title: Characterization and toxicity of hospital wastewaters in Turkey.
abstract: 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. HQHWWvalues higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQHWWof 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 HQWWTPeffluentvalues 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.
authors.affiliation: Department of Environmental Engineering, Faculty of Engineering, Istanbul University, 34320, Istanbul, Turkey. gulsum@istanbul.edu.tr.|Environmental Management Unit, Cerrahpasa Medical Faculty, Istanbul University, 34000, Istanbul, Turkey. gulsum@istanbul.edu.tr.
authors.forename: Gulsum
authors.initials: G
authors.lastname: Yilmaz
authors.affiliation: Department of Environmental Engineering, Faculty of Engineering, Istanbul University, 34320, Istanbul, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Kaya
authors.affiliation: Department of Environmental Engineering, Faculty of Engineering, Istanbul University, 34320, Istanbul, Turkey.
authors.forename: Ilda
authors.initials: I
authors.lastname: Vergili
authors.affiliation: Department of Environmental Engineering, Faculty of Engineering, Istanbul University, 34320, Istanbul, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Beril Gönder
authors.affiliation: Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, 34116, Istanbul, Turkey.
authors.forename: Gül
authors.initials: G
authors.lastname: Özhan
authors.affiliation: Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, 34116, Istanbul, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Ozbek Celik
authors.affiliation: Environmental Management Unit, Cerrahpasa Medical Faculty, Istanbul University, 34000, Istanbul, Turkey.
authors.forename: Serdar M
authors.initials: SM
authors.lastname: Altinkum
authors.affiliation: Environmental Management Unit, Cerrahpasa Medical Faculty, Istanbul University, 34000, Istanbul, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Bagdatli
authors.affiliation: Institut für Energie- und Umwelttechnik e.V. (IUTA, Institute of Energy and Environmental Technology), Bliersheimer Str. 58-60, 47229, Duisburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Boergers
authors.affiliation: Institut für Energie- und Umwelttechnik e.V. (IUTA, Institute of Energy and Environmental Technology), Bliersheimer Str. 58-60, 47229, Duisburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Tuerk
mesh_terms: D000900:Anti-Bacterial Agents / Q000032:analysis / Q000633:toxicity; D004352:Drug Resistance, Microbial; D004784:Environmental Monitoring; D006761:Hospitals; D017744:Medical Waste Disposal; D010575:Pesticides / Q000032:analysis; D018570:Risk Assessment; D014421:Turkey; D014865:Waste Disposal, Fluid; D062065:Wastewater / Q000737:chemistry*; D014874:Water Pollutants, Chemical / Q000032:analysis* / Q000633:toxicity
chemical_list: D000900:Anti-Bacterial Agents; D017744:Medical Waste Disposal; D010575:Pesticides; D062065:Wastewater; D014874:Water Pollutants, Chemical
keywords: Antibiotic-resistant bacteria; Environmental risk assessment; Hospital wastewater; Pharmaceuticals; Toxicity