Simultaneous determination of phenazopyridine HCl and trimethoprim in presence of phenazopyridine HCl impurity by univariate and multivariate spectrophotometric methods - Quantification of phenazopyridine HCl impurity by univariate methods

Three univariate and two multivariate spectrophotometric methods were developed and subsequently validated to determine phenazopyridine HCl (PHZ) and trimethoprim (TMP) in the presence of 2,6-Diaminopyridine (2,6-DAP). The first univariate method depends on direct determination of phenazopyridine by measuring its absorbance at 412 nm and performed in concentration range of 1.00-10.00 μg/mL. Then the contribution of phenazopyridine is removed by dividing the mixture spectrum with PHZ divisor (5 μg/mL) after that the constant is mathematically subtracted and finally the generated spectrum is multiplied with the PHZ divisor. These steps eliminate PHZ contribution and the recovered spectrum is that of TMP and 2,6-DAP only where different methods can be applied to determine TMP and 2,6-DAP through this binary mixture spectrum. The first method to determine both components depends on measuring both TMP and 2,6-DAP through their first derivative (¹DD) spectra at 244.70 and 259.60 nm for TMP and 2,6-DAP, respectively with concentration ranges of 4.00-24.00 μg/mL TMP and 4.00-26.00 μg/mL 2,6-DAP. The second method depends on application of the isoabsorptive method which was used for TMP determination at its isoabsorptive point with 2,6-DAP at 242.64 nm with concentration range 1.00-20.00 μg/mL for TMP. The developed univariate methods were successfully applied to determine PHZ, TMP and PHZ impurity (2,6-DAP). Two multivariate methods were applied for determination of PHZ and TMP in presence of 2,6-DAP namely, Principle Component Regression (PCR) and Partial Least Squares (PLS). The results of the two models show that simultaneous determination of PHZ and TMP in presence of PHZ impurity can be performed in the concentration ranges of 6.00-14.00 μg/mL PHZ and 24.00-56.00 μg/mL TMP. All the proposed methods were successfully applied to analyze PHZ and TMP in pharmaceutical formulations without interference from the dosage form additives and the results were statistically compared with the reported method.

Individual and simultaneous degradation of sulfamethoxazole and trimethoprim by ozone, ozone/hydrogen peroxide and ozone/persulfate processes: A comparative study

This study investigates the individual and simultaneous degradation and mineralization of the antibiotics, sulfamethoxazole (SMX) and trimethoprim (TMP) in aqueous solution by ozonation, ozone-activated persulfate (PS) and hydrogen peroxide (H₂O₂) processes. The trials were carried out in a semi-continuous column bubble reactor with an ozone diffuser located at the bottom of the column for a period of 2 h. Furthermore, the efficiency of studied processes were evaluated at two different initial pH and various doses of oxidants. The target compounds degradation observed pseudo-first-order rate constants (k_obs) and removal of total organic carbon (TOC) using ozone-based oxidation processes were compared. Irrespective of the applied processes, the mineralization of target compounds was less effective than their degradation in both individual and simultaneous systems. The highest antibiotics degradation rate constants were observed for individual oxidation of TMP (k_obs = 0.379 min^-1) and SMX (k_obs = 0.367 min^-1) at alkaline initial pH (pH₀) in the O₃/H₂O₂ system at an [antibiotic]/H₂O₂ molar ratio of 1/1. Irrespective of the antibiotic studied, the most effective TOC removal (~44%) was observed after a 2-h treatment with the O₃/H₂O₂ system at an [antibiotic]/H₂O₂ molar ratio of 1/5 (pH₀ 10.9). The O₃/PS system at an [antibiotic]/PS molar ratio of 1/5 (pH₀ 10.9) proved the most effective system for both mineralization and degradation (k_obs values of 0.294 min^-1 and 0.266 min^-1) of TMP and SMX, respectively, during the simultaneous oxidation of SMX-TMP. The decomposition by-products of SMX and TMP in studied ozone-based processes were identified using LC-MS analysis. The results of this study strongly suggest that using the O₃/PS process is a promising solution to reduce SMX-TMP contamination in water matrices.

Insight into dynamics and bioavailability of antibiotics in paddy soils by in situ soil moisture sampler

Plant-soil systems have complex regulatory mechanisms for xenobiotics uptake by plant, and these chemicals in soil pore water (SPW) are regarded as the bioavailable fraction. To date, little is known about the role of SPW in regard to the bioavailability of antibiotics for plant. In this study, in situ soil moisture sampler (SMS) was adopted to collect SPW from four paddy soils without disrupting the rhizosphere zone to evaluate antibiotic uptake in rice. The results show that SMS is applicable for antibiotics that have small molecular sizes and Log K_ow values, e.g., sulfadiazine (SDZ), sulfamethoxazole (SMZ), trimethoprim (TRM), and florfenicol (FLR). However, SMS performance was not feasible for large size and medium hydrophobic clarithromycin (CLR). Antibiotics in SPW demonstrated differences among chemicals and soils. Relatively higher levels of SDZ, SMZ, and FLR were observed in SPW than TRM, and neutral Panjin soil had the highest levels of antibiotics in SPW among four soils. The levels of antibiotics in SPW were negatively correlated with their soil partition parameter, K_d. Rapid decreases of SMZ, FLR, and SDZ in the SPW were consistent with their low residues in the final soils. All antibiotics were detectable in rice roots, followed by low detection levels in a few shoot samples, while no antibiotics were detectable in the grains of four soils. Relatively higher levels of SDZ, SMZ and FLR were observed in the roots of Panjin soil, consistent with their levels in SPW and K_d values. Furthermore, CLR and TRM were observed to have higher levels in roots, which was regarded as a consequence of their relatively longer persistence. Our study indicates that SMS is an applicable technique for in situ sampling of SPW, and level of antibiotics in SPW can work as a useful indicator to explore their bioavailability to plants.

Application of Fe-based metal-organic framework and its pyrolysis products for sulfonamide treatment

The occurrence and fate of antibiotic compounds in water can adversely affect human and animal health; hence, the removal of such substrates from soil and water is indispensable. Herein, we described the synthesis method of mesoporous carbon (MPC) via the pyrolysis route from a coordination polymer Fe-based MIL-53 (or MIL-53, shortly). The MPC structure was analyzed by several physical techniques such as SEM, TEM, BET, FT-IR, VSM, and XRD. The response surface methodology (RSM) was applied to find out the effects of initial concentration, MPC dosage, and pH on the removal efficiency of trimethoprim (TMP) and sulfamethoxazole (SMX) antibiotics in water. Under the optimized conditions, the removal efficiencies of TMP and SMX were found to be 87% and 99%, respectively. Moreover, the adsorption kinetic and isotherm studies showed that chemisorption and the monolayer adsorption controlled the adsorption process. The leaching test and recyclability studies indicated that the MPC structure was stable and can be reused for at least four times without any considerable change in the removal efficiency. Plausible adsorption mechanisms were also addressed in this study. Because of high maximum adsorption capacity (85.5 mg/g and 131.6 mg/g for TMP and SMX, respectively) and efficient reusability, MPC is recommended to be a potential adsorbent for TMP and SMX from water media.

Presumed Sulfonamide-Associated Uveitis With Stevens-Johnson Syndrome in a Quarter Horse Mare

We describe the case of a four-year-old Quarter Horse mare that presented with fever, respiratory infection with productive cough, disorientation, and bilateral anterior uveitis with discharge that had been previously treated with trimethoprim-sulfadiazine (TMPS). Acinetobacter johnsonii was cultured from an endoscopic tracheal wash. Treatment was initiated with cefquinome, systemic flunixin-meglumine, local ocular atropine, and corticosteroids. On subsequent days, the mare exhibited bilateral edematous, painful swelling of the face, primarily affecting the eyelids and lips. There were neither swellings nor pulsations of the metatarsal arteries. On day five of treatment, the facial swelling disappeared, the uveitis improved markedly, and the mare's periorbital skin, muzzle, and vulva began to slough, revealing underlying, nonpigmented skin. Although systemic use of sulfonamides has been associated with bilateral anterior uveitis and Stevens-Johnson syndrome (SJS or erythema multiforme major) in humans, these conditions are rare in horses. Stevens-Johnson syndrome has been associated most commonly with sulfonamide use but also with a range of other medications, including anti-infectives, anti-inflammatories, anticonvulsants, analgesics, and infections. A possible pathway for sulfonamide-induced SJS is discussed. To our knowledge, this is the first reported case of sulfonamide-associated uveitis and SJS in the horse.

Potential metabolism of pharmaceuticals in radish: Comparison of in vivo and in vitro exposure

Metabolism of pharmaceuticals in plants is important to evaluate their fate and accumulation in vegetables, and subsequently the risks to human health. However, limited knowledge is available to evaluate metabolism of pharmaceuticals in plants due to the lack of appropriate research approaches. In this study, radish was selected as a model plant to investigate metabolism of pharmaceuticals in intact plants (in vivo) growing in hydroponic solution and in plant tissue enzyme extracts (in vitro). For caffeine, six phase-I demethylation metabolites identified in the intact radish plant were also found in the plant enzyme extracts. After 7 days of in vivo exposure, the amount of the identified metabolites was about 5.4 times greater than the parent compound caffeine in radish roots. Furthermore, the metabolism potential of fifteen pharmaceuticals in radish was evaluated on the basis of mass balance. After 7 days of hydroponic exposure, oxytetracycline, trimethoprim, carbamazepine, lincomycin, monensin and tylosin manifested relatively less extent of metabolism with the mass recoveries ranging from 52.3 to 78.2%. In contrast, 17 β-estradiol, sulfamethoxazole, sulfadiazine, estrone, triclosan, acetaminophen, caffeine, carbadox and lamotrigine underwent extensive metabolism with only 3.0 to 32.1% of the parent compound recovered. In the in vitro system, 17 β-estradiol, estrone, triclosan, oxytetracycline, acetaminophen, sulfadiazine and sulfamethoxazole were readily metabolized in radish root enzyme extracts with 1.8 to 34.0% remaining after 96-h exposure. While in the leaf enzyme extracts, only triclosan was rapidly metabolized with 49.2% remaining, and others pharmaceuticals were ≥60%, indicating that the varying extents of metabolism occurred in different plant parts. This study highlights the importance of pharmaceutical metabolism in plants, and suggests that plant tissue enzyme extracts could serve as an alternative tool to assess pharmaceutical metabolism in plants.

Accelerated Oxidation of Organic Contaminants by Ferrate(VI): The Overlooked Role of Reducing Additives

This paper presents an accelerated ferrate(VI) (Fe^VIO₄^2-, Fe^VI) oxidation of contaminants in 30 s by adding one-electron and two-electron transfer reductants (R₍₁₎ and R₍₂₎). An addition of R₍₂₎ (e.g., NH₂OH, As^III, Se^IV, P^III, and NO₂^-, and S₂O₃^2-) results in Fe^IV initially, while Fe^V is generated with the addition of R₍₁₎ (e.g., SO₃^2-). R₍₂₎ additives, except S₂O₃^2-, show the enhanced oxidation of 20-40% of target contaminant, trimethoprim (TMP). Comparatively, enhanced oxidation of TMP was up to 100% with the addition of R₍₁₎ to Fe^VI. Interestingly, addition of S₂O₃^2- (i.e., R₍₂₎) also achieves the enhanced oxidation to 100%. Removal efficiency of TMP depends on the molar ratio ([R₍₁₎]:[Fe^VI] or [R₍₂₎]:[Fe^VI]). Most of the reductants have the highest removal at molar ratio of ∼0.125. A Fe^VI-S₂O₃^2- system also oxidizes rapidly a wide range of organic contaminants (pharmaceuticals, pesticides, artificial sweetener, and X-ray contrast media) in water and real water matrices. Fe^V and Fe^IV as the oxidative species in the Fe^VI-S₂O₃^2--contaminant system are elucidated by determining removal of contaminants in oxygenated and deoxygenated water, applying probing agent, and identifying oxidized products of TMP and sulfadimethoxine (SDM) by Fe^VI-S₂O₃^2- systems. Significantly, elimination of SO₂ from sulfonamide (i.e., SDM) is observed for the first time.

Biodegradation of typical pharmaceutical compounds by a novel strain Acinetobacter sp

A novel sulfamethoxazole (SMX)-degrading strain, Acinetobacter sp., was used to degrade other pharmaceutical compounds, including sulfadiazine (SD), sulfamethazine (SMT), trimethoprim (THM), triclosan (TCS), diclofenac (DFC) and carbamazepine (CBZ). The experimental results showed that Acinetobacter sp. can completely degrade SMX, SD and SMT, but with different mineralization efficiency. Acinetobacter sp. can mineralize 98.8% of SMX, while only 17.5% and 20.5% for SD and SMT, respectively. The intermediate products of SMX, SD and SMT degradation were tentatively identified. Based on the intermediates, it is inferred that the initial step for degrading sulfonamides by Acinetobacter sp. was the amidation of the amino groups in the benzene ring. The presence of methyl in the heterocyclic ring could induce the formation of methylase. By comparing the intermediates of SMX, SD and SMT degradation, it is concluded that Acinetobacter sp. preferred attacking the oxazole ring. However, Acinetobacter sp. cannot degrade THM, TCS, DFC and CBZ, while Acinetobacter sp. can still degrade SMX in the respective presence of THM, DFC and CBZ, although the degradation rate decreased. Moreover, the presence of TCS could completely inhibit the degradation of SMX by Acinetobacter sp.

Investigating antibiotics, antibiotic resistance genes, and microbial contaminants in groundwater in relation to the proximity of urban areas

Groundwater is an essential public and drinking water supply and its protection is a goal for global policies. Here, we investigated the presence and prevalence of antibiotic residues, antibiotic resistance genes (ARGs), mobile genetic elements (MGEs), and microbial contamination in groundwater environments at various distances from urban areas. Antibiotic concentrations ranged from below detection limit to 917 ng/L, being trimethoprim, macrolide, and sulfonamide the most abundant antibiotic classes. A total of eleven ARGs (aminoglycoside, β-lactam, chloramphenicol, Macrolide-Lincosamide-Streptogramin B - MLSB, sulfonamide, and tetracycline), one antiseptic resistance gene, and two MGEs were detected by qPCR with relative abundances ranging from 6.61 × 10^-7 to 2.30 × 10^-1 copies/16S rRNA gene copies. ARGs and MGEs were widespread in the investigated groundwater environments, with increased abundances not only in urban, but also in remote areas. Distinct bacterial community profiles were observed, with a higher prevalence of Betaproteobacteria and Bacteroidetes in the less-impacted areas, and that of Firmicutes in the contaminated groundwater. The combined characteristics of increased species diversity, distinct phylogenetic composition, and the possible presence of fecal and/or pathogenic bacteria could indicate different types of contamination. Significant correlations between ARGs, MGEs and specific taxa within the groundwater bacterial community were identified, revealing the potential hosts of resistance types. Although no universal marker gene could be determined, a co-selection of int1, qacEΔ1 and sulI genes, a proxy group for anthropogenic pollution, with the tetC, tetO, tetW resistance genes was identified. As the tet group was observed to follow the pattern of environmental contamination for the groundwater samples investigated in this study, our results strongly support the proposal of this group of genes as an environmental tracer of human impact. Overall, the present study investigated several emerging contaminants in groundwater habitats that may be included in monitoring programs to enable further regulatory and protection measures.

An experimental Staphylococcus aureus carriage and decolonization model in rhesus macaques (Macaca mulatta)

Our human model of nasal colonization and eradication of S. aureus is limited by safety issues. As rhesus macaques are closely related to humans and natural hosts for S. aureus, we developed an experimental decolonization and inoculation protocol in these animals. Animals were screened for nasal carriage of S. aureus and 20 carriers were selected. Decolonization was attempted using nasal mupirocin (10 animals) or mupirocin plus trimethoprim/sulfadiazine intramuscularly (10 animals) both once daily for 5 days, and checked by follow-up cultures for 10 weeks. Intranasal inoculation was performed with S. aureus strain 8325–4 in culture-negative animals. 11/20 animals, of which 5 received mupirocin and 6 the combination treatment, became culture-negative for S. aureus for 10 weeks and these 11 animals were subsequently inoculated. Swabs were taken once a week for 5 weeks to test for the presence of the inoculated strain. In 3 animals, strain 8325–4 was cultured from the nose 1 week after inoculation, indicating short-term survival of this strain only, a finding similar to that previously found in our human model. These data demonstrate that rhesus macaques may constitute a relevant animal model to perform S. aureus eradication and inoculation studies with relatively limited invasive handling of the animals.

A probabilistic approach to assess antibiotic resistance development risks in environmental compartments and its application to an intensive aquaculture production scenario

Estimating antibiotic pollution and antibiotic resistance development risks in environmental compartments is important to design management strategies that advance our stewardship of antibiotics. In this study we propose a modelling approach to estimate the risk of antibiotic resistance development in environmental compartments and demonstrate its application in aquaculture production systems. We modelled exposure concentrations for 12 antibiotics used in Vietnamese Pangasius catfish production using the ERA-AQUA model. Minimum selective concentration (MSC) distributions that characterize the selective pressure of antibiotics on bacterial communities were derived from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) Minimum Inhibitory Concentration dataset. The antibiotic resistance development risk (RDR) for each antibiotic was calculated as the probability that the antibiotic exposure distribution exceeds the MSC distribution representing the bacterial community. RDRs in pond sediments were nearly 100% for all antibiotics. Median RDR values in pond water were high for the majority of the antibiotics, with rifampicin, levofloxacin and ampicillin having highest values. In the effluent mixing area, RDRs were low for most antibiotics, with the exception of amoxicillin, ampicillin and trimethoprim, which presented moderate risks, and rifampicin and levofloxacin, which presented high risks. The RDR provides an efficient means to benchmark multiple antibiotics and treatment regimes in the initial phase of a risk assessment with regards to their potential to develop resistance in different environmental compartments, and can be used to derive resistance threshold concentrations.

The performance and evolution of bacterial community of activated sludge exposed to trimethoprim in a sequencing batch reactor

The performance and microbial community changes of an activated sludge sequencing batch reactor were evaluated after exposure to trimethoprim for 51days. The average chemical oxygen demand, ammonia nitrogen, phosphorus efficiencies were 88.6%±0.56%, 90.47%±0.29% and 64.25%±1.12%, respectively. The protein and polysaccharide contents increased with increasing trimethoprim concentration to protect the cells from the unfavorable conditions. The chemical composition of extracellular polymeric substances increased. For denitrifying bacteria, the read numbers of Pseudomonas, Flavobacterium and Bacillus were both significantly increased from Day 1 to 25 and sharply decreased by Day 50 (p<0.05), which is consistent with the tendency of Planctomyces (Anammox). The read number of Paracoccus displayed an increasing trend, whereas Nitrospirales, Nitrospira (nitrite oxidizer) and Nitrosomonadaceae (ammonia oxidizer) were significantly decreased (p<0.05). The read number of Rhodocyclaceae (phosphorus oxidizer) was significantly decreased from Day 1 to 25 and sharply increased by Day 50 (p<0.05).

Abundance of antibiotics, antibiotic resistance genes and bacterial community composition in wastewater effluents from different Romanian hospitals

Antimicrobial resistance represents a growing and significant public health threat, which requires a global response to develop effective strategies and mitigate the emergence and spread of this phenomenon in clinical and environmental settings. We investigated, therefore, the occurrence and abundance of several antibiotics and antibiotic resistance genes (ARGs), as well as bacterial community composition in wastewater effluents from different hospitals located in the Cluj County, Romania. Antibiotic concentrations ranged between 3.67 and 53.05 μg L^-1, and the most abundant antibiotic classes were β-lactams, glycopeptides, and trimethoprim. Among the ARGs detected, 14 genes confer resistance to β-lactams, aminoglycosides, chloramphenicol, macrolide-lincosamide-streptogramin B (MLSB) antibiotics, sulfonamides, and tetracyclines. Genes encoding quaternary ammonium resistance and a transposon-related element were also detected. The sulI and qacEΔ1 genes, which confer resistance to sulfonamides and quaternary ammonium, had the highest relative abundance with values ranging from 5.33 × 10^-2 to 1.94 × 10^-1 and 1.94 × 10^-2 to 4.89 × 10^-2 copies/16 rRNA gene copies, respectively. The dominant phyla detected in the hospital wastewater samples were Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. Among selected hospitals, one of them applied an activated sludge and chlorine disinfection process before releasing the effluent to the municipal collector. This conventional wastewater treatment showed moderate removal efficiency of the studied pollutants, with a 55-81% decrease in antibiotic concentrations, 1-3 order of magnitude lower relative abundance of ARGs, but with a slight increase of some potentially pathogenic bacteria. Given this, hospital wastewaters (raw or treated) may contribute to the spread of these emerging pollutants in the receiving environments. To the best of our knowledge, this study quantified for the first time the abundance of antibiotics and ARGs in wastewater effluents from different Romanian hospitals.

Roles of reactive chlorine species in trimethoprim degradation in the UV/chlorine process: Kinetics and transformation pathways

The UV/chlorine process, which forms several reactive species including hydroxyl radicals (HO) and reactive chlorine species (RCS) to degrade contaminants, is being considered to be an advanced oxidation process. This study investigated the kinetics and mechanism of the degradation of trimethoprim (TMP) by the UV/chlorine process. The degradation of TMP was much faster by UV/chlorine compared to UV/H₂O₂. The degradation followed pseudo first-order kinetics, and the rate constant (k') increased linearly as the chlorine dosage increased from 20 μM to 200 μM and decreased as pH rose from 6.1 to 8.8. k' was not affected by chloride and bicarbonate but decreased by 50% in the presence of 1-mg/L NOM. The contribution of RCS, including Cl, Cl₂^- and ClO, to the degradation removal rate was much higher than that of HO and increased from 67% to 87% with increasing pH from 6.1 to 8.8 under the experimental condition. The increasing contribution of RCS to the degradation with increasing pH was attributable to the increase in the ClO concentration. Kinetic modeling and radical scavenging tests verified that ClO mainly attacked the trimethoxybenzyl moiety of TMP. RCS reacted with TMP much faster than HOCl/OCl^- to form chlorinated products (i.e., m/z 325) and chlorinated disinfection byproducts such as chloroform, chloral hydrate, dichloroacetonitrile and trichloronitromethane. The hydroxylation and demethylation of m/z 325 driven by HO generated m/z 327 and m/z 341. Meanwhile, reactions of m/z 325 with HO and RCS/HOCl/OCl^- generated dichlorinated and hydroxylated products (i.e., m/z 377). All the chlorinated products could be further depleted to produce products with less degree of halogenation in the UV/chlorine process, compared to dark chlorination. The acute toxicity to Vibrio fischeri by UV/chlorine was lower than chlorination at the same removal rate of TMP. This study demonstrated the importance of RCS, in particular, ClO, in the degradation of micropollutants in the UV/chlorine process.

Prevalence of antibiotic susceptibility and resistance of Escherichia coli in acute uncomplicated cystitis in Korea: Systematic review and meta-analysis

BACKGROUND

The aim of this study is to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli Escherichia coli (E coli) in female uncomplicated cystitis in Korea using meta-analysis.

METHODS

A cross-search of the literature was performed with MEDLINE for all relevant data published before October 2015 and EMBASE from 1980 to 2015, the Cochrane Library, KoreaMed, RISS, KISS, and DBPia were also searched. Observational or prospective studies that reported the prevalence of antimicrobial susceptibility and resistance of E coli were selected for inclusion. No language or time restrictions were applied. We performed a meta-analysis using a random effects model to quantify the prevalence of antimicrobial susceptibility and resistance of E coli.

RESULTS

Ten studies were eligible for the meta-analysis, which together included a total of 2305 women with uncomplicated cystitis. The overall resistance rate to antibiotics was 0.28 (95% confidence interval [CI]: 0.25, 0.32). The pooled resistance rates were 0.08 (95% CI: 0.06, 0.11) for cephalosporin, 0.22 (95% CI: 0.18, 0.25) for fluoroquinolone (FQ), and 0.43 (95% CI: 0.35, 0.51) for trimethoprim/sulfamethoxazole (TMP/SMX). Regression analysis showed that resistance to FQ is increasing (P = 0.014) and resistance to TMP/SMX is decreasing (P = 0.043) by year. The generation of cephalosporin was not a significant moderator of differences in resistance rate.

CONCLUSION

The resistance rate of FQ in Korea is over 20% and is gradually increasing. Although the resistance rate of TMP/SMX is over 40%, its tendency is in decreasing state. Antibiotic strategies used for the treatment of uncomplicated cystitis in Korea have to be modified.

Assessment of the Risks of Mixtures of Major Use Veterinary Antibiotics in European Surface Waters

Effects of single veterinary antibiotics on a range of aquatic organisms have been explored in many studies. In reality, surface waters will be exposed to mixtures of these substances. In this study, we present an approach for establishing risks of antibiotic mixtures to surface waters and illustrate this by assessing risks of mixtures of three major use antibiotics (trimethoprim, tylosin, and lincomycin) to algal and cyanobacterial species in European surface waters. Ecotoxicity tests were initially performed to assess the combined effects of the antibiotics to the cyanobacteria Anabaena flos-aquae. The results were used to evaluate two mixture prediction models: concentration addition (CA) and independent action (IA). The CA model performed best at predicting the toxicity of the mixture with the experimental 96 h EC50 for the antibiotic mixture being 0.248 μmol/L compared to the CA predicted EC50 of 0.21 μmol/L. The CA model was therefore used alongside predictions of exposure for different European scenarios and estimations of hazards obtained from species sensitivity distributions to estimate risks of mixtures of the three antibiotics. Risk quotients for the different scenarios ranged from 0.066 to 385 indicating that the combination of three substances could be causing adverse impacts on algal communities in European surface waters. This could have important implications for primary production and nutrient cycling. Tylosin contributed most to the risk followed by lincomycin and trimethoprim. While we have explored only three antibiotics, the combined experimental and modeling approach could readily be applied to the wider range of antibiotics that are in use.

Solar photocatalytic ozonation of a mixture of pharmaceutical compounds in water

Aqueous solutions of mixtures of four pharmaceutical compounds (atenolol, hydrochlorothiazide, ofloxacin and trimethoprim) both in Milli-Q ultrapure water and in a secondary effluent from a municipal wastewater treatment plant have been treated at pH 7 by different oxidation methods, such as conventional ozonation, photolytic ozonation, TiO2 catalytic ozonation, TiO2 photocatalytic oxidation and TiO2 photocatalytic ozonation. Experiments were carried out using a solar compound parabolic concentrator. The performance results have been compared in terms of removal of emerging contaminants (ECs), generation rate of phenolic intermediates, organic matter mineralization, ecotoxicity removal and enhancement of biodegradability. Also, the consumption of ozone to achieve certain treatment goals (95% removal of ECs and 40% mineralization) is discussed. Results reveal that solar photocatalytic ozonation is a promising oxidation method as it led to the best results in terms of EC mineralization (∼85%), toxicity removal (∼90%) and efficient use of ozone (∼2mgO3mgEC(-1) to achieve complete EC removal and ∼18mgO3mgTOC(-1) to achieve 40% EC mineralization, respectively).

Acute morphine and cocaine related death after trimethoprim-adultered cocaine abuse

Over the last few decades, cocaine and morphine (heroin) have been among the primary causes of deaths related to drug abuse. Cocaine is frequently altered by dilution, substitution, contamination, and adulteration. Trimethoprim has never been identified in the powders of cocaine, making this the first post-mortem case report in which the presence of this compound is described. The case reported here is that of a 46-year-old woman with a history of cocaine and morphine abuse who was found dead inside her bathroom. The police found the corpse next to a syringe, with a telephone card containing trace of cocaine on the sink. Toxicological analysis was performed, and drug levels were measured by means of gas chromatography/mass spectrometry. In addition to the presence of cocaine and smaller alkaloids, trimethoprim was also detected on the syringe and telephone card and in the woman's nasal mucosa. Trimethoprim analysis is very quick and easy and can be added to the routine analysis of drugs of abuse seized on the illicit market to obtain more information.

The culturable soil antibiotic resistome: a community of multi-drug resistant bacteria

Understanding the soil bacterial resistome is essential to understanding the evolution and development of antibiotic resistance, and its spread between species and biomes. We have identified and characterized multi-drug resistance (MDR) mechanisms in the culturable soil antibiotic resistome and linked the resistance profiles to bacterial species. We isolated 412 antibiotic resistant bacteria from agricultural, urban and pristine soils. All isolates were multi-drug resistant, of which greater than 80% were resistant to 16-23 antibiotics, comprising almost all classes of antibiotic. The mobile resistance genes investigated, (ESBL, bla NDM-1, and plasmid mediated quinolone resistance (PMQR) resistance genes) were not responsible for the respective resistance phenotypes nor were they present in the extracted soil DNA. Efflux was demonstrated to play an important role in MDR and many resistance phenotypes. Clinically relevant Burkholderia species are intrinsically resistant to ciprofloxacin but the soil Burkholderia species were not intrinsically resistant to ciprofloxacin. Using a phenotypic enzyme assay we identified the antibiotic specific inactivation of trimethoprim in 21 bacteria from different soils. The results of this study identified the importance of the efflux mechanism in the soil resistome and variations between the intrinsic resistance profiles of clinical and soil bacteria of the same family.

Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility, and treatment outcome

Introduction

Stenotrophomonas maltophilia is acquiring increasing importance as a nosocomial pathogen.

Methods

We retrospectively studied the characteristics and outcome of patients with any type of S. maltophilia infection at the University Hospital of Heraklion, Crete, Greece, between 1/2005–12/2010. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. Prognostic factors for all-cause in-hospital mortality were assessed with multivariate logistic regression.

Results

Sixty-eight patients (median age: 70.5 years; 64.7% males) with S. maltophilia infection, not related to cystic fibrosis, were included. The 68 patients were hospitalized in medical (29.4%), surgical (26.5%), hematology/oncology departments (23.5%), or the intensive care units (ICU; 20.6%). The most frequent infection types were respiratory tract (54.4%), bloodstream (16.2%), skin/soft tissue (10.3%), and intra-abdominal (8.8%) infection. The S. maltophilia-associated infection was polymicrobial in 33.8% of the cases. In vitro susceptibility was higher to colistin (91.2%), trimethoprim/sulfamethoxazole and netilmicin (85.3% each), and ciprofloxacin (82.4%). The empirical and the targeted treatment regimens were microbiologically appropriate for 47.3% and 63.6% of the 55 patients with data available, respectively. Most patients received targeted therapy with a combination of agents other than trimethoprim/sulfamethoxazole. The crude mortality and the mortality and the S. maltophilia infection-related mortality were 14.7% and 4.4%, respectively. ICU hospitalization was the only independent prognostic factor for mortality.

Conclusion

S. maltophilia infection in a general hospital can be associated with a good prognosis, except for the patients hospitalized in the ICU. Combination reigmens with fluoroquinolones, colistin, or tigecycline could be alternative treatment options to trimethoprim/sulfamethoxazole.

Community-based outbreaks in vulnerable populations of invasive infections caused by Streptococcus pneumoniae serotypes 5 and 8 in Calgary, Canada

BACKGROUND

Outbreaks of invasive pneumococcal disease (IPD) typically occur within institutions. Beginning in 2005, we detected an increase in serotype (ST) 5 and ST8 IPD cases, predominantly in homeless persons living in an open community.

METHODOLOGY/PRINCIPAL FINDINGS

CASPER (Calgary Area S. pneumoniae Epidemiology Research) surveillance study of all IPD (sterile site isolates) in our region (pop ~1,100,000). Interviews and chart reviews of all cases and all isolates phenotypically analyzed and selected isolated tested by multi-locus sequence typing (MLST).

CONCLUSIONS/SIGNIFICANCE

During 2005-2007, 162 cases of ST5 IPD and 45 cases of ST8 IPD were identified. The isolates demonstrated phenotypic and genotypic clonality. The ST5 isolates were sequence type (ST) 289 and demonstrated intermediate susceptibility to TMP-SMX. The ST8 isolates were predominantly ST1268, with a susceptible antimicrobial susceptibility profile. Individuals with ST5 IPD were more likely to be middle aged (OR 2.6), homeless (OR 4.4), using illicit drugs(OR 4.8), and asthmatic(OR 2.6). Those with ST8 were more likely to be male (OR 4.4), homeless (OR 2.6), aboriginal (OR7.3), and a current smoker (OR 2.5). Overlapping outbreaks of ST5 and ST8 IPD occurred in an open community in Calgary, Canada and homelessness was a predominant risk factor. Homelessness represents a unique community in which pneumococcal outbreaks can occur.

Microbial degradation of pharmaceuticals in estuarine and coastal seawater

Microbial degradation rates were measured for 19 pharmaceuticals in estuarine and coastal surface water samples. Antipyrine, carbamazepine, cotinine, sulfamethoxazole, and trimethoprim were the most refractory (half-lives, t(1/2)=35 to >100 days), making them excellent candidates for wastewater tracers. Nicotine, acetaminophen, and fluoxetine were labile across all treatments (t(1/2)=0.68-11 days). Caffeine, diltiazem, and nifedipine were also and relatively labile in all but one of the treatments (t(1/2)=3.5-13 days). Microbial degradation of caffeine was further confirmed by production (14)CO(2). The fastest decay of non-refractory compounds was always observed in more sewage-affected Jamaica Bay waters. Degradation rates for the majority of these pharmaceuticals are much slower than reported rates for small biomolecules, such as glucose and amino acids. Batch sorption experiments indicate that removal of these soluble pharmaceuticals from the water column to sediments is a relatively insignificant removal process in these receiving waters.

Effect of trimethoprim-sulfamethoxazole on Na and K+ transport properties in the rabbit cortical collecting duct perfused in vitro

BACKGROUND

In this study, the membrane mechanisms of hyperkalemia caused by trimethoprim-sulfamethoxazole (TMP-SMX) combination antibiotics were assessed in the cortical collecting duct (CCD).

METHODS

We used the microelectrode technique and flux measurements, and examined the effects of TMP and SMX on electrical properties of the apical and basolateral membranes in the rabbit CCD perfused in vitro.

RESULTS

TMP in the lumen caused increases in apical membrane voltage, fractional apical membrane resistance (fRA), and transepithelial resistance (RT), all effects which were completely inhibited by luminal amiloride, but not by luminal Ba2+. The luminal TMP inhibited both net Na+ reabsorption and K+ secretion in the CCD. TMP in the bath slightly but significantly depolarized transepithelial voltage and basolateral membrane voltage without influencing fRA or RT. SMX in the lumen or bath had no effect on barrier voltages or resistances.

CONCLUSION

TMP mainly acts on the apical membrane of the CCD, inhibits the amiloride-sensitive macroscopic Na+ conductance in this membrane, and thereby decreases the net driving force for K+ exit across the membrane, resulting in an inhibition of K+ secretion. SMX in the lumen or bath had no effect on the CCD.