Antibiotics in hospital effluents: occurrence, contribution to urban wastewater, removal in a wastewater treatment plant, and environmental risk assessment.

The study presented the occurrence of antibiotics in 16 different hospital effluents, the removal of antibiotics in urban wastewater treatment plant (WWTP), and the potential ecotoxicological risks of the effluent discharge on the aquatic ecosystem. The total concentration of antibiotics in hospital effluents was ranged from 21.2 ± 0.13 to 4886 ± 3.80 ng/L in summer and from 497 ± 3.66 to 322,735 ± 4.58 ng/L in winter. Azithromycin, clarithromycin, and ciprofloxacin were detected the highest concentrations among the investigated antibiotics. The total antibiotic load to the influent of the WWTP from hospitals was 3.46 g/day in summer and 303.2 g/day in winter. The total antibiotic contribution of hospitals to the influent of the WWTP was determined as 13% in summer and 28% in winter. The remaining 87% in summer and 72% in winter stems from the households. The total antibiotic removal by conventional physical and biological treatment processes was determined as 79% in summer, whereas it decreased to 36% in winter. When the environmental risk assessment was performed, azithromycin and clarithromycin in the effluent from the treatment plant in winter posed a high risk (RQ > 10) for the aquatic organisms (algae and fish) in the receiving environment. According to these results, the removal efficiency of antibiotics at the WWTP is inadequate and plant should be improved to remove antibiotics by advanced treatment processes.