Translating antibiotic prescribing into antibiotic resistance in the environment: A hazard characterisation case study

The environment receives antibiotics through a combination of direct application (e.g., aquaculture and fruit production), as well as indirect release through pharmaceutical manufacturing, sewage and animal manure. Antibiotic concentrations in many sewage-impacted rivers are thought to be sufficient to select for antibiotic resistance genes. Yet, because antibiotics are nearly always found associated with antibiotic-resistant faecal bacteria in wastewater, it is difficult to distinguish the selective role of effluent antibiotics within a 'sea' of gut-derived resistance genes. Here we examine the potential for macrolide and fluoroquinolone prescribing in England to select for resistance in the River Thames catchment, England. We show that 64% and 74% of the length of the modelled catchment is chronically exposed to putative resistance-selecting concentrations (PNEC) of macrolides and fluoroquinolones, respectively. Under current macrolide usage, 115 km of the modelled River Thames catchment (8% of total length) exceeds the PNEC by 5-fold. Similarly, under current fluoroquinolone usage, 223 km of the modelled River Thames catchment (16% of total length) exceeds the PNEC by 5-fold. Our results reveal that if reduced prescribing was the sole mitigating measure, that macrolide and fluoroquinolone prescribing would need to decline by 77% and 85%, respectively, to limit resistance selection in the catchment. Significant reductions in antibiotic prescribing are feasible, but innovation in sewage-treatment will be necessary for achieving substantially-reduced antibiotic loads and inactivation of DNA-pollution from resistant bacteria. Greater confidence is needed in current risk-based targets for antibiotics, particularly in mixtures, to better inform environmental risk assessments and mitigation.

Predicting risks from down-the-drain chemicals in a developing country: Mexico and linear alkylbenzene sulfonate as a case study

It is recognized that the amount of natural dilution available can make a significant difference in the exposure and risk assessment of chemicals that emanate from wastewater treatment plants (WWTPs). However, data availability is a common limiting factor in exposure assessments for emerging markets. In the present study, we used a novel approach to derive dilution factors for the receiving waters within 5 km of wastewater discharge points in Mexico by combining locally measured river volumes, ecoregion categorization, data on WWTP capacity, and global river network models. Distributions of wastewater effluent into receiving stream dilution factors were developed for the entire country and organized by ecoregion type to explore spatial differences. The distribution of dilution factors in Mexico ranged from >1000 in tropical and temperate ecoregions to 1 in desert ecoregions. To demonstrate its utility, dilution factors were used to develop a probabilistic model to explore the potential ecological risks of the high-volume surfactant linear alkylbenzene sulfonate (LAS), commonly used in down-the-drain cleaning products. The predicted LAS river exposure values were below the predicted no-effect concentration in all regions. The methodology developed for Mexico can be used to derive refined exposure assessments in other countries with emerging markets throughout the world, resulting in more realistic risk assessments. Environ Toxicol Chem 2018;37:2475-2486. © 2018 SETAC.

Impact of climate change and population growth on a risk assessment for endocrine disruption in fish due to steroid estrogens in England and Wales

In England and Wales, steroid estrogens: estrone, estradiol and ethinylestradiol have previously been identified as the main chemicals causing endocrine disruption in male fish. A national risk assessment is already available for intersex in fish arising from estrogens under current flow conditions. This study presents, to our knowledge, the first set of national catchment-based risk assessments for steroid estrogen under future scenarios. The river flows and temperatures were perturbed using three climate change scenarios (ranging from relatively dry to wet). The effects of demographic changes on estrogen consumption and human population served by sewage treatment works were also included. Compared to the current situation, the results indicated increased future risk:the percentage of high risk category sites, where endocrine disruption is more likely to occur, increased. These increases were mainly caused by changes in human population. This study provides regulators with valuable information to prepare for this potential increased risk.

Nano silver and nano zinc-oxide in surface waters - exposure estimation for Europe at high spatial and temporal resolution

Nano silver and nano zinc-oxide monthly concentrations in surface waters across Europe were modeled at ~6 x 9 km spatial resolution. Nano-particle loadings from households to rivers were simulated considering household connectivity to sewerage, sewage treatment efficiency, the spatial distribution of sewage treatment plants, and their associated populations. These loadings were used to model temporally varying nano-particle concentrations in rivers, lakes and wetlands by considering dilution, downstream transport, water evaporation, water abstraction, and nano-particle sedimentation. Temporal variability in concentrations caused by weather variation was simulated using monthly weather data for a representative 31-year period. Modeled concentrations represent current levels of nano-particle production.Two scenarios were modeled. In the most likely scenario, half the river stretches had long-term average concentrations exceeding 0.002 ng L(-1) nano silver and 1.5 ng L(-1) nano zinc oxide. In 10% of the river stretches, these concentrations exceeded 0.18 ng L(-1) and 150 ng L(-1), respectively. Predicted concentrations were usually highest in July.

Exploiting monitoring data in environmental exposure modelling and risk assessment of pharmaceuticals

In order to establish the environmental impact of an active pharmaceutical ingredient (API), good information on the level of exposure in surface waters is needed. Exposure concentrations are typically estimated using information on the usage of an API as well as removal rates in the patient, the wastewater system and in surface waters. These input data are often highly variable and difficult to obtain, so model estimates often do not agree with measurements made in the field. In this paper we present an approach which uses inverse modelling to estimate overall removal rates of pharmaceuticals at the catchment scale using a hydrological model as well as prescription and monitoring data for a few representative sites for a country or region. These overall removal rates are then used to model exposure across the broader landscape. Evaluation of this approach for APIs in surface waters across England and Wales showed good agreement between modelled exposure distributions and available monitoring data. The use of the approach, alongside estimates of predicted no-effect concentrations for the 12 study compounds, to assess risk of the APIs across the UK landscape, indicated that, for most of the compounds, risks to aquatic life were low. However, ibuprofen was predicted to pose an unacceptable risk in 49.5% of the river reaches studied. For diclofenac, predicted exposure concentrations were also compared to the Environmental Quality Standard previously proposed by the European Commission and 4.5% of river reaches were predicted to exceed this concentration. While the current study focused on pharmaceuticals, the approach could also be valuable in assessing the risks of other 'down the drain' chemicals and could help inform our understanding of the important dissipation processes for pharmaceuticals in the pathway from the patient to ecological receptors.

Do natural rubber latex condoms pose a risk to aquatic systems?

The presence and potential adverse effects of plastic-polymers in the environment are receiving increasing attention in the popular and scientific press. However, quantifying emissions, exposure and effects of these materials remains a challenge. This paper describes the application of a questionnaire survey to quantify emissions of condom material from the domestic household to the sewage waste stream. Condoms are an important mainstay for birth control and the reduction of sexually transmitted infections. Survey participants were estimated to flush condoms down the toilet 2.96% of the time, and emissions were calculated as 0.99 mg of condom material per person per day. Using information on screening efficiencies at sewage treatment plants, the questionnaire data was combined with a GIS-based water quality model (LF2000-WQX) to predicted environmental concentrations (PEC) in a UK river basin catchment. Annual average PECs of condom material were 0.08-0.2 μg L(-1), under the model scenario used. To put these PECs into context, rubber latex condom material was degraded in outdoor microcosms. This resulted in the formation of a complex mixture of substances including chemical degradation products and particles in the nano range. The direct effects of the degradation mixture were investigated using two freshwater organisms with different life cycle traits, the water column crustacean Daphnia magna and the sediment-dwelling larval of Chironomus riparius. Ecotoxicity tests investigated both acute and chronic endpoints and were shown to exhibit no toxic effects. This precluded the derivation of a genuine no-effect concentration. Hence, the results suggest that limited risk to invertebrates is associated with latex condom degradation products to the organisms tested. Future studies should extend this risk framework to assess risks of condoms to other taxonomic groups as well as the risks of other polymer materials.

Estimating surface water concentrations of "down-the-drain" chemicals in China using a global model

Predictions of surface water exposure to "down-the-drain" chemicals are presented which employ grid-based spatially-referenced data on average monthly runoff, population density, country-specific per capita domestic water and substance use rates and sewage treatment provision. Water and chemical load are routed through the landscape using flow directions derived from digital elevation data, accounting for in-stream chemical losses using simple first order kinetics. Although the spatial and temporal resolution of the model are relatively coarse, the model still has advantages over spatially inexplicit "unit-world" approaches, which apply arbitrary dilution factors, in terms of predicting the location of exposure hotspots and the statistical distribution of concentrations. The latter can be employed in probabilistic risk assessments. Here the model was applied to predict surface water exposure to "down-the-drain" chemicals in China for different levels of sewage treatment provision. Predicted spatial patterns of concentration were consistent with observed water quality classes for China.

Assessing the ecotoxicologic hazards of a pandemic influenza medical response

BACKGROUND

The global public health community has closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention has been given to the impact of this response on the environment. Antivirals and antibiotics prescribed to treat influenza are excreted into wastewater in a biologically active form, which presents a new and potentially significant ecotoxicologic challenge to microorganisms responsible for wastewater nutrient removal in wastewater treatment plants (WWTPs) and receiving rivers.

OBJECTIVES

We assessed the ecotoxicologic risks of a pandemic influenza medical response.

METHODS

To evaluate this risk, we coupled a global spatially structured epidemic model that simulates the quantities of antivirals and antibiotics used during an influenza pandemic of varying severity and a water quality model applied to the Thames catchment to determine predicted environmental concentrations. An additional model was then used to assess the effects of antibiotics on microorganisms in WWTPs and rivers.

RESULTS

Consistent with expectations, our model projected a mild pandemic to exhibit a negligible ecotoxicologic hazard. In a moderate and severe pandemic, we projected WWTP toxicity to vary between 0-14% and 5-32% potentially affected fraction (PAF), respectively, and river toxicity to vary between 0-14% and 0-30% PAF, respectively, where PAF is the fraction of microbial species predicted to be growth inhibited (lower and upper 95% reference range).

CONCLUSIONS

The current medical response to pandemic influenza might result in the discharge of insufficiently treated wastewater into receiving rivers, thereby increasing the risk of eutrophication and contamination of drinking water abstraction points. Widespread drugs in the environment could hasten the generation of drug resistance. Our results highlight the need for empirical data on the effects of antibiotics and antiviral medications on WWTPs and freshwater ecotoxicity.

A national risk assessment for intersex in fish arising from steroid estrogens

The occurrence of intersex fish is widespread in the rivers of England and Wales. The extent of intersex in fish populations is believed to be strongly linked to their exposure to steroid estrogens. The present study presents, to our knowledge, the first national, catchment-based risk assessment for steroid estrogens in the world. A graphical information system-based model predicted the concentrations of estradiol (E2), estrone, and ethinylestradiol, which were combined and compared with known biological effect levels to predict the risk of endocrine disruption for 10,313 individual river reaches (21,452 km) receiving effluent from more than 2000 sewage treatment plants serving more than 29 million people. The large scale of this assessment underlines the usefulness of computer-based risk assessment methods. Overall, 61% [corrected] of the modeled reaches (all percentages are in terms of the total river length modeled) in England and Wales were predicted to be not at risk from endocrine disruption (mean concentrations, <1 ng/L E2 equivalents). A large range existed in the percentage of river reaches at risk in the various regions, from 5% in Wales to 67% in the Thames catchment. Important factors influencing this proportion are the population density, particularly their location, and the available dilution. A very small proportion of reaches (approximately 1-3%) were predicted to be at high risk (>10 ng/L E2 equivalents). Many of these high-risk reaches, however, were ditches, which were composed almost entirely of sewage effluent. The model could be applied equally well to any other chemical of concern emanating from the human population that would be impractical to assess by measurement.

A new generic approach for estimating the concentrations of down-the-drain chemicals at catchment and national scale

A new generic approach for estimating chemical concentrations in rivers at catchment and national scales is presented. Domestic chemical loads in waste water are estimated using gridded population data. River flows are estimated by combining predicted runoff with topographically derived flow direction. Regional scale exposure is characterised by two summary statistics: PEC(works), the average concentration immediately downstream of emission points, and, PEC(area), the catchment-average chemical concentration. The method was applied to boron at national (England and Wales) and catchment (Aire-Calder) scales. Predicted concentrations were within 50% of measured mean values in the Aire-Calder catchment and in agreement with results from the GREAT-ER model. The concentration grids generated provide a picture of the spatial distribution of expected chemical concentrations at various scales, and can be used to identify areas of potentially high risk.