Quantifying community-wide antibiotic usage via urban water fingerprinting: Focus on contrasting resource settings in South Africa

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.

Underestimated Cumulative Intake Risk of Veterinary Antibiotics Across Multiple Matrices within a Coupled Breeding-Cropping Model

The coupled breeding-cropping model has been increasingly applied in organic agriculture due to its high resource efficiency; however, the environmental risks of veterinary antibiotics within the solid-liquid-biological system remain unclear. This study focused on a typical poultry-crop system and investigated the migration patterns of enrofloxacin (ENX), ciprofloxacin (CIP), oxytetracycline (OTC), doxycycline (DOX), and florfenicol (FF) in manure, drain, paddy soil, and agricultural products. A strong source-sink relationship was established, with paddy soil identified as the primary reservoir, retaining over 40.1% of the total emissions. The migration behavior of antibiotics in the soil-rice system was primarily influenced by their organic carbon-normalized distribution coefficients, ionization forms, and soil organic carbon contents. Importantly, the cumulative risk of the five antibiotics was 1.4-828 times higher, exceeding risk thresholds by 13.9-fold. These findings emphasize the underestimated cumulative risks of mixed antibiotic use in agroecosystems.

Impact of easing COVID-19 restrictions on antibiotic usage in Eastern China using wastewater-based epidemiology

Coronavirus Disease 2019 (COVID-19) emerged in December 2019, prompting the implementation of a "zero-COVID" policy in Mainland China. The easing of this policy in December 2022 led to a surge in COVID cases, which was believed to significantly increase antibiotic usage, potentially due to antibiotic misuse or increased coinfections. Our study aimed to compare antibiotic consumption and patterns before and after this policy adjustment. We utilised wastewater-based epidemiology (WBE) to analyse antibiotic levels in samples collected from five wastewater treatment plants in Eastern China during January and February of 2021 and 2023. 27 antibiotics were quantified using ultra-high performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS) and analysed via WBE, with the resulting estimates compared with catchment-specific prescription data. 23 antibiotics were detected in wastewater samples, with a substantial increase in usage in 2023 (ranging from 531% to 3734%), consistent with prescription data. Here, we show a significant rise in antibiotic consumption during the COVID-19 surge and this underscores the need for further investigation into the impacts of inappropriate antibiotic use in China.

Uncovering urban water consumption patterns through time series clustering and entropy analysis

Sustainable urban water management is crucial for meeting the growing demands of urban populations. This study presents a novel approach that combines time series clustering, seasonal analysis, and entropy analysis to uncover residential water consumption patterns and their drivers. Using a three-year dataset from the SmartH2o project, encompassing 374 households, we identify nine distinct water consumption patterns through time series clustering, leveraging Dynamic Time Warping (DTW) as the optimal similarity measure. Multiple linear regression reveals key household characteristics influencing water usage behaviors, such as the number of bathrooms and appliance efficiency ratings. Seasonal analysis uncovers temporal dynamics, highlighting shifts towards lower consumption during summer months and increased variability in transitional seasons. Entropy analysis quantifies the diversity and complexity of water consumption at both cluster and household levels, informing targeted interventions. This comprehensive, granular approach enables the development of personalized water conservation strategies and policies, empowering water utilities to optimize resource management and contribute to sustainable urban water practices.

Diagnostics for Public Health - Infectious Disease Surveillance and Control

AbstractAccurate diagnostics are critical in public health to ensure successful disease tracking, prevention, and control. Many of the same characteristics are desirable for diagnostic procedures in both medicine and public health: for example, low cost, high speed, low invasiveness, ease of use and interpretation, day-to-day consistency, and high accuracy. This review lays out five principles that are salient when the goal of diagnosis is to improve the overall health of a population rather than that of a particular patient, and it applies them in two important use cases: pandemic infectious disease and antimicrobial resistance.

Significant differences in usage of antibiotics in three Chinese cities measured by wastewater-based epidemiology

Antibiotic use, particularly inappropriate use by irrational prescribing or over-the-counter purchases, is of great concern for China as it facilitates the spread of antibiotic resistances. In this study, we applied wastewater-based epidemiology (WBE) to monitor the total consumption of eight common antibiotics in three cities in northern, eastern and southern China. Wastewater samples were successively collected from 17 wastewater treatment plants including weekdays and weekends spanning four seasons between 2019 and 2021. The concentration of antibiotics and their corresponding metabolites showed a significant correlation, confirming the measured antibiotics were actually consumed. Different seasonal trends in antibiotic use were found among the cities. It was more prevalent in the winter in the northern city Beijing, with the high antibiotic consumption attributed to peak influenza occurrence in the city. This is clear evidence of irrational prescription of antibiotics since it's known that antibiotics do little to treat influenza. In terms of overall consumption, Foshan is significantly lower, thanks to warmer climate and higher use of herbal tea as a prevention measure. WBE estimates of antibiotic consumption were relatively comparable with other data sources, with azithromycin as the top antibiotic measured here. The studied cities had higher WBE estimated antibiotics consumption than results of previous studies in the literature. Monitoring antibiotic use in different areas and periods through WBE in combination with complementary information, can better inform appropriate antibiotic guideline policies in various regions and nations.

Pharmaceutical and Recreational Drug Usage Patterns during and Post COVID-19 Determined by Wastewater-Based Epidemiology

Wastewater-based epidemiology (WBE) was applied to evaluate the consumption trends of pharmaceuticals (i.e., antibiotics, non-steroidal anti-inflammatory drugs, antiepileptics, antihypertensives, and others), as well as recreational drugs (caffeine, alcohol, and nicotine), in Latvia from December 2020 to July 2023. The time period covers both the COVID-19 pandemic and the post-pandemic periods; therefore, the impact of the implemented restrictions and the consequences of the illness in terms of the usage of pharmaceuticals thereon were investigated. Additionally, the seasonality and impact of the seasonal flu and other acute upper respiratory infections were studied. The results revealed that the pandemic impacted the consumption of alcohol, nicotine, and caffeine, as well as several pharmaceuticals, such as antihypertensives, antidepressants, psychiatric drugs, and the painkiller ibuprofen. The findings suggest that the imposed restrictions during the pandemic may have had a negative effect on the population's health and mental well-being. Distinct seasonal trends were discovered in the consumption patterns of caffeine and alcohol, where lower use was observed during the summer. The seasonal consumption trends of pharmaceuticals were discovered in the case of antibiotics, the antiasthmatic drug salbutamol, and the decongestant xylometazoline, where higher consumption occurred during colder seasons.

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.