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Emerging contaminants (ECs) are contained in hospital wastewater (HWW), including pharmaceutical active compounds, personal care products, endocrine-disrupting compounds, and hormones. Antibiotics, X-ray contrast agents, disinfectants, and pharmaceuticals are examples of problematic compounds found in hospital wastewater. Many of these chemical compounds are resistant to standard wastewater treatment systems. If not treated properly, these contaminants might enter natural aquatic and terrestrial ecosystems, consequently jeopardizing the environment and human health. Regular wastewater treatment facilities are not intended to treat all chemicals and biological pollutants; thus, these toxic substances can be released into aquatic environments. Therefore, suitable processes and innovative technologies should be employed to avoid the release of ECs into aquatic habitats. Though for wastewater treatment, the required rules and legislation are available, efficiently removing ECs from HWW necessitates the usage of sophisticated and novel treatment knowledge. This review summarizes a compilation of the types of contaminants released from healthcare facilities, national and international guidelines, and HWW management, and provides a comprehensive understanding of traditional and contemporary strategies for efficiently managing HWW. A critical assessment of the present breakthroughs, gaps in understanding, and future research goals is also provided.Article Highlights: Emphasis on treating hospital effluents to mitigate their hazardous effects on the environment (MDR, ECs, radionuclides, etc.) Guidelines and regulations for managing hospital effluents have been elaborated. Conventional and advanced approaches for treating hospital wastewater are discussed. [ABSTRACT FROM AUTHOR]

Hospital wastewater contains microorganisms, heavy metals, toxic chemicals, and different drugs that might be treated insufficiently or not at all before they enter municipal wastewater, causing numerous problems for humans and other living organisms. The aim of this study was to assess the performance of the UV/H2O2/S2O82- process in the treatment of hospital wastewater. This process has been modelled and optimised using the statistical response-surface method (RSM), and the regression analysis showed that the data were well-fitted with a second-order polynomial equation. Based on the model, the biochemical oxygen demand (BOD) removal efficiency can reach 93.2% in optimal conditions of pH = 3.1, H2O2 dosage of 203.1 mg/L, and NaPS dosage of 44.7 mg/L. The results showed that in the presence of both persulphate and hydrogen peroxide, the process efficiency was higher in acidic conditions and in the range of the design experiment, more oxidants had more efficiency. Turbidity, total Kjeldahl nitrogen (TKN), total organic carbon (TOC), total coliform, and E. coli were also studied as supplementary parameters, and removal efficiencies of about 78.53%, 70%, 52%, 99%, and 99.8% were achieved, respectively. Kinetic studies revealed that the data were well-fitted with the second-order kinetic model and had a regression coefficient of 0.97 and a rate constant of 0.0018 (L/mg min). [ABSTRACT FROM AUTHOR]

Background: The high levels of antimicrobial consumption in hospitals contribute to the occurrence of antimicrobial resistant bacteria. Antimicrobial resistant bacteria and sub-lethal concentrations of antimicrobial metabolites can end up in hospital wastewater which can spread to the environment and to the community. However, information on the resistance profile of bacteria isolated from environments is not well studied. Thus, the main aim of this study was to determine the antibiotic resistance profile of bacteria from hospital wastewater in Bahir Dar City, Northwest Ethiopia. Method: A total of 70 hospital wastewater samples were collected from two comprehensive specialized hospitals using a grab-sampling technique. Bacteria were identified using colony morphology, Gram staining, and biochemical tests. The drug susceptibility test was performed using the Kirby-Bauer disc diffusion method on Muller-Hinton agar. Result: The most dominant bacterial isolates from hospital wastewater were Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Citrobacter spp., Acinetobacter spp., Enterobacter spp., Klebsiella pneumoniae (K. pneumoniae), and Pseudomonas aeruginosa (P. aeruginosa). All K. pneumoniae and 52.4% (11/21) E. coli were resistant to ceftazidime (third-generation cephalosporin), while Citrobacter spp., Acinetobacter spp., and Enterobacter spp., were susceptible to ceftazidime. Likewise, S. aureus revealed 64% (16/25) resistance to erythromycin. Overall, 22.2% of bacterial isolates were multidrug resistant bacteria to the commonly prescribed antimicrobials. Conclusion: Hospital waste waters contain high prevalence of multiple drug-resistant bacteria, particularly the third-generation cephalosporin resistant K. pneumoniae and E. coli would be a big concern. Infection prevention and control practices with proper treatment of hospital wastewater before discharging should be in practice to contain the spread of drug-resistant bacteria from hospital to external environment. [ABSTRACT FROM AUTHOR]

Single- and bimetallic carbon xerogels were prepared by incorporating iron and iron-cobalt precursors during their synthesis, respectively, and tested in the catalytic wet peroxide oxidation (CWPO) of ibuprofen spiked into a simulated matrix in batch mode. The bimetallic catalyst outperformed single and non-metallic catalyst by 25 and 85% after 360 min of reaction, at mild temperature (30 °C). The best-performing catalyst was further used to treat hospital wastewater in a CWPO system operating in full continuous mode. Process optimization was carried out considering different catalyst loads, temperatures, and pH. The results obtained showed that the best conditions are initial pH 3, T = 80 °C, and a catalyst load of 35.4 mg cm−3. Having maintained values of chemical oxygen demand (COD) removals as high as 80% after 24 h of continuous operation, the results herein reported revealed the high potential of the bimetallic carbon xerogel for CWPO of hospital wastewater beyond conventional applications in batch mode. Despite some catalytic deactivation, the bimetallic carbon xerogel still delivered a mineralization degree as high as 55% of the initial total organic carbon (TOC) content of the hospital wastewater in the third 24-h cycle of CWPO in continuous mode of operation with successive catalyst reuse, as opposed to a 73% TOC removal in the first cycle. Therefore, our results open prospects for the implementation of CWPO for hospital wastewater treatment in continuous mode of operation. [ABSTRACT FROM AUTHOR]

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SARS-CoV-2, primarily affecting the respiratory system, is also found in fecal samples from COVID-19 patients, demonstrating wastewater as a significant route for viral RNA transmission. During high prevalence periods, healthcare facility wastewater became a potential contamination source. Understanding the role of wastewater in epidemiology is crucial for public health risk assessment. In hospitals, with a specific number of COVID-19 cases, wastewater analysis offers a unique opportunity to link virus presence in wastewater with COVID-19 hospitalizations, a connection that is not possible in urban wastewater treatment plants (WWTPs). Shorter wastewater transit times enable more accurate virus tracking. With documented infection rates and rigorous testing, hospitals are ideal for wastewater monitoring, revealing practicalities and limitations. This review updates global efforts in quantifying SARS-CoV-2 in hospital wastewater, considering hospitalization rates' influence on viral RNA levels and comparing disinfection methods. Insights gleaned from this study contribute to Wastewater-based Epidemiology (WBE) and can be applied to other virus strains, enhancing our understanding of disease transmission dynamics and aiding in public health response strategies. [ABSTRACT FROM AUTHOR]

This study collected ten treated wastewater samples from Vinh Long General Hospital to determine their physicochemical characteristics and antibiotic properties. All treated wastewater samples collected during the monitoring periods complied with national regulations. In addition, these samples did not contain bacteria such as Salmonella, Shigella, and Vibrio cholerae. The investigation yielded a total of 25 Escherichia coli isolates. The E. coli isolates exhibied highest antibiotic resistance rate to ampicillin (100%), followed by ciprofloxacin, amoxicillin/clavulanic acid, and cefazolin (96%, 92%, and 92%, respectively). The resistance rate to fosfomycin was 88%, whereas 80% of the isolates were resistant to sulfamethoxazole-trimethoprim. The resistance rate to gentamicin was 72%, whereas that to imipenem and tetracycline was 52%. In addition, 44% isolates were resistant to chloramphenicol, and 32% of isolates were colistin-resistant. Among analyzed isolates, three were resistant to 10 of 11 tested antibiotics but only displayed intermediate resistance to imipenems (carbapenems). Surprisingly, 23 out of 25 isolates showed a positive ESBL phenotype. Eleven of them had both the blaTEM and blaCTX-M-1 group structural genes, while twelve only had the blaCTX-M-1 group gene. Furthermore, none of the isolated E. coli isolates exhibited the blaSHV gene. The minimum inhibitory concentration (MIC) of colistin exceeded 4 μg/mL in 8 out of 25 (32%) isolates. Seven of eight isolates (87.5%) carried the mcr-1 gene, while one (12.5%) carried the mcr-8 gene. None of the other mcr (mcr-2 to mcr-9) genes were found. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is a major global concern and economic threat, necessitating a reliable monitoring approach to understand its frequency and spread via the environment. Hospital wastewater serves as a critical reservoir for antimicrobial-resistant organisms; however, its role in resistance gene distribution and dissemination remains poorly understood. This study integrates metagenomic and metatranscriptomic analyses, elucidating the dynamics of antimicrobial resistance in hospital wastewater. Integrated metagenomic and metatranscriptomic sequencing were used to identify actively expressed antimicrobial-resistant genes and antimicrobial-resistant bacteria, offering comprehensive insights into antimicrobial resistance dynamics in hospital wastewater. Liquid chromatography–tandem mass spectrometry analysis revealed the presence of ampicillin, sulbactam, levofloxacin, sulfamethoxazole, and trimethoprim in the sample, which could apply selective pressure on antimicrobial resistance gene expression. While multidrug resistance genes were the most prevalent sequences in both metagenome-assembled genomes and plasmids, plasmid-derived sequences showed a high mRNA/DNA ratio, emphasizing the presence of functionally expressed antimicrobial resistance genes on plasmids rather than on chromosomes. The metagenomic and metatranscriptomic analyses revealed Serratia nevei MAG14 with high mRNA levels of antimicrobial resistance genes; moreover, multidrug-resistant Serratia sp., genetically related to MAG14, was isolated from the wastewater, supporting the phenotypic characterization of crucial antimicrobial-resistant bacteria and validating the genome analysis results. The findings underscore key genes and bacteria as targets for antimicrobial resistance surveillance in hospital wastewater to protect public and environmental health. [ABSTRACT FROM AUTHOR]

The hospital wastewater is major contributor to pharmaceutical contaminants, particularly antibiotic like tetracycline. Tetracycline is often found as a pollutant in water bodies, primarily due to its improper disposal and excretion through human and animal waste. This wastewater poses serious environmental and health risks. We synthesized a novel composite material M type lead hexaferrites/g-carbon nitride (PbFe12O19/g-C3N4) to address this alarming issue. The combine effect of lead hexaferrite with graphitic-C3N4, aiming to enhance the degradation of tetracycline (TC). The characterization of the synthesized composite was conducted using X-ray diffraction spectroscopy (XRD), Scanning electron microscope (SEM), Fourier transform infrared radiation spectroscopy (FTIR) and UV-Visible spectroscopy. The photocatalytic output of the samples was evaluated under sunlight irradiation. The results demonstrated superior removal efficiency of tetracycline up to 90% in only 60 min compared to individual components. This work highlights the potential of PbFe12O19/g-C3N4 composites as effective photocatalysts for treating pharmaceutical contaminants especially tetracycline in wastewater. Highlights: Combination of PbFe12O19 and g-C3N4 enhanced charge separation and increased surface area. The nanocomposites have a band gap of 2.03 eV, ideal for photocatalysis under visible light. Achieved 90% degradation of tetracycline in 60 min under sunlight. g-C3N4-based composites offer high conductivity and porosity for effective antibiotic removal. [ABSTRACT FROM AUTHOR]

Background: Klebsiella michiganensis is an emerging human pathogen that causes nosocomial infections. Its prevalence and spread in the environment should not be ignored. This study identified and characterized Klebsiella michiganensis co-harboring blaKPC-2 and TmexCD2-ToprJ2 in hospital wastewater samples. Methods: Twelve K. michiganensis strains were isolated from wastewater samples collected at a tertiary hospital in Beijing, China. The genomic characteristics of K. michiganensis strains were analyzed using whole-genome sequences, providing information on the comparison between the genome of K. michiganensis strains and the reference genome, antibiotic resistance genes (ARGs), virulence genes, secretion systems, and mobile genetic elements (plasmids, insertion sequences [ISs], and prophages). Results: Genome analysis showed that the twelve multi-drug resistant (MDR) strains carried a variety of ARGs and virulence genes, as well as four macromolecular secretion systems (T1SS, T2SS, T5aSS, T5bSS, and T4aP). The genetic environments of both the TmexCD2-ToprJ2 gene cluster and blaKPC-2 gene contained ISs. The plasmids carrying TmexCD2-ToprJ2 gene cluster of nine strains in clade 1 and two strains in clade 2 were annotated as IncR plasmid and rep_cluster_1254 type, respectively. The plasmids carrying blaKPC-2 in 10 strains in clade 1 were identified as IncU, and the plasmids carrying blaKPC-2 in the k11 and k12 strains in clade 2 were IncU and IncX6. The phylogenetic tree and heatmap revealed that the secretion system of type VI (T6SSi) existed in 10 strains in clade 1, and Type IV (T4SS) only existed in the k11 strain in clade 2. In addition, K. michiganensis strains carried 13 plasmids, 14 ISs, and 138 prophages. Conclusion: In this study, the whole genome sequencing demonstrated the diversity of K. michiganensis genome despite 12 K. michiganensis strains from a hospital wastewater, which lays the foundation for further genetic research and drug resistance gene transmission. [ABSTRACT FROM AUTHOR]

Abstract Background The high levels of antimicrobial consumption in hospitals contribute to the occurrence of antimicrobial resistant bacteria. Antimicrobial resistant bacteria and sub-lethal concentrations of antimicrobial metabolites can end up in hospital wastewater which can spread to the environment and to the community. However, information on the resistance profile of bacteria isolated from environments is not well studied. Thus, the main aim of this study was to determine the antibiotic resistance profile of bacteria from hospital wastewater in Bahir Dar City, Northwest Ethiopia. Method A total of 70 hospital wastewater samples were collected from two comprehensive specialized hospitals using a grab-sampling technique. Bacteria were identified using colony morphology, Gram staining, and biochemical tests. The drug susceptibility test was performed using the Kirby-Bauer disc diffusion method on Muller-Hinton agar. Result The most dominant bacterial isolates from hospital wastewater were Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Citrobacter spp., Acinetobacter spp., Enterobacter spp., Klebsiella pneumoniae (K. pneumoniae), and Pseudomonas aeruginosa (P. aeruginosa). All K. pneumoniae and 52.4% (11/21) E. coli were resistant to ceftazidime (third-generation cephalosporin), while Citrobacter spp., Acinetobacter spp., and Enterobacter spp., were susceptible to ceftazidime. Likewise, S. aureus revealed 64% (16/25) resistance to erythromycin. Overall, 22.2% of bacterial isolates were multidrug resistant bacteria to the commonly prescribed antimicrobials. Conclusion Hospital waste waters contain high prevalence of multiple drug-resistant bacteria, particularly the third-generation cephalosporin resistant K. pneumoniae and E. coli would be a big concern. Infection prevention and control practices with proper treatment of hospital wastewater before discharging should be in practice to contain the spread of drug-resistant bacteria from hospital to external environment.

Abstract Emerging contaminants (ECs) are contained in hospital wastewater (HWW), including pharmaceutical active compounds, personal care products, endocrine-disrupting compounds, and hormones. Antibiotics, X-ray contrast agents, disinfectants, and pharmaceuticals are examples of problematic compounds found in hospital wastewater. Many of these chemical compounds are resistant to standard wastewater treatment systems. If not treated properly, these contaminants might enter natural aquatic and terrestrial ecosystems, consequently jeopardizing the environment and human health. Regular wastewater treatment facilities are not intended to treat all chemicals and biological pollutants; thus, these toxic substances can be released into aquatic environments. Therefore, suitable processes and innovative technologies should be employed to avoid the release of ECs into aquatic habitats. Though for wastewater treatment, the required rules and legislation are available, efficiently removing ECs from HWW necessitates the usage of sophisticated and novel treatment knowledge. This review summarizes a compilation of the types of contaminants released from healthcare facilities, national and international guidelines, and HWW management, and provides a comprehensive understanding of traditional and contemporary strategies for efficiently managing HWW. A critical assessment of the present breakthroughs, gaps in understanding, and future research goals is also provided.

Jiamin Long,1,2,* Jiali Chen,3,* Yue Yuan,4,* Shaozhen Yang,5,* Xinya Xie,1,2 Xuelian Wu,1,2 Yuan Liu,1,2 Jinpeng Guo,2 Yong Chen,1,2 Changjun Wang,1,2 Xiong Liu2 1School of Public Health, China Medical University, Shenyang, 110122, People’s Republic of China; 2Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, People’s Republic of China; 3School of Medicine, NanKai University, Tianjin, 300071, People’s Republic of China; 4Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, People’s Republic of China; 5School of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiong Liu; Changjun Wang, Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, People’s Republic of China, Email liuxiong714@163.com; science2008@hotmail.comBackground: Klebsiella michiganensis is an emerging human pathogen that causes nosocomial infections. Its prevalence and spread in the environment should not be ignored. This study identified and characterized Klebsiella michiganensis co-harboring blaKPC-2 and TmexCD2-ToprJ2 in hospital wastewater samples.Methods: Twelve K. michiganensis strains were isolated from wastewater samples collected at a tertiary hospital in Beijing, China. The genomic characteristics of K. michiganensis strains were analyzed using whole-genome sequences, providing information on the comparison between the genome of K. michiganensis strains and the reference genome, antibiotic resistance genes (ARGs), virulence genes, secretion systems, and mobile genetic elements (plasmids, insertion sequences [ISs], and prophages).Results: Genome analysis showed that the twelve multi-drug resistant (MDR) strains carried a variety of ARGs and virulence genes, as well as four macromolecular secretion systems (T1SS, T2SS, T5aSS, T5bSS, and T4aP). The genetic environments of both the TmexCD2-ToprJ2 gene cluster and blaKPC-2 gene contained ISs. The plasmids carrying TmexCD2-ToprJ2 gene cluster of nine strains in clade 1 and two strains in clade 2 were annotated as IncR plasmid and rep_cluster_1254 type, respectively. The plasmids carrying blaKPC-2 in 10 strains in clade 1 were identified as IncU, and the plasmids carrying blaKPC-2 in the k11 and k12 strains in clade 2 were IncU and IncX6. The phylogenetic tree and heatmap revealed that the secretion system of type VI (T6SSi) existed in 10 strains in clade 1, and Type IV (T4SS) only existed in the k11 strain in clade 2. In addition, K. michiganensis strains carried 13 plasmids, 14 ISs, and 138 prophages.Conclusion: In this study, the whole genome sequencing demonstrated the diversity of K. michiganensis genome despite 12 K. michiganensis strains from a hospital wastewater, which lays the foundation for further genetic research and drug resistance gene transmission.Keywords: Klebsiella michiganensis, hospital wastewater, whole-genome sequencing, blaKPC-2, TmexCD2-ToprJ2

BACKGROUND: Hospital wastewater (HWW) charges wastewater treatment plants (WWTPs) with a mixture of contaminants such as pharmaceutically active compounds (PhACs) and pathogenic bacteria. This matrix is considered highly toxic to the ecosystem and organisms, and it may induce the development of antibiotic resistant bacteria (ARB) and the transfer of antibiotic resistance genes (ARGs) within microbial communities. Conventional WWTPs cannot treat HWW effectively, because they have not been designed to confront this challenge. Therefore, this study investigated the applicability of photocatalysis to purify HWW, regarding its ecotoxicity and the removal rates of targeted substances, selected pathogenic bacteria and specific ARGs. RESULTS: The HWW samples showed high toxicity towards the bioindicator Daphnia magna population, while they also contained significant levels of ARB and ARGs. Upon application of the photocatalytic treatment, the pharmaceutical concentrations decreased at a rate of >80% and the removal rates of the examined bacteria (Escherichia coli, Enterococci, Klebsiella sp. and Staphylococcus sp.) were >80%. Importantly, the bacteria remaining after photocatalysis were sensitive to the tested antibiotics. Conversely, the examined ARGs were present in high concentrations before and after photocatalytic treatment. For example, the concentrations of the selected genes, namely ampC, sul2, tetA and qnrA, in the effluents were from 104 to 106 gene copies L−1. CONCLUSIONS: Photocatalysis may be a promising treatment technique for the elimination of PhACs and pathogenic bacteria from HWW. Moreover, it proved capable of altering the antibiotic resistance profile of the bacteria surviving after treatment, making them sensitive to certain antibiotic compounds. However, the main concern regarding public health protection remains, as the presence of ARGs in effluents in considerable concentrations may induce antibiotic resistance in bacterial communities of aquatic environments. © 2023 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry (SCI). [ABSTRACT FROM AUTHOR]

The periphery of the hospital water system interfaces at multiple points with patients and staff in clinical areas. This comprises mostly sinks and showers and presents a significant infection control risk. Wastewater drains in particular act as a reservoir of pathogens that can be transmitted to patients. Numerous strategies have been investigated as potential methods to reduce biofilm and bacterial load including regular application of biocidal chemicals. Traditional methods of assessing the efficacy of such products relies on culture-based microbiological techniques, usually targeting a limited range of key pathogens. We assessed the efficacy of a peracetic acid containing drain disinfectant product on seven clinical handwash basin drains, taking daily samples over six weeks (before, during and after use of the drain disinfectant product). We used a rapid, culture-independent estimation of total bacterial viable count (TVC) to assess efficacy. We applied long-read metagenomic sequencing to study the entire drain microbiome, which allowed taxonomic changes to be documented following use of the drain disinfectant product. All samples were found to be heavily contaminated, however the drain disinfectant product reduced the TVC from an estimated mean of 4228 cfu/mL to 2874 cfu/mL. This reduction was sustained in the two weeks following cessation of the product. Long-read metagenomic sequencing showed a microbiome dominated with Gram-negative organisms, with some taxonomic shifts in samples before and after application of the drain disinfectant. The impact on hospital-acquired infections from reducing bioburden in hospital drains by approximately a third, along with any associated changes in bacterial composition, needs evaluation in future studies. [ABSTRACT FROM AUTHOR]

Environmental release of wastewater that contains cytostatic drugs can cause genotoxic impact, since these drugs act directly on the genetic material of aquatic organisms. Thus, the aim of this study was to evaluate the removal of the cytostatic drugs cytarabine (CTR) and methotrexate (MTX) using different physico-chemical methods individually (i.e. US, O3, H2O2 and UV) and combined (i.e. O3/US, US/H2O2, O3/H2O2 and O3/US/H2O2) under different pH conditions (4, 7 and 10). In the degradation tests, the efficiency of the methods applied was found to be dependent on the pH of the solution, with the degradation of CTR being better at pH 4 and MTX at pH 7 and pH 10. The US, H2O2 and US + H2O2 methods were the least efficient in degrading CTR and MTX under the pH conditions tested. The highest MTX degradation rate after 16 min of treatment at pH 7 was achieved by the O3 + H2O2 method (97.05% – C/C0 = 0.0295). For CTR, the highest degradation rate after 16 min of treatment was achieved by the O3 process (99.70% – C/C0 = 0.0030) at pH 4. In conclusion, most of the treatment methods tested for the degradation of CTR and MTX are effective. Notably, ozonolysis is an efficient process applied alone. Also, in combination with other methods (US + O3, O3 + H2O2 and O3 + H2O2 + US) it increases the degradation performance, showing a rapid removal rate of 70–94% in less than 4 min of treatment. [ABSTRACT FROM AUTHOR]

The problem of antimicrobial resistance (AMR) is not limited to the medical field but is also becoming prevalent on a global scale in the environmental field. Environmental water pollution caused by the discharge of wastewater into aquatic environments has caused concern in the context of the sustainable development of modern society. However, there have been few studies focused on the treatment of hospital wastewater, and the potential consequences of this remain unknown. This study evaluated the efficacy of the inactivation of antimicrobial-resistant bacteria (AMRB) and antimicrobial resistance genes (AMRGs) in model wastewater treatment plant (WWTP) wastewater and hospital effluent based on direct ultraviolet (UV) light irradiation provided by a conventional mercury lamp with a peak wavelength of 254 nm and an ultraviolet light-emitting diode (UV-LED) with a peak emission of 280 nm under test conditions in which the irradiance of both was adjusted to the same intensity. The overall results indicated that both UV- and UV-LED-mediated disinfection effectively inactivated the AMRB in both wastewater types (>99.9% after 1–3 min of UV and 3 min of UV-LED treatment). Additionally, AMRGs were also removed (0.2–1.4 log10 for UV 254 nm and 0.1–1.3 log10 for UV 280 nm), and notably, there was no statistically significant decrease (p < 0.05) in the AMRGs between the UV and UV-LED treatments. The results of this study highlight the importance of utilizing a local inactivation treatment directly for wastewater generated by a hospital prior to its flow into a WWTP as sewage. Although additional disinfection treatment at the WWTP is likely necessary to remove the entire quantity of AMRB and AMRGs, the present study contributes to a significant reduction in the loads of WWTP and urgent prevention of the spread of infectious diseases, thus alleviating the potential threat to the environment and human health risks associated with AMR problems. [ABSTRACT FROM AUTHOR]

The increase in the prevalence of carbapenem-resistant Gram-negative bacteria, in particular Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA), poses a serious threat for public health worldwide. This article reviews the alarming data on the prevalence of infections caused by CRAB and CRPA pathogens and their presence in hospital and municipal wastewater, and it highlights the environmental impact of antibiotic resistance. The article describes the key role of antibiotic resistance genes (ARGs) in the acquisition of carbapenem resistance and sheds light on bacterial resistance mechanisms. The main emphasis was placed on the transfer of ARGs not only in the clinical setting, but also in the environment, including water, soil, and food. The aim of this review was to expand our understanding of the global health risks associated with CRAB and CRPA in hospital and municipal wastewater and to analyze the spread of these micropollutants in the environment. A review of the literature published in the last decade will direct research on carbapenem-resistant pathogens, support the implementation of effective preventive measures and interventions, and contribute to the development of improved strategies for managing this problem. [ABSTRACT FROM AUTHOR]

The increasing concerns surrounding micropollutant contamination necessitate urgent and effective strategies for their elimination. Several stages explored the photocatalytic degradation of pharmaceutical contaminants in wastewater using novel magnetic g-C3N4/MXene nano photocatalysts are synthesized in this work. The surface chemistry, morphology, crystallinity, surface area, and propensity to participate in electron transfer reactions of the g-C3N4/MXene nano were characterized using a set of analytical measurements. These analyses confirmed the successful formation of a unique complex with ferromagnetic properties conferred by incorporating Fe3O4. After 120 min of sunlight exposure, the g-C3N4/MXene magnetic catalyst showed a superior reduction of 92 % of clindamycin in real wastewater. High organic carbon removal of > 38 % was also observed after the 2 h period. The study also observed the stability of the catalyst over four cycles, maintaining a removal level of > 58 %, highlighting its potential applications in water treatment processes by increasing the interlayer spacing, g-C3N4, and MXene combined to produce an excellent surface area with more active sites on their surface, which enhanced the transfer of electron/hole pairs and provided excellent degradation capacity.

In this experiment, we employed Real-time PCR(RT-PCR) and metagenomic Next-Generation Sequencing (mNGS) techniques to detect the presence of Norovirus, Rotavirus Group A, Adenovirus Group F, and Astrovirus in untreated sewage from three major hospitals. A comparison with clinical lab test outcomes revealed Norovirus as having the highest infection rate, followed by Adenovirus Group F and Rotavirus Group A. Despite not testing for Astrovirus in clinical labs, its sewage detection rate was surpassed only by Norovirus, suggesting a potentially high clinical infection rate. Further analysis of these viruses in treated sewage revealed that chlorination failed to eliminate the virus, maintaining viral concentrations in the treated sewage between 10^2 and 10^3 copies/ml. Even though nucleic acid testing methods fail to detect viral actions, the possible danger they present to public safety should not be ignored. During this experiment, viral nucleic acid was extracted directly from the samples without prior concentration. This method, unlike conventional virus detection post-concentration, bypasses concerns such as recovery efficiency, offering a clearer representation of virus concentrations in water samples and facilitating easier operation.

The alarming rise of pharmaceutical contaminants in wastewater poses a significant environmental and public health challenge. Addressing this issue, this study investigated the potential of alkaline-treated pineapple leaf fiber (PALF) as an eco-friendly adsorbent for pharmaceutical removal, coupled with UV-LED technology. Alkaline treatment enhanced PALF's adsorption capabilities, increasing surface area to 68.3 m2/g and pore volume to 0.120 cm³/g. Adsorption experiments showed high efficiencies (up to 89.7 % for ciprofloxacin, 88.5 % for paracetamol, and 77.1 % for ibuprofen), following a pseudo-second-order kinetic model. Isotherm analysis indicated a maximum adsorption capacity of 35.4 mg/g for ciprofloxacin. PALF maintained 85.9 % removal efficiency after five regeneration cycles, with no adverse effects on aquatic organisms observed in toxicity assays. This research highlights PALF's promise as a sustainable solution for pharmaceutical wastewater treatment, aligning with the focus on environmental sustainability and innovative materials.

Qianwen Zhang,1,&ast; Shengcen Zhang,1,&ast; Binbin Xu,1 Luyan Dong,1 Zhichang Zhao,2 Bin Li1 1Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fujian, 350001, People’s Republic of China; 2Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bin Li, Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fujian, 350001, People’s Republic of China, Email leonlee307@hotmail.com Zhichang Zhao, Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian, People’s Republic of China, Email slip2046@126.comBackground: Hospital wastewater (HWW) promotes the spread of carbapenem resistance genes (CRGs). Aeromonas carry a large number of CRGs in HWW, they may play a role as a suitable reservoir for CRGs, while resistomes in HWW are still poorly characterized regarding carbapenem resistant Aeromonas. Thus, the aim of the study was to evaluate the molecular epidemiological characteristics of carbapenem resistant Aeromonas in HWW.Methods: A total of 33 carbapenem resistant Aeromonas were isolated from HWW. Antimicrobial susceptibility testing and polymerase chain reaction (PCR) were used to assess the antimicrobial resistance profiles. Molecular typing was performed using enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) and multilocus sequence typing (MLST). The horizontal transmission mode of blaKPC was explored through conjugation and transformation experiments. The stability of blaKPC-IncP-6 plasmids was assessed through plasmid stability and in vitro competition test. The PCR mapping method was used to investigate the structural diversity of blaKPC.Results: The detection rates of blaKPC and cphA in Aeromonas were 97.0% and 39.4% respectively. Aeromonas caviae were grouped into 13 clusters by ERIC-PCR and 12 STs by MLST. Aeromonas veronii were grouped into 11 clusters by ERIC-PCR and 4 STs by MLST. 56.3% blaKPC were located on mobilizable IncP-6 plasmids. blaKPC-IncP-6 plasmid showed high stability and low cost fitness.Conclusion: Carbapenem resistant Aeromonas from HWW mainly carried blaKPC, which exhibited great structural diversity. Aeromonas might serve as reservoirs for blaKPC and blaKPC might spread mainly through transformation in HWW.Keywords: hospital wastewater, carbapenem resistance, Aeromonas, IncP-6, blaKPC

Abstract The study aims to develop an eco-friendly solution for addressing contaminants in hospital wastewater. To achieve this, banana peel, a cost-effective and easily available agricultural waste, was chemically modified using sulfuric acid and sodium hydroxide. The hospital wastewater was analyzed using an Atomic Absorption Spectrometer to identify the presence of heavy metals. The physicochemical properties were measured and compared against the standards set by the World Health Organization (WHO). Scanning electron microscopy and Fourier-transform infrared spectroscopy were used to characterize the chemically modified banana peel. Batch adsorption was conducted with the wastewater using the prepared adsorbent. The effect of contact time, mixing rate, temperature, and adsorbent dosage was examined to know the removal efficiency of the adsorbent. The experimental design incorporates Taguchi OA design to optimize the process. The total heavy metals discovered in the wastewater were As, Cd, Fe, Cu, Ni, Cr, Pb, Mn and Zn. The percentage of Cd, Fe, Cu, Ni, Cr and Pb removed were 79.5%, 87.9%, 56.9%, 89.0%, 88.5% and 93.5%, respectively, at temperature, adsorbent dosage, mixing rate and contact time of 30 °C, 3 g, 700 rpm and 60 min, respectively. The physicochemical properties remain within the acceptable WHO range except the turbidity. At optimum point, the percentage removal of Cd, Fe, Cu, Ni, Cr, Pb and Zn were 64.3%, 80.5%, 51.4%, 82.3%, 72.4%, 86.6% and 72.1%, respectively; while, the conductivity, pH, TDS, and turbidity value were, respectively, 20.57 mS/cm, 6.8, 10.16 mg/l, and 86.31 NTU. Characterization revealed the existence of active functional groups on the adsorbent surface enhancing the hospital wastewater treatment and change in its morphological structure after the treatment was noticed. In conclusion, the modified banana peel was effective for the treatment of hospital wastewater.

Hospital wastewater has been identified as a hotspot for the emergence and transmission of multidrug-resistant (MDR) pathogens that present a serious threat to public health. Therefore, we investigated the current status of antibiotic resistance as well as the phenotypic and genotypic basis of biofilm formation in Pseudomonas aeruginosa from hospital wastewater in Dhaka, Bangladesh. The disc diffusion method and the crystal violet assay were performed to characterize antimicrobial resistance and biofilm formation, respectively. Biofilm and integron-associated genes were amplified by the polymerase chain reaction. Isolates exhibited varying degrees of resistance to different antibiotics, in which >80% of isolates showed sensitivity to meropenem, amikacin, and gentamicin. The results indicated that 93.82% of isolates were MDR and 71 out of 76 MDR isolates showed biofilm formation activities. We observed the high prevalence of biofilm-related genes, in which algD+pelF+pslD+ (82.7%) was found to be the prevalent biofilm genotypic pattern. Sixteen isolates (19.75%) possessed class 1 integron (int1) genes. However, statistical analysis revealed no significant association between biofilm formation and multidrug resistance (χ2 = 0.35, P = 0.55). Taken together, hospital wastewater in Dhaka city may act as a reservoir for MDR and biofilm-forming P. aeruginosa, and therefore, the adequate treatment of wastewater is recommended to reduce the occurrence of outbreaks. HIGHLIGHTS A high occurrence of P. aeruginosa was observed in hospital effluents.; 93.82% of isolates were multidrug-resistant.; Most of the isolates showed biofilm formation activities.; 19.75% of isolates harbored class 1 integron genes.; Hospital wastewater in Dhaka acts as a reservoir of MDR P. aeruginosa.;

This study assessed wastewater treatment by visible-light/Peroxymonosulfate process using its linking with TiO2@Fe3O4 nanoparticles coated on chitosan. Meropenem and Imipenem photodegradation was evaluated as a model-resistant contaminant by TiO2@Fe2O3/chitosan nanocomposite. The synthesised TiO2@Fe2O3/chitosan was characterised using various techniques. Fe2O3 and TiO2 nanoparticles on the chitosan surface were affirmed via XRD, EDX, and FTIR findings. The FESEM and TEM results verified the deposition of TiO2@Fe2O3 on the chitosan surface. Under optimum circumstances (pH = 4, catalyst dosage = 0.5 g/L, antibiotics concentration = 25 mg/L reaction time = 30 min, and PMS = 2 mM), maximum degradation efficiency was obtained at about 95.64 and 93.9% for Meropenem and Imipenem, respectively. Also, the experiments demonstrated that TiO2@Fe2O3/chitosan had a better performance than photolysis and adsorption by catalyst without visible light irradiation in degrading antibiotics. The scavenger tests confirmed that ${\rm O}_2^{\cdot -}$ O 2 ⋅ − , ${\rm SO}_4^{\cdot -}$ SO 4 ⋅ − , ${\rm HO}\cdot$ HO ⋅ , and h+ are present simultaneously during the pollutant photodegradation process. After five recovery cycles, the system eliminated over 80 percent of antibiotics. It suggested that the catalyst's capacity to be reused may be cost-effective. [ABSTRACT FROM AUTHOR]

This study investigates the removal of amoxicillin micropollutants (AM) from hospital wastewater using CoMoO4-modified graphitic carbon nitride (CMO/gCN). Consequently, CMO/gCN exhibits notable improvements in visible light absorption and electron–hole separation rates compared to unmodified gCN. Besides, CMO/gCN significantly enhances the removal efficiency of AM, attaining an impressive 96.5%, far surpassing the performance of gCN at 48.6%. Moreover, CMO/gCN showcases outstanding reusability, with AM degradation performance exceeding 70% even after undergoing six cycles of reuse. The removal mechanism of AM employing CMO/gCN involves various photoreactions of radicals (•OH, •O2−) and amoxicillin molecules under light assistance. Furthermore, CMO/gCN demonstrates a noteworthy photodegradation efficiency of AM from hospital wastewater, reaching 92.8%, with a near-complete reduction in total organic carbon levels. Detailed discussions on the practical applications of the CMO/gCN photocatalyst for removal of micropollutants from hospital wastewater are provided. These findings underline the considerable potential of CMO/gCN for effectively removing various pollutants in environmental remediation strategies. [ABSTRACT FROM AUTHOR]

The extent of removal of pharmaceuticals by African-based wastewater treatment plants (WWTPs) is relatively unknown with various studies observing high concentrations in effluents. This is mainly due to WWTPs still utilising the traditional treatment methods which are known to be less effective. In this study, 15 selected antibiotics (amoxicillin, ampicillin, azithromycin, ciprofloxacin, doxycycline, erythromycin, gentamicin, metronidazole, norfloxacin, ofloxacin, penicillin, sulfamethoxazole, sulfapyridine, tetracycline and trimethoprim) were monitored in wastewater as it goes through sedimentation (primary and secondary), aeration and chlorination stages of a WWTP. Analytical method involved solid-phase extraction followed by liquid chromatographic determination. Removal efficiencies during sedimentation were generally positive with doxycycline achieving 80–95.8%, while negative removal efficiencies were observed for penicillin V (−46.4 to −17.1%) and trimethoprim (−26.2 to −18.9%). The aeration and agitation stage resulted in concentration enhancement for several antibiotics with seven of them ranging between −273 and −15.5%. This stage was responsible for the relatively low overall removal efficiencies in which only 4 antibiotics (doxycycline, tetracycline, ciprofloxacin, and erythromycin) experienced overall removal efficiencies above 50%. The recorded effluent concentrations ranging between 0.0130 and 0.383 ng/mL were translated to low potential for development of antibiotic resistance genes in the receiving environments while ecotoxicity risk was high for only amoxicillin, ampicillin and sulfapyridine. The study has provided an overview of the performance of common wastewater treatment processes in South Africa and hopes that more monitoring and environmental risk data can be made available towards drafting of antibiotic priority lists that cater for Africa. [ABSTRACT FROM AUTHOR]

The study aims to develop an eco-friendly solution for addressing contaminants in hospital wastewater. To achieve this, banana peel, a cost-effective and easily available agricultural waste, was chemically modified using sulfuric acid and sodium hydroxide. The hospital wastewater was analyzed using an Atomic Absorption Spectrometer to identify the presence of heavy metals. The physicochemical properties were measured and compared against the standards set by the World Health Organization (WHO). Scanning electron microscopy and Fourier-transform infrared spectroscopy were used to characterize the chemically modified banana peel. Batch adsorption was conducted with the wastewater using the prepared adsorbent. The effect of contact time, mixing rate, temperature, and adsorbent dosage was examined to know the removal efficiency of the adsorbent. The experimental design incorporates Taguchi OA design to optimize the process. The total heavy metals discovered in the wastewater were As, Cd, Fe, Cu, Ni, Cr, Pb, Mn and Zn. The percentage of Cd, Fe, Cu, Ni, Cr and Pb removed were 79.5%, 87.9%, 56.9%, 89.0%, 88.5% and 93.5%, respectively, at temperature, adsorbent dosage, mixing rate and contact time of 30 °C, 3 g, 700 rpm and 60 min, respectively. The physicochemical properties remain within the acceptable WHO range except the turbidity. At optimum point, the percentage removal of Cd, Fe, Cu, Ni, Cr, Pb and Zn were 64.3%, 80.5%, 51.4%, 82.3%, 72.4%, 86.6% and 72.1%, respectively; while, the conductivity, pH, TDS, and turbidity value were, respectively, 20.57 mS/cm, 6.8, 10.16 mg/l, and 86.31 NTU. Characterization revealed the existence of active functional groups on the adsorbent surface enhancing the hospital wastewater treatment and change in its morphological structure after the treatment was noticed. In conclusion, the modified banana peel was effective for the treatment of hospital wastewater. [ABSTRACT FROM AUTHOR]

Hospital wastewater has been identified as a hotspot for the emergence and transmission of multidrug-resistant (MDR) pathogens that present a serious threat to public health. Therefore, we investigated the current status of antibiotic resistance as well as the phenotypic and genotypic basis of biofilm formation in Pseudomonas aeruginosa from hospital wastewater in Dhaka, Bangladesh. The disc diffusion method and the crystal violet assay were performed to characterize antimicrobial resistance and biofilm formation, respectively. Biofilm and integron-associated genes were amplified by the polymerase chain reaction. Isolates exhibited varying degrees of resistance to different antibiotics, in which .80% of isolates showed sensitivity to meropenem, amikacin, and gentamicin. The results indicated that 93.82% of isolates were MDR and 71 out of 76 MDR isolates showed biofilm formation activities. We observed the high prevalence of biofilm-related genes, in which algDþpelFþpslDþ (82.7%) was found to be the prevalent biofilm genotypic pattern. Sixteen isolates (19.75%) possessed class 1 integron (int1) genes. However, statistical analysis revealed no significant association between biofilm formation and multidrug resistance (χ2 = 0.35, P = 0.55). Taken together, hospital wastewater in Dhaka city may act as a reservoir for MDR and biofilm-forming P. aeruginosa, and therefore, the adequate treatment of wastewater is recommended to reduce the occurrence of outbreaks. [ABSTRACT FROM AUTHOR]

The source and composition of hospital wastewater are complex，including pathogenic microorganisms，chemical drugs and metabolites，heavy metals，contrast agents，resistance genes，etc. When it in a special period of repeated outbreaks of Corona Virus Disease 2019（COVID-19）， the number of patients in the hospital is increasing rapidly，and the corresponding consumed therapeutic drugs，disinfectants，pathogenic microorganisms are increasing significantly. If the hospital wastewater is not effectively treated by cutting off the ways of pathogenic microorganisms and toxic and harmful substances into the environment，the risk caused by effluent would increase rapidly. This paper analyzes the current situation and problems of domestic hospital wastewater treatment，and clarifies the conventional and frontiers technologies on effluent treatment based on the main components and characteristics of hospital wastewater，and combines with the existing policies and technical specifications on hospital wastewater treatment. Finally，some relative countermeasures and constructive suggestions were proposed to provide some technical reference for the hospital wastewater treatment in China.

Antimicrobial resistance is a major global concern and economic threat, necessitating a reliable monitoring approach to understand its frequency and spread via the environment. Hospital wastewater serves as a critical reservoir for antimicrobial-resistant organisms; however, its role in resistance gene distribution and dissemination remains poorly understood. This study integrates metagenomic and metatranscriptomic analyses, elucidating the dynamics of antimicrobial resistance in hospital wastewater. Integrated metagenomic and metatranscriptomic sequencing were used to identify actively expressed antimicrobial-resistant genes and antimicrobial-resistant bacteria, offering comprehensive insights into antimicrobial resistance dynamics in hospital wastewater. Liquid chromatography–tandem mass spectrometry analysis revealed the presence of ampicillin, sulbactam, levofloxacin, sulfamethoxazole, and trimethoprim in the sample, which could apply selective pressure on antimicrobial resistance gene expression. While multidrug resistance genes were the most prevalent sequences in both metagenome-assembled genomes and plasmids, plasmid-derived sequences showed a high mRNA/DNA ratio, emphasizing the presence of functionally expressed antimicrobial resistance genes on plasmids rather than on chromosomes. The metagenomic and metatranscriptomic analyses revealed Serratia nevei MAG14 with high mRNA levels of antimicrobial resistance genes; moreover, multidrug-resistant Serratia sp., genetically related to MAG14, was isolated from the wastewater, supporting the phenotypic characterization of crucial antimicrobial-resistant bacteria and validating the genome analysis results. The findings underscore key genes and bacteria as targets for antimicrobial resistance surveillance in hospital wastewater to protect public and environmental health.

Introduction: Hospitals are breeding grounds for multidrug-resistant (MDR) bacteria, posing treatment challenges and increasing the risk of spreading "superbugs." This study investigates the prevalence of colistinresistant bacteria, a last-resort antibiotic, in wastewater from tertiary hospitals in Enugu, Nigeria. Methods: Twenty wastewater samples were collected over three months from two tertiary hospitals in Enugu. A standardized protocol by the American Public Health Association (APHA) was followed. Samples were collected aseptically from key drainage points and transported to the lab within 2 hours. Bacteria were isolated using the pour-plate method and characterized by morphological and biochemical tests, including Catalase, Oxidase, and Glucose Fermentation. Antibiotic susceptibility was assessed using Kirby-Bauer disc diffusion, and colistin resistance was confirmed via broth microdilution. Multiplex PCR detected mcr genes indicating plasmid-mediated resistance. Data were analyzed using SPSS version 23 with Chi-Square and ANOVA tests at a significance level of P < 0.05. Results: Gram-negative bacteria were isolated from 63.1% of samples, with Klebsiella spp. being the most prevalent, accounting for 24.6%. Colistin resistance was phenotypically observed in E. coli (83%), Klebsiella spp. (75%), and Pseudomonas aeruginosa (100%). Genotypically, E. coli harbored mcr-1 (17%) and mcr-3 (83%), while all Klebsiella and Pseudomonas isolates carried multiple mcr genes. Additionally, these bacteria showed resistance to multiple antibiotics, including Septrin, Gentamycin, and Ceftriaxone. Conclusion: The significant presence of colistin-resistant bacteria, especially E. coli and Klebsiella, poses a public health concern, potentially leading to treatment failures and spreading resistance genes. Stricter monitoring of hospital wastewater is necessary to identify emerging resistance trends and improve antibiotic practices in hospitals. [ABSTRACT FROM AUTHOR]

Hospitals discharge large amounts of pathogenic microbes into municipal wastewater and aquatic environments, posing significant challenges in terms of human health and ecological impacts. It is crucial to develop and implement effective techniques for managing and treating such wastewater. In this study, we aimed to design a potential strategy for the treatment of microbial hospital wastewater (HWW) by utilizing a combination of cold plasma (CP) and silver nanoparticles (Ag NPs). Melia azedarach (M. azedarach) leaf extract was used for the biosynthesis of Ag NPs by the green method. Various techniques were employed for Ag NPs characterization. The results obtained from the ultra-violet visible (UV–vis) spectroscopy showed ab absorbance peak at 430 nm. The scanning electron microscope (SEM) images revealed that the biosynthesized Ag NPs appeared spherical with an average size of 13.6 nm. X-ray diffraction (XRD) analysis determined the formation of Ag NPs. Fourier-transform infrared spectroscopy (FTIR) indicated the involvement of biomolecules in the reduction and stabilization of the Ag NPs. For the treatment of HWW, the antibacterial activity of Ag NPs was evaluated at the highest concentration (1:1), while CP was tested at the longest duration of exposure (60 s). The results showed a significant reduction in the average number of bacterial colonies to 18 and 5 colonies, respectively, compared to the control sample (without treatment), which had an average of 175 colonies. Moreover, the combined treatment of Ag NPs and CP resulted in complete inhibition of bacterial growth, with an average number of zero colonies for all samples and treatment conditions. Based on these findings, we believe that the synergistic effect between Ag NPs and CP holds promise as an advanced treatment technology for the elimination of microbes from HWW. This technology has the potential to contribute to a more sustainable and environmentally responsible healthcare system. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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