Fate characteristics, exposure risk, and control strategy of typical antibiotics in Chinese sewerage system: A review

Multigenerational toxicity effects and impact of antibiotics exposed to duckweed, Lemna minor

The escalating presence of antibiotics in aquatic ecosystems poses substantial risks to public health and ecosystem stability. The objective of this study was to examine the effects of three common antibiotics-ciprofloxacin (CIP), erythromycin (ERY), and sulfamethoxazole (SMX)-on the growth and physiology of Lemna minor (L. minor) across three generations (parental (F0), first filial (F1), and second filial (F2)). Specifically, the research aimed to determine how these antibiotics influence frond number, frond area, root area, and photosynthetic pigment content in L. minor. Higher concentrations of CIP (50 μg/L, 250 μg/L, and 1250 μg/L) significantly decreased frond numbers (F2 > F1 > F0), while ERY exhibited the opposite trend, and SMX displayed adaptation in F2. ERY increased frond area at a lower concentration (10 μg/L), while high concentrations of CIP (250 μg/L and 1250 μg/L) and lower concentrations of SMX (10 μg/L and 50 μg/L) reduced it. CIP displayed a biphasic response on root growth, with 10 μg/L decreasing root area by 760 μm2 and 50 μg/L and 1250 μg/L, increasing it by 2480 μm2 and 2300 μm2, respectively. ERY consistently inhibited root growth. The F1 generation showed the most pronounced reduction in green area, particularly under higher CIP concentrations (1250 μg/L). Chlorophyll A (Chl A) and carotenoid contents were resilient to antibiotic stress, while Chlorophyll B (Chl B) exhibited generation-specific responses. This study highlights the need for continued monitoring of antibiotics in aquatic systems and calls for further research on the long-term impacts of antibiotics on aquatic plants and ecosystems.

Tracing antibiotics in sewers: Concentrations, measurement techniques, and mathematical approaches

Antibiotic contamination in sewer networks has significant environmental and health concerns worldwide, primarily due to its role in promoting bacterial resistance. In this literature review, antibiotic concentrations reported in urban sewers and hospital effluents, techniques for antimicrobial compound detection and quantification, and current modeling strategies are analyzed and discussed based on 91 papers published between 2014 and 2024. One-hundred and nine antibiotic compounds were reported across 80 studies, with sulfonamides, fluoroquinolones, and macrolides being the most frequently detected classes, while amphenicols and aminocyclitols were the least monitored. Advanced analytical techniques such as liquid chromatography and mass spectrometry are the most common approaches used for antibiotic quantification. Modeling efforts remain limited, with kinetic models, Risk Quotient (RQ) assessments, and Wastewater-Based Epidemiology (WBE) representing the main approaches identified. This review compiles 992 reports into a comprehensive dataset intended to support future research, especially for global monitoring, the development of predictive models, and the formulation of regulatory frameworks for managing antibiotic pollution in sewer systems.

Distribution and risk characteristics of antibiotics in China surface water from 2013 to 2024

The continuous release of large quantities of antibiotics into the aquatic environment has led to widespread water pollution in China. Therefore, this study investigated the antibiotic pollution levels and ecological risks of surface water in seven major Chinese watersheds based on research papers from 2013 to 2024. Measured concentrations and ecotoxicity data of sulfonamides (SAs), tetracyclines (TCs), fluoroquinolones (FQs), and macrolides (MLs) in the aquatic environments of China were collected and compiled. The environmental concentration and distribution characteristics of antibiotics in seven major watersheds were statistically analyzed to carry out the evaluation of multiple ecological risks of antibiotics in watersheds across the country, and at the same time, the traceability analysis of antibiotic pollution in different regions was carried out, which will provide a certain theoretical basis for the precise management of antibiotic pollution in the future. The results showed that the distribution and environmental risks of the four antibiotics in different watersheds varied greatly, with the Yangtze River Basin, the Huanghuai Basin, and the Pearl River Basin being affected by anthropogenic activities, economic development, and other factors, with a wider range of antibiotic sampling sites and higher detection concentrations, and with the Northwestern Basin, the Southwestern Basin, and the Songhua and Liaohe River Basins having an overall lower risk of antibiotics. FQs were detected at high concentrations in all the basins, mostly posing high risk to aquatic environments. SAs were the most frequently detected but had the lowest ecological risk. The results of the more refined risk assessment (joint probability curves, JPCs) were ranked in order of risk, with FQs ≥ TCs > MLs > SAs. These results can be used as a reference for integrated management and sustainability studies on basins across the country.

Occurrence and risks of PPCPs of a typical mountainous region: Implications for sustainable urban water systems

Urban wastewater treatment plants (WWTPs) and drinking water treatment plants (DWTPs) play vital roles in the urban water cycle, ensuring access to safe drinking water and maintaining aquatic ecosystems. This study comprehensively assessed the occurrence and risks of pharmaceuticals and personal care products (PPCPs) in urban WWTPs and DWTPs. Our findings revealed widespread PPCPs presence, with concentrations ranging from <1 ng/L to several thousand ng/L. Significant regional disparities in occurrence and composition were observed linked to population types and economic structures. Furthermore, strong correlations were observed between DWTPs and WWTPs indicating consistent transport and transformation patterns of PPCPs within the urban water cycle. Approximately two-thirds of PPCPs were degraded post-WWTP treatment, with about one-tenth persisting in drinking water following surface water dilution and purification processes. Thus, we suggested that controlling the total concentration of the five priority PPCPs in the effluent from the WWTP to <1100 ng/L have potential to reduce the environmental and health risk of PPCPs. Additionally, this research identified influential water quality parameters, such as pH, dissolved oxygen, and temperature, through redundancy analysis. This research underscores the importance of establishing emission standards to mitigate PPCP-related risks and supports sustainable urban water system advancement.

Influence of combined application of tetracycline and streptomycin on microbial diversity and function in rice soil

A microcosm experiment was performed to quantify the residues of antibiotics [tetracycline (TC), streptomycin (STR), and streptocycline (STC; a mixture of TC and STR)] in rice soil and to assess their impact on microbial community structure and function using Illumina-MiSeq metagenomic analysis. Antibiotics were applied at half the recommended dose (0.5RD), recommended dose (RD), and double the recommended dose (2RD). At RD, TC was degraded in soil within 9 days of its application, whereas it took 21 days for STR and STC to degrade below limit of quantification (LOQ) level. The residue data were fitted in decay models, and half-lives (DT50) were 46.5-53.3 h and 177.6-198 h for TC and STR, respectively. Soil enzyme activities (dehydrogenase, β-glucosidase, fluorescein diacetate hydrolase, acid phosphatase, alkaline phosphatase) were negatively affected in the antibiotic-treated soil. Targeted metagenomic analysis showed that the major bacterial phyla such as Chloroflexi, Actinobacteria, Planctomycetes, Crenarchaeota, and Gemmatimonadetes were suppressed by antibiotic treatments as compared to control. Shannon, Simpson, ACE, and Chao1 diversity indices showed that bacterial diversity decreased with the application of antibiotics, and decrease in bacterial diversity was more prominent in case of STC as compared to TC and STR. Overall, the combination of antibiotics negatively affected the soil microbial community structure and function in comparison to their individual application.

Municipal-treated wastewater as a practical alternative to conventional rice irrigation: Effects on antibiotic resistance genes, virulence factors and human bacterial pathogens in soil, and responses of rice grain quality

Reuse of municipal-treated wastewater for agricultural irrigation is becoming increasingly prevalent due to growing demand and decline in freshwater supplies. However, the microbial contamination profile, including antibiotic resistance genes (ARGs), virulence factors (VFs), and human bacterial pathogens (HBPs) in agricultural soil irrigated with municipal-treated wastewater for paddy cultivation, was unknown. Here, metagenomic analysis was applied to provide a systematic insight into the resistome, VFs and HBPs in paddy soils irrigated with municipal-treated wastewater. The obtained results revealed that the residual antibiotics in municipal-treated wastewater has an impact on the antibiotic resistome by increasing both the total number and abundance of ARGs. Furthermore, it was found that sul1 could serve as a potential risk indicator for assessing ARG contamination. VFs, core HBP abundance, and dangerous pathogens remain unaffected by municipal-treated wastewater irrigation for paddy. The good coexistence patterns of ARGs-HBPs and ARGs-VFs demonstrated the presence of resistant pathogenic bacteria. The network analysis revealed that ARGs-bearing Legionella pneumophila, Mycobacterium marinum, Bordetella pertussis, Staphylococcus aureus, and Pseudomonas aeruginosa might be ranked as high-risk HBPs. Additionally, our investigation also demonstrated that reuse of municipal-treated wastewater for agricultural irrigation had no detrimental effects on rice plant growth and grain quality. This study was the first to investigate the response of VFs and HBPs in paddy soil under long-term municipal-treated wastewater irrigation. The obtained results provide a scientific basis for the safe application of municipal-treated wastewater.

Ecological risk assessment of commonly used antibiotics in aquatic ecosystems along the coast of China

The consistent input of antibiotics into aquatic environments may pose risks to various creatures and ecosystems. However, risk assessment of pharmaceuticals and personal care products (PPCPs) in aquatic environments is frequently limited by the lack of toxicity data. To investigate the risk of commonly used antibiotics to various aquatic creatures, we focused on the distribution patterns and temporal dynamics of antibiotics in the coastal estuary area of China and performed a comprehensive ecological risk assessment for four antibiotics: erythromycin (ERY), tetracycline (TCN), norfloxacin (NOR) and sulfamethoxazole (SMX). An interspecies correlation estimation (ICE)-species sensitivity distribution (SSD) combined model was applied to predict the toxicity data of untested aquatic species, and an accurate ecological risk assessment procedure was developed to evaluate the risk level of PPCPs. The results of risk quotient assessments and probabilistic risk assessments (PRAs) suggested that four objective antibiotics in the Chinese coastal estuary area were at a low risk level. These antibiotics posed a high risk in antibiotic-related global hot spots, with probabilistic risk values for ERY, NOR, SMX, and TCN of 81.33 %, 27.08 %, 21.13 %, and 15.44 %, respectively. We applied an extrapolation method to overcome the lack of toxicity data in ecological risk assessment, enhanced the ecological reality of water quality criteria derivation and reduced the uncertainty of risk assessment for antibiotics.

Research progress on the origin, fate, impacts and harm of microplastics and antibiotic resistance genes in wastewater treatment plants

Previous studies reported microplastics (MPs), antibiotics, and antibiotic resistance genes (ARGs) in wastewater treatment plants (WWTPs). There is still a lack of research progress on the origin, fate, impact and hazards of MPs and ARGs in WWTPs. This paper fills a gap in this regard. In our search, we used "microplastics", "antibiotic resistance genes", and "wastewater treatment plant" as topic terms in Web of Science, checking the returned results for relevance by examining paper titles and abstracts. This study mainly explores the following points: (1) the origins and fate of MPs, antibiotics and ARGs in WWTPs; (2) the mechanisms of action of MPs, antibiotics and ARGs in sludge biochemical pools; (3) the impacts of MPs in WWTPs and the spread of ARGs; (4) and the harm inflicted by MPs and ARGs on the environment and human body. Contaminants in sewage sludge such as MPs, ARGs, and antibiotic-resistant bacteria enter the soil and water. Contaminants can travel through the food chain and thus reach humans, leading to increased illness, hospitalization, and even mortality. This study will enhance our understanding of the mechanisms of action among MPs, antibiotics, ARGs, and the harm they inflict on the human body.

Development of a High-Throughput Analytical Method for Antimicrobials in Wastewater Using an Automated Pipetting and Solid-Phase Extraction System

Antimicrobial resistance (AMR) has emerged and spread globally. Recent studies have also reported the presence of antimicrobials in a wide variety of aquatic environments. Conducting a nationwide monitoring survey of AMR in the environment to elucidate its status and to assess its impact on ecosystems and human health is of social importance. In this study, we developed a novel high-throughput analysis (HTA) system based on a 96-well plate solid-phase extraction (SPE), using automated pipetting and an SPE pre-treatment system. The effectiveness of the system as an HTA for antimicrobials in environmental water was verified by comparing it with a conventional manual analytical system in a domestic hospital over a period of two years and four months. The results of the manual analysis and HTA using a combination of automated pipetting and SPE systems were generally consistent, and no statistically significant difference was observed (p > 0.05) between the two systems. The agreement ratios between the measured concentrations based on the conventional and HTA methods were positively correlated with a correlation coefficient of r = 0.99. These results indicate that HTA, which combines automated pipetting and an SPE pre-treatment system for rapid, high-volume analysis, can be used as an effective approach for understanding the environmental contamination of antimicrobials at multiple sites. To the best of our knowledge, this is the first report to present the accuracy and agreement between concentrations based on a manual analysis and those measured using HTA in hospital wastewater. These findings contribute to a comprehensive understanding of antimicrobials in aquatic environments and assess the ecological and human health risks associated with antimicrobials and antimicrobial-resistant bacteria to maintain the safety of aquatic environments.

Urban agglomerations as an environmental dimension of antibiotics transmission through the "One Health" lens

The spatiotemporal distributions of antibiotics in different media have been widely reported; however, their occurrence in the environmental dimension of the Chinese urban agglomerations has received less attention, especially in bioaccumulation and health risks of antibiotics through the "One Health" lens. The review presents the current knowledge on the environmental occurrence, bioaccumulation, as well as health exposure risks in urban agglomerations through the "One Health" lens, and identifies current information gaps. The reviewed studies suggested antibiotic concentrations in water and soil were more sensitive to social indicators of urban agglomerations than those in sediment. The ecological risk and resistance risk of antibiotics in water were much higher than those of sediments, and the high-risk phenomenon occurred at a higher frequency in urban agglomerations. Erythromycin-H2O (ETM-H2O), amoxicillin (AMOX) and norfloxacin (NFC) were priority-controlled antibiotics in urban waters. Tetracyclines (TCs) posed medium to high risks to soil organisms in the soil of urban agglomerations. Health risk evaluation based on dietary intake showed that children had the highest dietary intake of antibiotics in urban agglomerations. The health risk of antibiotics was higher in children than in other age groups. Our results also demonstrated that dietary structure might impact health risks associated with target antibiotics in urban agglomerations to some extent.

In-sewer stability assessment of 140 pharmaceuticals, personal care products, pesticides and their metabolites: Implications for wastewater-based epidemiology biomarker screening

The monitoring of pharmaceuticals, personal care products (PCPs), pesticides, and their metabolites through wastewater-based epidemiology (WBE) provides timely information on pharmaceutical consumption patterns, chronic disease treatment rates, antibiotic usage, and exposure to harmful chemicals. However, before applying them for quantitative WBE back-estimation, it is necessary to understand their stability in the sewer system to screen suitable WBE biomarkers thereby reducing research uncertainty. This study investigated the in-sewer stability of 140 typical pharmaceuticals, PCPs, pesticides, and their metabolites across 15 subcategories, using a series of laboratory sewer sediment and biofilm reactors. For the first time, stability results for 89 of these compounds were reported. Among the 140 target compounds, 61 biomarkers demonstrated high stability in all sewer reactors, while 41 biomarkers were significantly removed merely by sediment processes. For biomarkers exhibiting notable attenuation, the influence of sediment processes was generally more pronounced than biofilm, due to its stronger microbial activities and more pronounced diffusion or adsorption processes. Adsorption emerged as the predominant factor causing biomarker removal compared to biodegradation and diffusion. Significantly different organic carbon-water partitioning coefficient (Koc) and distribution coefficient at pH = 7 (logD) values were observed between highly stable and unstable biomarkers, with most hydrophobic substances (Koc > 100 or logD > 2) displaying instability. In light of these findings, we introduced a primary biomarker screening process to efficiently exclude inappropriate candidates, achieving a commendable 77 % accuracy. Overall, this study represents the first comprehensive report on the in-sewer stability of 89 pharmaceuticals, PCPs, pesticides, and their metabolites, and provided crucial reference points for understanding the intricate sewer sediment processes.

Occurrence, removal, emission and environment risk of 32 antibiotics and metabolites in wastewater treatment plants in Wuhu, China

Wastewater treatment plants (WWTPs) are considered important sources of antibiotics and metabolites in aquatic environments and pose a serious threat to the safety of aquatic organisms. In this study, we investigated the seasonal occurrence, removal, emission, and environmental risk assessment (ERA) of 32 antibiotics and metabolites at four WWTPs located in Wuhu, China. The main findings of this study are as follows: Ofloxacin concentrations dominated all WWTPs, and large quantities of sulfachinoxalin were only detected in WWTP 2 treating mixed sewage. The average apparent removal of individual parent antibiotics or metabolites ranged from -94.7 to 100 %. There was a noticeable seasonal emission pattern (independent t-test, t = 9.89, p < 0.001), with lower emissions observed during summer. WWTPs discharged 85.2 ± 43.8 g of antibiotics and metabolites each day. Approximately 87 % of emissions were discharged into the mainstream of the Yangtze River, while the remainder were discharged into its tributary, the Zhanghe River. The total emissions of 21 parent antibiotics were approximately 18 % of the prescription data, indicating that a considerable and alarming amount of prototype drugs entered the receiving water body. Based on the risk quotient (RQ) of the ERA, the Zhanghe River has a moderate risk of ofloxacin (RQ = 0.111-0.583), a low or insignificant risk of sulfamethoxazole (RQ = 0.003-0.048), and an insignificant risk of other antibiotics or metabolites. However, the risk of antibiotics or metabolites in the mainstream of Yangtze River is insignificant. This study could help understand the seasonal emission patterns of antibiotics and metabolites, as well as more antibiotics sensitive of environmental risks in tributary than that in mainstream.

Response of heavy-metal and antibiotic resistance genes and their related microbe in rice paddy irrigated with treated municipal wastewaters

Paddy irrigation with secondary effluents from municipal wastewater treatment plants (MWTPs) is a well-established practice to alleviate water scarcity. However, the reuse might lead to more complicated contamination caused by interactions between residual antibiotics in effluents and heavy metals in paddy soil. To date, no information is available for the potential effects of dual stress of heavy metals and antibiotics on heavy-metal resistance genes (MRGs) and antibiotic resistance genes (ARGs). Here, this study investigated the response of heavy metal and antibiotic resistance genes, and related microorganisms to the dual threat of antibiotics and heavy metals under the long-term MWTP effluent irrigation for rice paddy using metagenome. The results showed that there was not a negative effect on rice consumption if MWTP effluent was used to irrigate rice for a long time. The concentration of antibiotics could reshape the ARGs and MRG profiles in rice paddy soil. The findings revealed the co-occurrence of ARGs and MRGs in rice paddy soils, thus highlighting the need for simultaneous elimination of antibiotics and heavy metals to effectively reduce ARGs and MRGs. Acn and sul1 genes encoding Iron and sulfonamides resistance mechanisms are the most abundant MRG and ARG, respectively. Network analysis revealed the possibility that IntI1 plays a role in the co-transmission of MRG and ARG to host microbes, and that Proteobacteria are the most dominant hosts for MRG, ARG, and integrons. The presence of antibiotics in irrigated MWTP effluents has been found to stimulate the proliferation of heavy metal and antibiotic resistances by altering soil microbial communities. This study will enhance our comprehension of the co-selection between ARGs and MRGs, as well as reveal the concealed environmental impacts of combined pollution. The obtained results have important implications for food safety and human health in rice.

Stability and WBE biomarkers possibility of 17 antiviral drugs in sewage and gravity sewers

Wastewater-based epidemiology (WBE) is a promising technique for monitoring the rapidly increasing use of antiviral drugs during the COVID-19 pandemic. It is essential to evaluate the in-sewer stability of antiviral drugs in order to determine appropriate biomarkers. This study developed an analytical method for quantification of 17 typical antiviral drugs, and investigated the stability of target compounds in sewer through 4 laboratory-scale gravity sewer reactors. Nine antiviral drugs (lamivudine, acyclovir, amantadine, favipiravir, nevirapine, oseltamivir, ganciclovir, emtricitabine and telbivudine) were observed to be stable and recommended as appropriate biomarkers for WBE. As for the other 8 unstable drugs (abacavir, arbidol, ribavirin, zidovudine, ritonavir, lopinavir, remdesivir and efavirenz), their attenuation was driven by adsorption, biodegradation and diffusion. Moreover, reaction kinetics revealed that the effects of sediments and biofilms were regarded to be independent in gravity sewers, and the rate constants of removal by biofilms was directly proportional to the ratio of surface area against wastewater volume. The study highlighted the potential importance of flow velocity for compound stability, since an increased flow velocity significantly accelerated the removal of unstable biomarkers. In addition, a framework for graded evaluation of biomarker stability was proposed to provide reference for researchers to select suitable WBE biomarkers. Compared with current classification method, this framework considered the influences of residence time and different removal mechanisms, which additionally screened four antiviral drugs as viable WBE biomarkers. This is the first study to report the stability of antiviral drugs in gravity sewers.

Effect of live and inactivated Chlamydomonas reinhardtii on the removal of tetracycline in aquatic environments

With the development of medical drugs, the widely used tetracycline has brought many adverse effects on the ecosystem and human health. Tetracycline pollution of water environment is becoming more and more serious, and has become an emerging environmental problem. As single celled organisms, microalgae are not only model organisms for risk assessment of aquatic ecosystems, but also can efficiently purify sewage. Microalgae-mediated pollutant remediation has attracted more and more attention from researchers. In this paper, Chlamydomonas reinhardtii (C. reinhardtii) was used to remove tetracycline in aqueous solution, and the removal efficiency and mechanism of microalgae on tetracycline were studied. The results showed that the removal rates of tetracycline by active and inactivated microalgae at a density of 5 × 10⁶ cells·mL^-1 were 81.9% and 89.8%, respectively. C. reinhardtii removed tetracycline through biosorption and nonmetabolic processes. Microalgal cell supernatant and hydroxyl radicals could significantly promote the removal of tetracycline. The positively charged tetracycline was electrostatically adsorbed on the microalgae surface and extracellular polymeric substances. Microalgae biomass can promote the production of ROS and enhance the ability of microalgae to remove tetracycline.