Identification of Antibiotics in Surface-Groundwater. A Tool towards the Ecopharmacovigilance Approach: A Portuguese Case-Study

From wastewater to clean water: Recent advances on the removal of metronidazole, ciprofloxacin, and sulfamethoxazole antibiotics from water through adsorption and advanced oxidation processes (AOPs)

Antibiotics released into water sources pose significant risks to both human health and the environment. This comprehensive review meticulously examines the ecotoxicological impacts of three prevalent antibiotics-ciprofloxacin, metronidazole, and sulfamethoxazole-on the ecosystems. Within this framework, our primary focus revolves around the key remediation technologies: adsorption and advanced oxidation processes (AOPs). In this context, an array of adsorbents is explored, spanning diverse classes such as biomass-derived biosorbents, graphene-based adsorbents, MXene-based adsorbents, silica gels, carbon nanotubes, carbon-based adsorbents, metal-organic frameworks (MOFs), carbon nanofibers, biochar, metal oxides, and nanocomposites. On the flip side, the review meticulously examines the main AOPs widely employed in water treatment. This includes a thorough analysis of ozonation (O3), the photo-Fenton process, UV/hydrogen peroxide (UV/H2O2), TiO2 photocatalysis, ozone/UV (O3/UV), radiation-induced AOPs, and sonolysis. Furthermore, the review provides in-depth insights into equilibrium isotherm and kinetic models as well as prospects and challenges inherent in these cutting-edge processes. By doing so, this review aims to empower readers with a profound understanding, enabling them to determine research gaps and pioneer innovative treatment methodologies for water contaminated with antibiotics.

Effects of four antibiotics on the photosynthetic light reactions in the green alga Chlorella pyrenoidosa

Antibiotics are ubiquitously present in aquatic environments, posing a serious ecological risk to aquatic ecosystems. However, the effects of antibiotics on the photosynthetic light reactions of freshwater algae and the underlying mechanisms are relatively less understood. In this study, the effects of 4 representative antibiotics (clarithromycin, enrofloxacin, tetracycline, and sulfamethazine) on a freshwater alga (Chlorella pyrenoidosa) and the associated mechanisms, primarily focusing on key regulators of the photosynthetic light reactions, were evaluated. Algae were exposed to different concentrations of clarithromycin (0.0-0.3 mg/L), enrofloxacin (0.0-30.0 mg/L), tetracycline (0.0-10.0 mg/L), and sulfamethazine (0.0-50.0 mg/L) for 7 days. The results showed that the 4 antibiotics inhibited the growth, the photosynthetic pigment contents, and the activity of antioxidant enzymes. In addition, exposure to clarithromycin caused a 118.4 % increase in malondialdehyde (MDA) levels at 0.3 mg/L. Furthermore, the transcripts of genes for the adenosine triphosphate (ATP) - dependent chloroplast proteases (ftsH and clpP), genes in photosystem II (psbA, psbB, and psbC), genes related to ATP synthase (atpA, atpB, and atpH), and petA (related to cytochrome b6/f complex) were altered by clarithromycin. This study contributes to a better understanding of the risk of antibiotics on primary producers in aquatic environment.

Tackling Carbapenem Resistance and the Imperative for One Health Strategies-Insights from the Portuguese Perspective

Carbapenemases, a class of enzymes specialized in the hydrolysis of carbapenems, represent a significant threat to global public health. These enzymes are classified into different Ambler's classes based on their active sites, categorized into classes A, D, and B. Among the most prevalent types are IMI/NMC-A, KPC, VIM, IMP, and OXA-48, commonly associated with pathogenic species such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The emergence and dissemination of carbapenemase-producing bacteria have raised substantial concerns due to their ability to infect humans and animals (both companion and food-producing) and their presence in environmental reservoirs. Adopting a holistic One Health approach, concerted efforts have been directed toward devising comprehensive strategies to mitigate the impact of antimicrobial resistance dissemination. This entails collaborative interventions, highlighting proactive measures by global organizations like the World Health Organization, the Center for Disease Control and Prevention, and the Food and Agriculture Organization. By synthesizing the evolving landscape of carbapenemase epidemiology in Portugal and tracing the trajectory from initial isolated cases to contemporary reports, this review highlights key factors driving antibiotic resistance, such as antimicrobial use and healthcare practices, and underscores the imperative for sustained vigilance, interdisciplinary collaboration, and innovative interventions to curb the escalating threat posed by antibiotic-resistant pathogens. Finally, it discusses potential alternatives and innovations aimed at tackling carbapenemase-mediated antibiotic resistance, including new therapies, enhanced surveillance, and public awareness campaigns.

Antibiotic occurrence, environmental risks, and their removal from aquatic environments using microalgae: Advances and future perspectives

Antibiotic pollution has caused a continuous increase in the development of antibiotic-resistant bacteria and antibiotic-resistant genes (ARGs) in aquatic environments worldwide. Algae-based bioremediation technology is a promising eco-friendly means to remove antibiotics and highly resistant ARGs, and the generated biomass can be utilized to produce value-added products of industrial significance. This review discussed the prevalence of antibiotics and ARGs in aquatic environments and their environmental risks to non-target organisms. The potential of various microalgal species for antibiotic and ARG removal, their mechanisms, strategies for enhanced removal, and future directions were reviewed. Antibiotics can be degraded into non-toxic compounds in microalgal cells through the action of extracellular polymeric substances, glutathione-S-transferase, and cytochrome P450; however, antibiotic stress can alter microalgal gene expression and growth. This review also deciphered the effect of antibiotic stress on microalgal physiology, biomass production, and biochemical composition that can impact their commercial applications.

Risks of benzalkonium chlorides as emerging contaminants in the environment and possible control strategies from the perspective of ecopharmacovigilance

An unprecedented increase in the use of disinfection products triggered by the coronavirus disease 2019 (COVID-19) pandemic is resulting in aggravating environmental loads of disinfectants as emerging contaminants, which has been considered a cause for worldwide secondary disasters. This review analyzed the literature published in the last decade about occurrence, bioaccumulation, and possible environmental risks of benzalkonium chlorides (BKCs) as emerging contaminants. Results indicated that BKCs globally occurred in municipal wastewater, surface water, groundwater, reclaimed water, sludge, sediment, soil, roof runoff, and residential dust samples across 13 countries. The maximum residual levels of 30 mg/L and 421 μg/g were reported in water and solid environmental samples, respectively. Emerging evidences suggested possible bioaccumulation of BKCs in plants, even perhaps humans. Environmentally relevant concentrations of BKCs exert potential adverse impacts on aquatic and terrestrial species, including genotoxicity, respiratory toxicity, behavioural effects and neurotoxicity, endocrine disruption and reproductive impairment, phytotoxicity, etc. Given the intrinsic biocidal and preservative properties of disinfectants, the inductive effects of residual BKCs in environment in terms of resistance and imbalance of microorganisms have been paid special attention. Considering the similarities of disinfectants to pharmaceuticals, from the perspective of ecopharmacovigilance (EPV), a well-established strategy for pharmaceutical emerging contaminants, we use the control of BKC pollution as a case, and provide some recommendations for employing the EPV measures to manage environmental risks posed by disinfectant emerging contaminants.

Pharmaceutical residues in the ecosystem: Antibiotic resistance, health impacts, and removal techniques

Hospital wastewater has emerged as a major category of environmental pollutants over the past two decades, but its prevalence in freshwater is less well documented than other types of contaminants. Due to compound complexity and improper operations, conventional treatment is unable to remove pharmaceuticals from hospital wastewater. Advanced treatment technologies may eliminate pharmaceuticals, but there are still concerns about cost and energy use. There should be a legal and regulatory framework in place to control the flow of hospital wastewater. Here, we review the latest scientific knowledge regarding effective pharmaceutical cleanup strategies and treatment procedures to achieve that goal. Successful treatment techniques are also highlighted, such as pre-treatment or on-site facilities that control hospital wastewater where it is used in hospitals. Due to the prioritization, the regulatory agencies will be able to assess and monitor the concentration of pharmaceutical residues in groundwater, surface water, and drinking water. Based on the data obtained, the conventional WWTPs remove 10-60% of pharmaceutical residues. However, most PhACs are eliminated during the secondary or advanced therapy stages, and an overall elimination rate higher than 90% can be achieved. This review also highlights and compares the suitability of currently used treatment technologies and identifies the merits and demerits of each technology to upgrade the system to tackle future challenges. For this reason, pharmaceutical compound rankings in regulatory agencies should be the subject of prospective studies.

Predicted Environmental Risk Assessment of Antimicrobials with Increased Consumption in Portugal during the COVID-19 Pandemic; The Groundwork for the Forthcoming Water Quality Survey

The environmental release of antimicrobial pharmaceuticals is an imminent threat due to ecological impacts and microbial resistance phenomena. The recent COVID-19 outbreak will likely lead to greater loads of antimicrobials in the environment. Thus, identifying the most used antimicrobials likely to pose environmental risks would be valuable. For that, the ambulatory and hospital consumption patterns of antimicrobials in Portugal during the COVID-19 pandemic (2020–2021) were compared with those of 2019. A predicted risk assessment screening approach based on exposure and hazard in the surface water was conducted, combining consumption, excretion rates, and ecotoxicological/microbiological endpoints in five different regions of Portugal. Among the 22 selected substances, only rifaximin and atovaquone demonstrated predicted potential ecotoxicological risks for aquatic organisms. Flucloxacillin, piperacillin, tazobactam, meropenem, ceftriaxone, fosfomycin, and metronidazole showed the most significant potential for antibiotic resistance in all analysed regions. Regarding the current screening approach and the lack of environmental data, it is advisable to consider rifaximin and atovaquone in subsequent water quality surveys. These results might support the forthcoming monitorisation of surface water quality in a post-pandemic survey.

Synthesis of neodymium ferrite incorporated graphitic carbonitride (NdFe2O4@g-C3N4) and its application in the photodegradation of ciprofloxacin and ampicillin in a water system

Purification of antibiotic-contaminated drinking water sources is faced with limitations. Therefore, this study incorporated neodymium ferrite (NdFe2O4) in graphitic carbonitride (g-C3N4) to form NdFe2O4@g-C3N4 as a photocatalyst for removing ciprofloxacin (CIP) and ampicillin (AMP) from aqueous systems. X-ray diffraction (XRD) revealed a crystallite size of 25.15 nm for NdFe2O4 and 28.49 nm for NdFe2O4@g-C3N4. The bandgap is 2.10 and 1.98 eV for NdFe2O4 and NdFe2O4@g-C3N4, respectively. The transmission electron micrograph (TEM) images of NdFe2O4 and NdFe2O4@g-C3N4 gave an average particle size of 14.10 nm and 18.23 nm, respectively. Scanning electron micrograph (SEM) images showed heterogeneous surfaces with irregular-sized particles suggesting agglomeration at the surfaces. NdFe2O4@g-C3N4 (100.00 ± 0.00% for CIP and 96.80 ± 0.80% for AMP) exhibited better photodegradation efficiency towards CIP and AMP than NdFe2O4 (78.45 ± 0.80% for CIP and 68.25 ± 0.60% for AMP) in a process described by pseudo-first-order kinetics. NdFe2O4@g-C3N4 showed a stable regeneration capacity towards degradation of CIP and AMP with a capacity that is above 95% even at the 15th cycle of treatment. The use of NdFe2O4@g-C3N4 in this study revealed its potential as a promising photocatalyst for removing CIP and AMP in water systems.

Attitudes and opinions about ecopharmacovigilance from multi-disciplinary perspectives: a cross-sectional survey among academic researchers in China

As a promising upstream strategy to reduce the environmental loads of pharmaceutical emerging contaminants (PECs) through source control, ecopharmacovigilance (EPV) is concerned with the set of activities to identify, evaluate, understand, and prevent against diverse PEC-related problems, and has been accepted as a multi-disciplinary and multi-stakeholder system. This cross-sectional observational survey aimed to assess the attitudes and opinions about EPV from multi-disciplinary perspectives among Chinese academic professors from four main EPV-related disciplines including pharmacy, management, clinical medicine, and environmental and ecological science based on a self-developed questionnaire. Forty-two usable survey instruments were acquired. Results showed that the responding Chinese academic researchers from different disciplines expressed consistently positive attitudes and strong intentions for EPV, in spite of several disparities existing among disciplinary groups showing that pharmacy and medical researchers felt more certain of the environmental adverse effects of PECs, and researchers in pharmacy and environmental and ecological science were more interested in EPV. A multi-disciplinary consensus was achieved in regard to the types of key stakeholders in EPV practices including the pharmaceutical manufacturers, the public, the drug safety authority, hospitals, and the environmental protection agency. The main roles and responsibilities of each stakeholder identity in EPV practices were summarized based on the expert opinions.

Outstanding Enrofloxacin Removal Using an Unmodified Low-Cost Sorbent Prepared from the Leaves of Pyracantha koidzumii

Increasing discharges of synthetic antimicrobial agents from industrial and municipal sewage, as well as from agricultural runoffs into water bodies, is still a global challenge. Here, an unmodified low-cost sorbent was prepared in an ecofriendly manner from Pyracantha koidzumii leaves for the removal of enrofloxacin (ENR). Sorbent characterization was accomplished using Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), BET surface area, zeta potential, and point of zero charge. Biosorption assays were carried out via batch mode concerning the impact of adsorbent dosage, contact time, solution pH, solution ionic strength, adsorbate concentration, and temperature. In general, ENR adsorption was significantly correlated with pH and ionic strength. At a neutral pH, the sorbent had a theoretical maximal ENR uptake of 138.89 mg/g. However, the adsorption capacity was significantly affected by the presence of high concentrations of divalent cations (Ca2+ and Mg2+). The findings from the kinetics and isotherms showed that the pseudo-second-order kinetic and Langmuir isotherm models best fit the experimental data. Electrostatic interactions, hydrogen bonding, and π-π stacking were the most important mechanisms of adsorption of ENR onto the P. koidzumii sorbent. Overall, this study suggests the promising application of this agricultural residue for the efficient removal of ENR from water.

The study of polar emerging contaminants in seawater by passive sampling: A review

Emerging Contaminants (ECs) in marine waters include different classes of compounds, such as pharmaceuticals and personal care products, showing "emerging concern" related to the environment and human health. Their measurement in seawater is challenging mainly due to the low concentration levels and the possible matrix interferences. Mass spectrometry combined with chromatographic techniques represents the method of choice to study seawater ECs, due to its sensitivity and versatility. Nevertheless, these instrumental techniques have to be preceded by suitable sample collection and pre-treatment: passive sampling represents a powerful approach in this regard. The present review compiles the existing occurrence studies on passive sampling coupled to mass spectrometry for the monitoring of polar ECs in seawater and discusses the availability of calibration data that enabled quantitative estimations. A vast majority of the published studies carried out during the last two decades describe the use of integrative samplers, while applications of equilibrium samplers represent approximately 10%. The polar Chemcatcher was the first applied to marine waters, while the more sensitive Polar Organic Chemical Integrative Sampler rapidly became the most widely employed passive sampler. The organic Diffusive Gradients in Thin film technology is a recently introduced and promising device, due to its more reliable sampling rates. The best passive sampler selection for the monitoring of ECs in the marine environment as well as future research and development needs in this area are further discussed. On the instrumental side, combining passive sampling with high resolution mass spectrometry to better assess polar ECs is strongly advocated, despite the current challenges associated.

Recovery of the Structure and Function of the Pig Manure Bacterial Community after Enrofloxacin Exposure

A stable intestinal bacterial community balance is beneficial for animal health. Enrofloxacin is widely used in animal husbandry as a therapeutic drug, but it can cause intestinal environmental imbalance.

Long-Term Study of Antibiotic Presence in Ebro River Basin (Spain): Identification of the Emission Sources

Water monitoring is key to determining the presence of potentially hazardous substances related to urban activities and intensive farming. This research aimed to perform a long-term (four years) quantitative monitoring of selected antibiotics (azithromycin, enrofloxacin, trimethoprim and sulfadiazine) both in rivers and wastewaters belonging to the Ebro River basin (North of Spain). The target antibiotics were chosen on the basis of a preliminary multispecies screening. The analysis of the antibiotics was carried out by LC-MS/MS on wastewater-treatment plant (WWTP) effluent, effluents of a slaughterhouse and hospital, rivers downstream and upstream of these WWTPs, and rivers close to extensive farming areas. The ANOVA test was performed to study the significant differences between the points exposed to concrete emission sources and antibiotic concentration. The monitoring, carried out from 2018 to 2020, has been essential to illustrating the presence of the most abundant antibiotics that were detected in the Ebro River basin. Enrofloxacin has appeared in river waters in significant concentrations, especially near intensive farming, meanwhile azithromycin has been frequently detected in wastewaters.