. Metal tolerance genes belonging to P_IB-type and resistance nodulation division family of proteins were evident in these isolates. The antibiotic resistance genes like mexB, mexF and mexY occurred in Pseudomonas isolates while sdeB genes were present in Serratia isolates. Phylogenetic incongruency and GC composition analysis of P_IB-type genes suggested that some of these isolates had acquired resistance through horizontal gene transfer (HGT). Therefore, the Teesta River has become a reservoir for resistant gene exchange or movement via selective pressure exerted by metals and antibiotics. The resultant adaptive mechanisms and altered phenotypes are potential tools to track metal tolerant strains with clinically significant antibiotic resistance traits.

Metallic nanoparticles photodegraded antibiotics and co-application improved wheat growth and nutritional quality through stress alleviation

Antibiotics are now considered as emerging environmental pollutants due to their persistent nature and continuous exposure through irrigation with wastewater contaminated with antibiotics. The aim of present study was to assess the potential of nanoparticles for the photodegradation of antibiotics and subsequent stress alleviation via Titania oxide (TiO₂) application for improvement in crop productivity and quality in terms of the nutritional composition. In the first phase, different nanoparticles, TiO₂, Zinc oxide (ZnO), and Iron oxide (Fe₂O₃) with varying concentrations (40-60 mg L^-1) and time-periods (1-9 days) were tested to degrade amoxicillin (Amx) and levofloxacin (Lev) @ 5 mg L^-1 under the visible light. Results indicated that TiO₂ nanoparticles (50 mg L^-1) were the most effective nanoparticles for the removal of both antibiotics with maximum degradation of 65% and 56% for Amx and Lev, respectively, on the 7th day. In the second phase, a pot experiment was conducted in which TiO₂ (50 mg L^-1) was applied individually and along with antibiotics (5 mg L^-1) in order to evaluate the effect of nanoparticles on stress alleviation for growth promotion of wheat exposed to antibiotics. Plant biomass was reduced by Amx (58.7%) and Lev (68.4%) significantly (p < 0.05) when compared to the control. However, co-application of TiO₂ and antibiotics improved the total iron (34.9% and 42%), carbohydrate (33% and 31%), and protein content (36% and 33%) in grains under Amx and Lev stress, respectively. The highest plant length, grain weight, and nutrient uptake were observed upon application of TiO₂ nanoparticles alone. Total iron, carbohydrates, and proteins in grains were significantly increased by 52%, 38.5%, and 40%, respectively compared to the control (with antibiotics). The findings highlight the potential of TiO₂ nanoparticles for stress alleviation, growth, and nutritional improvement under antibiotic stress upon irrigation with contaminated wastewater.

The Fitness of Beta-Lactamase Mutants Depends Nonlinearly on Resistance Level at Sublethal Antibiotic Concentrations

Adaptive evolutionary processes are constrained by the availability of mutations which cause a fitness benefit and together make up the fitness landscape, which maps genotype space onto fitness under specified conditions. Experimentally derived fitness landscapes have demonstrated a predictability to evolution by identifying limited "mutational routes" that evolution by natural selection may take between low and high-fitness genotypes. However, such studies often utilize indirect measures to determine fitness. We estimated the competitive fitness of mutants relative to all single-mutation neighbors to describe the fitness landscape of three mutations in a β-lactamase enzyme. Fitness assays were performed at sublethal concentrations of the antibiotic cefotaxime in a structured and unstructured environment. In the unstructured environment, the antibiotic selected for higher-resistance types-but with an equivalent fitness for a subset of mutants, despite substantial variation in resistance-resulting in a stratified fitness landscape. In contrast, in a structured environment with a low antibiotic concentration, antibiotic-susceptible genotypes had a relative fitness advantage, which was associated with antibiotic-induced filamentation. These results cast doubt that highly resistant genotypes have a unique selective advantage in environments with subinhibitory concentrations of antibiotics and demonstrate that direct fitness measures are required for meaningful predictions of the accessibility of evolutionary routes. IMPORTANCE The evolution of antibiotic-resistant bacterial populations underpins the ongoing antibiotic resistance crisis. We aim to understand how antibiotic-degrading enzymes can evolve to cause increased resistance, how this process is constrained, and whether it can be predictable. To this end, competition experiments were performed with a combinatorially complete set of mutants of a β-lactamase gene subject to subinhibitory concentrations of the antibiotic cefotaxime. While some mutations confer on their hosts high resistance to cefotaxime, in competition these mutations do not always confer a selective advantage. Specifically, high-resistance mutants had equivalent fitnesses despite different resistance levels and even had selective disadvantages under conditions involving spatial structure. Together, our findings suggest that the relationship between resistance level and fitness at subinhibitory concentrations is complex; predicting the evolution of antibiotic resistance requires knowledge of the conditions that select for resistant genotypes and the selective advantage evolved types have over their predecessors.

Metagenomic profiling of antibiotic resistance genes in Red Sea brine pools

Antibiotic resistance (AR) is an alarming global health concern, causing an annual death rate of more than 35,000 deaths in the US. AR is a natural phenomenon, reported in several pristine environments. In this study, we report AR in pristine Red Sea deep brine pools. Antimicrobial resistance genes (ARGs) were detected for several drug classes with tetracycline and macrolide resistance being the most abundant. As expected, ARGs abundance increased in accordance with the level of human impact with pristine Red Sea samples having the lowest mean ARG level followed by estuary samples, while activated sludge samples showed a significantly higher ARG level. ARG hierarchical clustering grouped drug classes for which resistance was detected in Atlantis II Deep brine pool independent of the rest of the samples. ARG abundance was significantly lower in the Discovery Deep brine pool. A correlation between integrons and ARGs abundance in brine pristine samples could be detected, while insertion sequences and plasmids showed a correlation with ARGs abundance in human-impacted samples not seen in brine pristine samples. This suggests different roles of distinct mobile genetic elements (MGEs) in ARG distribution in pristine versus human-impacted sites. Additionally, we showed the presence of mobile antibiotic resistance genes in the Atlantis II brine pool as evidenced by the co-existence of integrases and plasmid replication proteins on the same contigs harboring predicted multidrug-resistant efflux pumps. This study addresses the role of non-pathogenic environmental bacteria as a silent reservoir for ARGs, and the possible horizontal gene transfer mechanism mediating ARG acquisition.

Antimicrobial Susceptibility of Bacteria Isolated from Freshwater Mussels in the Wildcat Creek Watershed, Indiana, United States

Antimicrobial resistance (AMR) is a global health crisis that threatens the health of humans and animals. The spread of resistance among species may occur through our shared environment. Prevention of AMR requires integrated monitoring systems, and these systems must account for the presence of AMR in the environment in order to be effective. The purpose of this study was to establish and pilot a set of procedures for utilizing freshwater mussels as a means of surveillance for microbes with AMR in Indiana waterways. One hundred and eighty freshwater mussels were sampled from three sites along the Wildcat Creek watershed in north-central Indiana. Specimens were evaluated for the presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species), Escherichia coli, Campylobacter, and Salmonella species, and the isolates were tested for antimicrobial resistance. A total of 24 bacterial isolates were obtained from tissue homogenates of freshwater mussels collected at a site directly downstream from Kokomo, Indiana. Of these, 17 were Enterobacter spp., five were Escherichia coli, one was Pseudomonas aeruginosa, and one was Klebsiella pneumoniae. All isolates were resistant to three or more antimicrobial drug classes. Further work is necessary to determine the source of the bacterial species found in the mussels.

Spatial and temporal distribution characteristics of antibiotics and heavy metals in the Yitong River basin and ecological risk assessment

Due to rapid socioeconomic development, antibiotic pollution and heavy metal pollution are receiving increasing amounts of attention. Both antibiotics and heavy metals in the environment are persistent and toxic, and the interactions between the pollutants create potential long-term hazards for the ecological environment and human health as mixed pollutants. In this study, the surface water of the Yitong River in Changchun was used as the research object, and the hazards associated with antibiotics and heavy metals in the surface water were assessed by analyzing the spatial and temporal distribution characteristics of antibiotics and heavy metals and by using ecological risk assessment and human health risk assessment models. The results showed that ofloxacin (OFL) and norfloxacin (NOR) varied seasonally according to the seasonal climate, with total concentrations ranging from 17.65 to 902.47 ng/L and ND to 260.49 ng/L for OFL and NOR, respectively, and from 8.30 to 120.40 μg/L, 1.52 to 113.41 μg/L and 0.03 to 0.04 μg/L for copper (Cu), zinc (Zn) and cadmium (Cd), respectively. In terms of spatial distribution, the concentration of antibiotics in the urban sections, which had intensive human activities, was higher than that in the suburban sections, while the concentration of heavy metals in the suburban sections, which had intensive agricultural operations, was greater than that in the urban section. Ecological risk evaluation showed that NOR and OFL were present in the water bodies at a high-risk level, Cd was at a low pollution level, and the heavy metal Cd was the primary pollutant associated with health risks toward for adults and children, and it was mainly at a medium risk level. Additionally, both antibiotics and heavy metals posed higher health risks for children than for adults.

Assessment of knowledge, perception, practices and drivers of antimicrobial resistance and antimicrobial usage among veterinarians in Pakistan

BACKGROUND

Antimicrobial resistance (AMR) and irrational antimicrobial usage (AMU) are a global problem, particularly evident in low- and middle-income countries including Pakistan. Our study aimed to assess the knowledge, attitudes and prescribing practices (KAP) of field veterinarians regarding AMR and AMU.

METHODS

A questionnaire-based online survey was conducted using Google forms to collect data on AMR and AMU from veterinary practitioners in Pakistan between July 25, 2020, and February 2, 2021. The questionnaire was comprised of four sections: 1) Demographic information of the respondents, 2) Knowledge about AMR, and AMU, 3) Antibiotic prescribing behavior, attitudes and influencing drivers and 4) Practices of respondents about AMU and drug disposal.

RESULTS

A total of 545 participants (Male 84%, Female 16%) completed the survey. The respondents' qualification (P = 0.008), gender (P = 0.007) and type of practitioner (P < 0.001) had a significant association with the mean knowledge score about AMR. Most of the veterinarians had never attended any training, symposium, or awareness session on AMR (63%) and methods to detect antibiotic residues (71%). Participating veterinarians frequently included "critically important antimicrobials" in their treatment regimens. Most veterinarians (60%) prescribed antibiotics for viral diseases. Our study showed that about 44% of veterinarians disposed of expired drugs in the garbage. Antibiotics were prescribed as mass medication and for prophylaxis by 59% and 33% of the veterinarians, respectively, while about 60% of the veterinarians prescribed antibiotics starting with double doses in their treatment regimens. Importantly, only 4% of the veterinarians recognized the concept of One Health. Male veterinarians had higher odds of prescribing mass medication (OR=3.07, P < 0.001) and use of antibiotics for disease prophylaxis (OR=2.31, P = 0.002) than females, whereas improper disposal of expired antimicrobials (OR=2.12, P = 0.003) was more common in female veterinarians. Government veterinarians had 2 (OR=1.95, P = 0.016) and 3 (OR=3.05, P < 0.001) times higher odds to prescribe antibiotics prophylactically and for mass treatments, respectively compared to full-time private veterinarians.

CONCLUSION

Our study identifies key factors influencing veterinarians' decision about antimicrobial prescription and highlights important shortcomings such as lack of training on rational use of antimicrobials, frequent use of antimicrobials for mass medication and prophylaxis, widespread use of critically important antimicrobials, and improper disposal practices. There is a dire need to improve knowledge of veterinary practitioners regarding AMR and to adopt a One Health approach to rationalize AMU at the national level in line with the regional and international guidelines.

A Cross-Sectional Study of Potential Antimicrobial Resistance and Ecology in Gastrointestinal and Oral Microbial Communities of Young Normoweight Pakistani Individuals

Antimicrobial resistance (AMR) is a major global public health concern mainly affecting low- and middle-income countries (LMICs) due to lack of awareness, inadequate healthcare and sanitation infrastructure, and other environmental factors. In this study, we aimed to link microbial assembly and covariates (body mass index, smoking, and use of antibiotics) to gut microbiome structure and correlate the predictive antimicrobial gene prevalence (piARG) using PICRUSt2. We examined the gastrointestinal and oral microbial profiles of healthy adults in Pakistan through 16S rRNA gene sequencing with a focus on different ethnicities, antibiotic usage, drinking water type, smoking, and other demographic measures. We then utilised a suite of innovative statistical tools, driven by numerical ecology and machine learning, to address the above aims. We observed that drinking tap water was the main contributor to increased potential AMR signatures in the Pakistani cohort compared to other factors considered. Microbial niche breadth analysis highlighted an aberrant gut microbial signature of smokers with increased age. Moreover, covariates such as smoking and age impact the human microbial community structure in this Pakistani cohort.

Heavy Metal (Arsenic) Induced Antibiotic Resistance among Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria of Nosocomial Origin

Antimicrobial resistance (AMR) is a leading cause of treatment failure for many infectious diseases worldwide. Improper overdosing and the misuse of antibiotics contributes significantly to the emergence of drug-resistant bacteria. The co-contamination of heavy metals and antibiotic compounds existing in the environment might also be involved in the spread of AMR. The current study was designed to test the efficacy of heavy metals (arsenic) induced AMR patterns in clinically isolated extended-spectrum β-lactamase (ESBL) producing bacteria. A total of 300 clinically isolated ESBL-producing bacteria were collected from a tertiary care hospital in Lahore, Pakistan, with the demographic characteristics of patients. After the collection of bacterial isolates, these were reinoculated on agar media for reidentification purposes. Direct antimicrobial sensitivity testing (AST) for bacterial isolates by disk diffusion methods was used to determine the AST patterns with and without heavy metal. The heavy metal was concentrated in dilutions of 1.25 g/mL. The collected bacterial isolates were isolated from wounds (n = 63, 21%), urine (n = 112, 37.3%), blood (n = 43, 14.3%), pus (n = 49, 16.3%), and aspirate (n = 33, 11%) samples. From the total 300 bacterial isolates, n = 172 were Escherichia coli (57.3%), 57 were Klebsiella spp. (19%), 32 were Pseudomonas aeruginosa (10.6%), 21 were Proteus mirabilis (7%) and 18 were Enterobacter spp. (6%). Most of the antibiotic drugs were found resistant to tested bacteria. Colistin and Polymyxin-B showed the highest sensitivity against all tested bacteria, but when tested with heavy metals, these antibiotics were also found to be significantly resistant. We found that heavy metals induced the resistance capability in bacterial isolates, which leads to higher AMR patterns as compared to without heavy metal tested isolates. The results of the current study explored the heavy metal as an inducer of AMR and may contribute to the formation and spread of AMR in settings that are contaminated with heavy metals.

High Frequency of Antibiotic Resistance Genes (ARGs) in the Lerma River Basin, Mexico

The spread of beta-lactamase-producing bacteria is of great concern and the environment has been found to be a main source of contamination. Herein, it was proposed to determine the frequency of antimicrobial-resistant-Gram-negative bacteria throughout the Lerma River basin using phenotypic and molecular methods. Resistant bacteria were isolated with chromogenic media and antimicrobial susceptibility tests were used to characterize their resistance. ARGs for beta-lactams, aminoglycosides, and quinolones were detected by PCR. Species were identified by Sanger sequencing the 16S rRNA gene and the representative genomes of MDR strains were sequenced by NGS. A high variation in the number of isolates was observed in the 20 sampled sites, while observing a low diversity among the resistant bacteria. Of the 12 identified bacterial groups, C. freundii, E. coli, and S. marcescens were more predominant. A high frequency of resistance to beta-lactams, quinolones, and aminoglycosides was evidenced, where the bla_CTX,qnrB, qnrS y, and aac(6')lb-cr genes were the most prevalent. C. freundii showed the highest frequency of MDR strains. Whole genome sequencing revealed that S. marcescens and K. pneumoniae showed a high number of shared virulence and antimicrobial resistance genes, while E. coli showed the highest number of unique genes. The contamination of the Lerma River with MDR strains carrying various ARGs should raise awareness among environmental authorities to assess the risks and regulations regarding the optimal hygienic and sanitary conditions for this important river that supports economic activities in the different communities in Mexico.

Recent advances in electrochemical sensor developments for detecting emerging pollutant in water environment

In the latest times, considerable studies have been performed closer to detecting emerging pollutant such as paracetamol in wastewater. Electrochemical sensor developments have recently started to determine in fewer concentrations effectively. The detection of paracetamol using standard protocols corresponding to electroanalytical techniques has a greater impact noticed in directing the detecting process toward biosensors. Non-enzymatic sensors are the peak of all electro analysis approaches. Functionalized materials, such as metal oxide nanoparticles, conducting polymers, and carbon-based materials for electrode surface functionalization have been used to create a fortification for distributing passive enzyme-free biosensors. Synergic effects are possible by enhancing loading capacity and mass transfer of reactants for attaining high analytical sensitivity using a variety of nanomaterials with large surface areas. The main focus of this study is to address the prevailing issues in the identification of paracetamol with the tasks in the non-enzymatic sensors field, followed by the useful methods of electro analysis studies.

A national online survey of Filipinos' knowledge, attitude, and awareness of antibiotic use and resistance: A cross-sectional study

BACKGROUND

Antibiotic resistance is one of the 21st century's most challenging clinical and public health issues. However, this health issue remains underreported in the Philippines.

AIM

This study examined Filipinos' knowledge, attitude, and awareness regarding antibiotic use and resistance and the associated predictive variables of antibiotic resistance.

METHODS

A cross-sectional design and Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used in this study. Convenience sampling of 3767 participants completed the Eurobarometer survey on antibiotic resistance from October 2021 to February 2022. χ² and regression analysis were used to analyze the data.

RESULTS

Most participants were familiar with the popular types of available antibiotics. Males and healthcare workers had a higher percentage of correct responses on antibiotic resistance knowledge. Participants had moderate to high knowledge levels of antibiotic resistance. Age, educational attainment, profession, antibiotic use in the previous year, and household members taking antibiotics were significant predictors of the level of knowledge of antibiotic resistance. There was a significant difference in participants' sex, age, and educational attainment in their attitudes toward acquisition, hygienic practices, and the role of health professionals in antibiotic resistance.

CONCLUSION

Government agencies and policymakers should consider the identified predictors when establishing policies on antibiotic resistance. This will ensure that antibiotic use is safe and effective.

Distribution and genetic diversity of multi-drug-resistant Klebsiella pneumoniae at the human–animal–environment interface in Pakistan

Klebsiella pneumoniae is ubiquitous and known to be a notorious pathogen of humans, animals, and plant-based foods. K. pneumoniae is a recognized trafficker of antibiotic resistance genes (ARGs) between and from different ecological niches. A total of 775 samples (n = 775) were collected from September 2017 to August 2019 from humans, animals, and environmental sources by applying the random convenient sampling technique. A total of 120 (15.7%) samples were confirmed as K. pneumoniae. The distribution of K. pneumoniae among humans, the environment, and animals was 17.1, 12.38, and 10%, respectively. Isolates have shown significant resistance against all the subjected antibiotics agents except colistin. ARGs profiling revealed that the highest percentage prevalence (67.5%) of bla_CTX–M was estimated in the isolates, and various carbapenem resistance genes that were found in the study were bla_NDM–1 (43.3%), bla_OXA–48 (38%), and (1.67%) bla_KPC–2. Overall, 21 distinct sequence types (ST) and 13 clonal complexes (CCs) were found through the multi-locus sequence typing (MLST) analysis. Taking together, the distribution of multi-drug resistance (MDR) K. pneumoniae clones in the  community and associated environment is alarming for the health care system of the country. Health policymakers should consider the role of all the integral parts of humans, animals, and the associated environment intently to cope with this serious public and animal health concern.

Biotransformation of sulfamethoxazole by microalgae: Removal efficiency, pathways, and mechanisms

Recently, the biotransformation of sulfamethoxazole (SMX) by microalgae has attracted increasing interest. In particular, cytochrome P450 (CYP450) has been suggested to be the main enzymatic contributor to this biodegradation. However, the molecular evidence of CYP450 enzymes being involved in SMX biodegradation remains relatively unclear, hindering its applicability. Herein, the biodegradation of SMX by Chlorella sorokiniana (C. sorokiniana) was investigated, and comprehensively elucidated the reaction mechanism underlying CYP450-mediated SMX metabolism. C. sorokiniana was able to efficiently remove over 80% of SMX mainly through biodegradation, in which CYP450 enzymes responded substantially to metabolize SMX in cells. Additionally, screening of transformation products (TPs) revealed that N⁴-hydroxylation-SMX (TP270) was the main TP in the SMX biodegradation pathway of microalgae. Molecular dynamics (MD) simulation suggested that the aniline of SMX was the most prone to undergo metabolism, while density functional theory (DFT) indicated that SMX was metabolized by CYP450 enzymes through H-abstraction-OH-rebound reaction. Collectively, this work reveals key details of the hydroxylamine group of SMX, elucidates the SMX biodegradation pathway involving CYP450 in microalgae in detail, and accelerates the development of using microalgae-mediated CYP450 to eliminate antibiotics.

Efficient removal of antibiotics from water resources is a public health priority: a critical assessment of the efficacy of some remediation strategies for antibiotics in water

This review discusses the fundamental principles and mechanism of antibiotic removal from water of some commonly applied treatment techniques including chlorination, ozonation, UV-irradiation, Fenton processes, photocatalysis, electrochemical-oxidation, plasma, biochar, anaerobicdigestion, activated carbon and nanomaterials. Some experimental shortfalls identified by researchers such as certain characteristics of degradation agent applied and the strategies explored to override the identified limitations are briefly discussed. Depending on interactions of a range of factors including the type of antibiotic compound, operational parameters applied such as pH, temperature and treatment time, among other factors, all reviewed techniques can eliminate or reduce the levels of antibiotic compounds in water to varying extents. Some of the reviewed techniques such as anaerobic digestion generally require longer treatment times (up to 360, 193 and 170 days, according to some studies), while others such as photocatalysis achieved degradation within short contact time (within a minimum of 30, but up to 60, 240, 300 and 1880 minutes, in some cases). For some treatment techniques such as ozonation and Fenton, it is apparent that subjecting compounds to longer treatment times may improve elimination efficiency, whereas for some other techniques such as nanotechnology, application of longer treatment time generally meant comparatively minimal elimination efficiency. Based on the findings of experimental studies summarized, it is apparent that operational parameters such as pH and treatment time, while critical, do not exert sole or primary influence on the elimination percentage(s) achieved. Elimination efficiency achieved rather seems to be due more to the force of a combination of several factors.

Occurrence, Comparison and Priority Identification of Antibiotics in Surface Water and Sediment in Urbanized River: A Case Study of Suzhou Creek in Shanghai

Antibiotics in water have attracted increasing attention due to their potential threat to aquatic ecosystems and public health. Most previous studies have focused on heavily polluted environments, while ignoring urbanized rivers with high population density. Taking Suzhou Creek in Shanghai as an example, this study attempted to explore the antibiotic pollution characteristics of typical urbanized rivers. Further, it screened out priority antibiotics so as to provide reference for the regular monitoring of antibiotics in urban surface water in the study’s later stage. Four classes of 27 antibiotics in surface water samples and sediment samples were detected and analyzed by SPE-UPLC-MS/MS under both wet season and dry season. Results demonstrate that the total amount of antibiotics detected reached 1936.9 ng/L and 337.3 ng/g in water samples and sediment samples, respectively. Through Pearson correlation analysis, it can be shown that there is a very significant correlation between a variety of antibiotics in water and sediment. The results of ecological risk assessment based on risk quotient (RQ) show that certain antibiotics presented high and medium risk to the surrounding ecosystem. Finally, the priority antibiotics selected by optimized priority screening method were EM, SPD, CLR and RTM. Therefore, we have proven that the antibiotics being discharged in urbanized rivers show different types of antibiotics, while presenting a toxicological risk to certain species.

Occurrence, Distribution, and Risk Assessment of Antibiotics in the Aquatic Environment of the Karst Plateau Wetland of Yangtze River Basin, Southwestern China

In this study, the occurrence, distribution, and ecological risk of 40 commonly used antibiotics, including 15 sulfonamides (SAs), 9 fluoroquinolones (FQs), 7 macrolides (MCs), 3 tetracyclines (TCs), 2 chloramphenicols (CAPs), and 4 other categories, in the aquatic environment of the karst plateau wetland Caohai of the Yangtze River basin in southwestern China are reported. In total, 27 antibiotics were detected, with the detection rate ranging from 5% to 100%. The total concentration at each site ranged from 21.8 ng/L to 954 ng/L, with the average concentration being 189 ng/L. FQs and MCs were the most predominant categories, contributing 29.3% and 25.0% of the total antibiotic burden. The five most commonly detected antibiotics were ciprofloxacin (CIP), oxytetracycline (OTC), acetyl sulfamethoxazole (ASMZ), norfloxacin (NOR), and florfenicol (FF). The spatial distribution of the total concentration at each site demonstrated a decreasing trend from the southeastern area upstream adjoining the main counties to the northwestern area downstream, indicating that human activities have a great impact. Meanwhile, the natural attenuation rates of different types of antibiotics in the direction of flow ranged from 17.6% to 100%, which implied the natural purification potential of the wetland for antibiotics. The cluster analysis results indicated that domestic sewage and wastewater from agriculture and animal husbandry were the main sources of contamination in the surrounding wetland. Risk quotients (RQs) assessment showed that most of the individuals were at low to medium risk and that the adverse risks posed by mixtures of antibiotics were higher than those posed by the individual antibiotics.

Cross-regional scale pollution of freshwater biofilms unveiled by antibiotic resistance genes

A comprehensive global profile of the distribution of ARGs in freshwater biofilms is lacking. We utilized metagenomic approaches to reveal the diversity, abundance, transferability and hosts of ARGs in 96 freshwater biofilm samples from 38 sampling sites across four countries. The abundant ARGs were associated with bacitracin, multidrug, polymyxin macrolide-lincosamide-streptogramin (MLS) aminoglycoside, β-lactam, chloramphenicol, sulfonamide and tetracycline resistance, consistent with the spectrum of antibiotics commonly used in human or veterinary medicine. As expected, the resistome in freshwater biofilm habitats was significantly influenced by geographical location and human footprint. Based on the co-occurrence pattern revealed by network analysis, mdtC, kdpE, and emrB were proposed as ARG indicators in freshwater biofilms that can be used to evaluate the abundance of 46 other co-occurring ARG subtypes quantitatively. Metagenomic assembly analysis revealed that the identified ARGs were hosted by more than 46 bacterial phyla, including various pathogens, which greatly expands the knowledge of resistome diversity in freshwater biofilms. Our study points to the central roles of biofilms in harbouring ARGs. The results could enhance understanding the distribution of ARGs in freshwater habitats, thereby strengthening the global environmental risk assessment and management of ARGs.

Metagenomic insights into the microbial community structure and resistomes of a tropical agricultural soil persistently inundated with pesticide and animal manure use

Persistent use of pesticides and animal manure in agricultural soils inadvertently introduced heavy metals and antibiotic/antibiotic resistance genes (ARGs) into the soil with deleterious consequences. The microbiome and heavy metal and antibiotic resistome of a pesticide and animal manure inundated agricultural soil (SL6) obtained from a vegetable farm at Otte, Eiyenkorin, Kwara State, Nigeria, was deciphered via shotgun metagenomics and functional annotation of putative ORFs (open reading frames). Structural metagenomics of SL6 microbiome revealed 29 phyla, 49 classes, 94 orders, 183 families, 366 genera, 424 species, and 260 strains with the preponderance of the phyla Proteobacteria (40%) and Actinobacteria (36%), classes Actinobacteria (36%), Alphaproteobacteria (18%), and Gammaproteobacteria (17%), and genera Kocuria (16%), Sphingobacterium (11%), and Brevundimonas (10%), respectively. Heavy metal resistance genes annotation conducted using Biocide and Metal Resistance Gene Database (BacMet) revealed the detection of genes responsible for the uptake, transport, detoxification, efflux, and regulation of copper, cadmium, zinc, nickel, chromium, cobalt, selenium, tungsten, mercury, and several others. ARG annotation using the Antibiotic Resistance Gene-annotation (ARG-ANNOT) revealed ARGs for 11 antibiotic classes with the preponderance of β-lactamases, mobilized colistin resistance determinant (mcr-1), macrolide-lincosamide-streptogramin (MLS), glycopeptide, and aminoglycoside resistance genes, among others. The persistent use of pesticide and animal manure is strongly believed to play a major role in the proliferation of heavy metal and antibiotic resistance genes in the soil. This study revealed that agricultural soils inundated with pesticide and animal manure use are potential hotspots for ARG spread and may accentuate the spread of multidrug resistant clinical pathogens.

A first calibration of culturable bacterial diversity and their dual resistance to heavy metals and antibiotics along altitudinal zonation of the Teesta River

Culturable bacterial diversity and co-occurrence of heavy metal and antibiotic resistance were investigated from the water and sediments along the course of the Teesta River, in the Eastern Himalayas. Water and sediment samples collected from six sampling points during the monsoon and winter seasons were subjected to analysis of physico-chemical parameters, heavy metal contamination and antibiotic tolerance. The culturable bacterial diversity established by application of bacterial culture and 16S rRNA gene sequencing, ascertained the majority belonged to Proteobacteria, Actinobacteria, Firmicutes, Bacteroidetes and Deinococcus-Thermus. Among the 5 phyla, Proteobacteria and Actinobacteria were the dominant phyla present in both water and sediment samples, whereas Bacteroidetes, Firmicutes and Deinococcus-Thermus were unique to particular sites. The Shannon index indicated that the bacterial richness was more in the water column as compared to sediment. From the total of 245 isolates, 69 genera were identified. Heavy metal tolerance and antibiotic resistance profiles showed some isolates to be tolerant to high levels of heavy metals and multiple antibiotics indicating a major concern in terms of river ecosystem serving as a pool for dissemination of such resistant genes. The antibiotic resistance and heavy metal contamination diversified along the human-impacted downstream sites, endorsing the contribution of anthropogenic factors. The present report on bacterial diversity and the associated metal and antibiotics tolerance among bacteria is the first of its kind on Teesta River, the only major river system flowing through the state of Sikkim and parts of North Bengal.

Multi-biomarkers approach to determine the toxicological impacts of sulfamethoxazole antibiotic on freshwater fish Cyprinus carpio

Antibiotics are increasingly detected in the aquatic environment and are raising severe concerns for human and ecological health. Sulfamethoxazole being a widely recommended antibiotic in both human and veterinary medicine is consequently found in the aquatic environment. The current research was aimed to investigate the potential bioaccumulation and sub-lethal toxicity in terms of oxidative stress and histopathology of targeted antibiotic sulfamethoxazole in Cyprinus carpio at environmentally relevant concentrations over a prolonged period. Fish were exposed for 28 days to environmentally realistic concentrations (25-200 μg/L) of sulfamethoxazole. HPLC analysis revealed an inverse relationship between dosages applied and bioaccumulation in fish muscle tissues. The highest concentrations of sulfamethoxazole in the muscle tissues exposed to 25, 50, 100 and 200 μg/L were 124, 202,104.5, and 123.2 ng/g, respectively at different sampling times. Moreover, exposure to sulfamethoxazole enabled ROS (Reactive oxygen species) production in both brain and gill tissues of fish, where the increase in ROS formation was dose and time dependent. Furthermore, histopathological analysis of gills and liver revealed various alterations including pycnotic nuclei, bile stagnation, vacuolization in the liver, and partial and complete fusion of lamella and blood congestion in gills, respectively. Organ pathological index also revealed that the intensity of tissue damage increased as sulfamethoxazole dosage was increased. Quantitative evaluation of gills morphometric parameters divulged that severity of histopathological changes increased with time for all the exposed groups at the end of exposure time (28th day) indicating physio-metabolic turmoil caused by molecular and biochemical action of sulfamethoxazole. In conclusion, the assessment of bioaccumulative potential, measurement of ROS, and histopathology of Cyprinus carpio appeared to be a useful biomarker to evaluate the toxic impacts of antibiotics on the health of fish.

Insights to antimicrobial resistance: heavy metals can inhibit antibiotic resistance in bacteria isolated from wastewater

The alarming upsurge in the co-existence of heavy metal and antibiotic resistance may have a devastating impact on humans, animals, and the environment. Four metal-resistant bacteria were isolated from hospital effluents and industrial drain. Heavy metal resistance and antimicrobial resistance were examined in the isolates followed by identification through 16S rRNA gene sequencing. Delftia tsuruhatensis strain FK-01 and Carnobacterium inhibens strain FK-02 tolerated arsenic with maximal tolerated concentration (MTC) of 30 mM and 10 mM, respectively. Staphylococcus hominis strain FK-04 tolerated copper up to 4 mM and lead-resistant Raoultella ornithinolytica strain FK-05 exhibited tolerance to 1 mM lead. The growth kinetics of bacteria were monitored in the presence of metals and the following antibiotics, tetracycline, chloramphenicol, and kanamycin. The presence of arsenate significantly enhanced tetracycline resistance in C. inhibens. Heavy metal-induced antibiotic resistance was also observed in S. hominis and R. ornithinolytica, against chloramphenicol and tetracycline respectively. D. tsuruhatensis showed resistance to kanamycin but when grown in the presence of arsenic and kanamycin, bacteria lost resistance to the antibiotic. Therefore, it is suggested that the novel arsenate-resistant strain Delftia tsuruhatensis FK-01 has a unique ability to inhibit antimicrobial resistance that can be harnessed in bioremediation.

Metagenomic profiles of the resistome in subtropical estuaries: Co-occurrence patterns, indicative genes, and driving factors

Estuaries are resistome hotspots owing to resistome accumulation and propagation at these locations from surrounding rivers, yet the large-scale biogeographic pattern of resistome, especially biocide and metal resistance genes (BMRGs) and its driving mechanisms in estuarine waters remains to be elucidated. Here, a metagenomics-based approach was firstly used to investigate resistome and mobilome profiles in waters from 30 subtropical estuaries, South China. The Pearl River estuaries had a higher diversity and abundance of antibiotic resistance genes (ARGs), BMRGs, and mobile genetic elements (MGEs) when compared with estuaries from east and west regions. Genes resistant to multiple antibiotics, metals, and biocides were the most abundant gene types in the resistome. The abundance of MGEs (e.g., intI1, IS91, and tnpA) was highly associated with the total abundance of resistance genes, suggesting their utility as potential indicators for quantitative estimations of the resistome contamination. Further, MGEs contributed more than bacterial communities in shaping the resistome in subtropical estuaries. Physicochemical factors (e.g., pH) regulated MGE composition and stochastic assembly, which mediated the co-selection of ARGs and BMRGs via horizontal gene transfer. Our findings have important implications and provide a reference on the management of ARGs and BMRGs in subtropical estuarine ecosystems.

Environmental spreading of clinically relevant carbapenem-resistant gram-negative bacilli: the occurrence of blaKPC-or-NDM strains relates to local hospital activities

Background

Aquatic matrices impacted by sewage may shelter carbapenem-resistant (CR) Gram-negative bacilli (GNB) harboring resistance genes of public health concern. In this study, sewage treatment plants (STPs) servicing well-defined catchment areas were surveyed for the presence of CR-GNB bearing carbapenemase genes (bla_KPC or bla_NDM).

Results

A total of 325 CR-GNB were recovered from raw (RS) and treated (TS) sewage samples as well as from water body spots upstream (UW) and downstream (DW) from STPs. Klebsiella-Enterobacter (KE) group amounted to 116 isolates (35.7%). CR-KE isolates were recovered from TS, DW (35.7%) and RS samples (44.2%) (p = 0.001); but not from UW samples. KE isolates represented 65.8% of all bla_KPC or bla_NDM positive strains. The frequency of bla_KPC-or-NDM strains was positively associated with the occurrence of district hospitals located near STPs, as well as with the number of hospitalizations and of sewer connections serviced by the STPs. bla_KPC-or-NDM strains were recovered from ST samples in 7 out of 14 STPs, including four tertiary-level STPs; and from 6 out of 13 DW spots whose RS samples also had bla_KPC-or-NDM strains.

Conclusions

Clinically relevant GNB bearing bla_KPC-or-NDM resist sewage treatments and spread into environmental aquatic matrices mainly from STPs impacted by hospital activities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12866-021-02400-1.

Environmental Biofilms as Reservoirs for Antimicrobial Resistance

Characterizing the response of microbial communities to a range of antibiotic concentrations is one of the strategies used to understand the impact of antibiotic resistance. Many studies have described the occurrence and prevalence of antibiotic resistance in microbial communities from reservoirs such as hospitals, sewage, and farm feedlots, where bacteria are often exposed to high and/or constant concentrations of antibiotics. Outside of these sources, antibiotics generally occur at lower, sub-minimum inhibitory concentrations (sub-MICs). The constant exposure to low concentrations of antibiotics may serve as a chemical "cue" that drives development of antibiotic resistance. Low concentrations of antibiotics have not yet been broadly described in reservoirs outside of the aforementioned environments, nor is the transfer and dissemination of antibiotic resistant bacteria and genes within natural microbial communities fully understood. This review will thus focus on low antibiotic-concentration environmental reservoirs and mechanisms that are important in the dissemination of antibiotic resistance to help identify key knowledge gaps concerning the environmental resistome.

A Review of the Occurrence of Pharmaceutical Compounds as Emerging Contaminants in Treated Wastewater and Aquatic Environments

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In recent years, pharmaceutical compounds have emerged as potential contaminants in the aquatic matrices of the environment. High production, consumption, and limited removal through conventional treatment processes/wastewater treatment plants (WWTPs) are the major causes for the occurrence of pharmaceutical compounds in wastewater and aquatic environments worldwide. A number of studies report adverse health effects and risks to aquatic life and the ecosystem because of the presence of pharmaceutical compounds in the aquatic environment. This paper provides a state-of-the-art review of the occurrence of pharmaceutical compounds in treated wastewater from various WWTPs, surface water and groundwater bodies. Additionally, this review provides comprehensive information and pointers for research in wastewater treatment and waterbodies management.

Impact of Zr6 Node in a Metal-Organic Framework for Adsorptive Removal of Antibiotics from Water

Quinolone-based antibiotics commonly detected in surface, ground, and drinking water are difficult to remove and therefore pose a threat as organic contaminants of aqueous environment. We performed adsorptive removal of quinolone antibiotics, nalidixic acid and ofloxacin, using a zirconium-porphyrin-based metal-organic framework (MOF), PCN-224. PCN-224 exhibits the highest adsorption capacities for both nalidixic acid and ofloxacin among those reported for MOFs to date. The accessible metal sites of Zr metal nodes are responsible for efficient adsorptive removal. This study offers a pragmatic approach to design MOFs optimized for adsorptive removal of antibiotics.

Beta-lactam resistance development during the treatment processes of municipal wastewater treatment plants

This work monitored the effect of a municipal and a village wastewater treatment plant (WWTP) technology on the fate of beta-lactam resistance genes in bacterial populations in different phases of the wastewater treatment process. In case of the municipal WWTP1, the bacteria possessing a high ampicillin resistance (minimal inhibitory concentration (MIC) values of 20 mg/mL) accumulated in the sedimentation tank, which was accompanied with a higher concentration of ampicillin in the wastewater samples (28.09 ng/L) and an increase in the relative abundance of the blaTEM gene in the bacterial population. However, an opposite trend was revealed with the blaNDM-1 gene, making the sedimentation processes of WWTP1 crucial only for the accumulation of the blaTEM gene. Similarly, the comparison with the WWTP2 showed that the accumulation of the ampicillin resistance in bacterial population probably depended on the WWTP technology and wastewater composition. Out of the four tested resistance genes (blaTEM, blaKPC, blaNDM-1, and blaOXA-48), blaTEM and blaNDM-1 genes were the only two detected in this study. According to NGS analysis of bacterial 16 S rRNA gene, Gammaproteobacteria dominated the ampicillin-resistant bacteria of the WWTP sedimentation tanks. Their relative abundance in the bacterial population also increased during the sedimentation processes in WWTP1. It could indicate the role of the bacterial taxon in ampicillin resistance accumulation in this WWTP and show that only 9.29% of the original bacterial population from the nitrification tank is involved in the documented shifts in beta-lactam resistance of the bacterial population.

Removal of Pharmaceuticals from Water by Adsorption and Advanced Oxidation Processes: State of the Art and Trends

Pharmaceutical products have become a necessary part of life. Several studies have demonstrated that indirect exposure of humans to pharmaceuticals through the water could cause negative effects. Raw sewage and wastewater effluents are the major sources of pharmaceuticals found in surface waters and drinking water. Therefore, it is important to consider and characterize the efficiency of pharmaceutical removal during wastewater and drinking-water treatment processes. Various treatment options have been investigated for the removal/reduction of drugs (e.g., antibiotics, NSAIDs, analgesics) using conventional or biological treatments, such as activated sludge processes or bio-filtration, respectively. The efficiency of these processes ranges from 20–90%. Comparatively, advanced wastewater treatment processes, such as reverse osmosis, ozonation and advanced oxidation technologies, can achieve higher removal rates for drugs. Pharmaceuticals and their metabolites undergo natural attenuation by adsorption and solar oxidation. Therefore, pharmaceuticals in water sources even at trace concentrations would have undergone removal through biological processes and, if applicable, combined adsorption and photocatalytic degradation wastewater treatment processes. This review provides an overview of the conventional and advanced technologies for the removal of pharmaceutical compounds from water sources. It also sheds light on the key points behind adsorption and photocatalysis.