Yilmaz Gulsum, Kaya Yasemin, Vergili Ilda, Beril Gönder Z, Özhan Gül, Ozbek Celik Berna, Altinkum Serdar M, Bagdatli Yasar, Boergers Andrea, Tuerk Jochen
Department of Environmental Engineering, Faculty of Engineering, Istanbul University, 34320, Istanbul, Turkey.
Environmental Management Unit, Cerrahpasa Medical Faculty, Istanbul University, 34000, Istanbul, Turkey.
Environ Monit Assess. 2017 Feb;189(2):55. doi: 10.1007/s10661-016-5732-2. Epub 2017 Jan 12.
The aim of the study was to present first preliminary characterization of Turkish hospital wastewaters, their environmental risk, and a method for toxicity assessment. The hospital wastewater samples were collected from two of the largest medical faculty hospitals and a training and research hospital in Istanbul, Turkey. The samples from the selected hospitals were taken as grab samples on March 2014. Overall, 55 substances including pharmaceuticals and their metabolites, pesticides, and corrosion inhibitors were analyzed in all hospital wastewaters. Analysis of toxicity and the antibiotic resistance bacteria were investigated in addition to the chemical analysis in the wastewater of one hospital. Hazard quotients (HQs) and toxic units (TUs) were calculated as basis of the environmental risk assessment. Fourteen pharmaceuticals in hospital wastewater (HWW) were classified as "high risk" with HQ > 10. HQ values higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQ of 9090 was observed to be the most hazardous compound. HQ and TU values of the wastewater treatment plant (WWTP) effluent dropped significantly due to dilution in the sewer. Further elimination by biological degradation or adsorption was observed only in some cases. However, the decreased HQ values do not the change environmental load significantly. Therefore, advanced treatment processes should be applied to remove the persistent compounds. In combination with the results on antibiotic resistance, we would prefer on-site treatment of hospital wastewater. Toxicological assessment was performed using cytotoxic and mutagenic screening tests. The results of the Ames assay showed that the native hospital wastewaters had strongly mutagenic activity with a ≤10-fold increase relative to negative controls. The mutagenic potentials of the samples were generally concentration and metabolic activation dependent. Multiple antibiotic resistances were demonstrated with the tested isolates to ciprofloxacin, trimethoprim, and ceftazidime. This study demonstrates that the hospital wastewaters in Istanbul exhibit strong environmental and toxicological risks, as well as high multiple drug resistance to commonly used antibiotics.
本研究的目的是首次对土耳其医院废水进行初步表征，评估其环境风险，并提出一种毒性评估方法。医院废水样本采集自土耳其伊斯坦布尔的两所最大的医学院附属医院以及一所培训和研究医院。所选医院的样本于2014年3月采集，为瞬时水样。总体而言，对所有医院废水中的55种物质进行了分析，包括药品及其代谢物、农药和缓蚀剂。除了对一家医院的废水进行化学分析外，还对其毒性和抗生素抗性细菌进行了研究。计算了危害商数（HQs）和毒性单位（TUs），作为环境风险评估的基础。医院废水中有14种药物被归类为“高风险”，HQ > 10。五种抗生素和一种镇痛药，即氧氟沙星、克拉霉素、环丙沙星、磺胺吡啶、甲氧苄啶和双氯芬酸的HQ值高于100。观察到HQ为9090的氧氟沙星是最危险的化合物。由于在下水道中稀释，污水处理厂（WWTP）出水的HQ和TU值显著下降。仅在某些情况下观察到通过生物降解或吸附进一步去除。然而，降低的HQ值并未显著改变环境负荷。因此，应采用先进的处理工艺去除持久性化合物。结合抗生素抗性结果，我们更倾向于对医院废水进行现场处理。使用细胞毒性和诱变筛选试验进行了毒理学评估。艾姆斯试验结果表明，原生医院废水具有很强的诱变活性，相对于阴性对照增加了≤10倍。样品的诱变潜力通常取决于浓度和代谢活化。测试的分离株对环丙沙星、甲氧苄啶和头孢他啶表现出多重抗生素抗性。本研究表明，伊斯坦布尔的医院废水具有很强的环境和毒理学风险，以及对常用抗生素的高多重耐药性。
