Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica

This work aims to determine the occurrence, hazard and prioritization of pharmaceuticals from hospital wastewater in Costa Rica through the monitoring of 70 compounds and assessing their environmental risk through a hazard quotient approach (HQ). Moreover, the quantification of selected antibiotic r...

Descripción completa

Detalles Bibliográficos
Autores: Rodríguez Rodríguez, Carlos E., Ramírez Morales, Didier Daniel, Masís Mora, Mario Alberto, Montiel Mora, José Rolando, Soto Garita, Claudio, Araya Valverde, Emanuel, Cambronero Heinrichs, Juan Carlos, Sànchez Melsió, Alexandre, Briceño Guevara, Susana, Méndez Rivera, Michael, Balcázar, José Luis
Tipo de recurso: artículo
Fecha de publicación:2023
País:Costa Rica
Institución:Universidad de Costa Rica
Repositorio:Kérwá
Idioma:inglés
OAI Identifier:oai:kerwa.ucr.ac.cr:10669/91154
Acceso en línea:https://www.sciencedirect.com/science/article/abs/pii/S0045653523020131?via%3Dihub
https://hdl.handle.net/10669/91154
https://doi.org/10.1016/j.chemosphere.2023.139746
Access Level:acceso abierto
Palabra clave:COSTA RICA
SEWAGE WATER
HOSPITAL
RISK
PHARMACEUTICAL PRODUCTS
EVALUATION
id CR_4d3b094bffdd7e7b6dcb08fbdfd3cc97
oai_identifier_str oai:kerwa.ucr.ac.cr:10669/91154
network_acronym_str CR
network_name_str Costa Rica
repository_id_str
dc.title.es_ES.fl_str_mv Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
title Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
spellingShingle Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
Rodríguez Rodríguez, Carlos E.
COSTA RICA
SEWAGE WATER
HOSPITAL
RISK
PHARMACEUTICAL PRODUCTS
EVALUATION
title_short Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
title_full Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
title_fullStr Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
title_full_unstemmed Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
title_sort Occurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica
dc.creator.none.fl_str_mv Rodríguez Rodríguez, Carlos E.
Ramírez Morales, Didier Daniel
Masís Mora, Mario Alberto
Montiel Mora, José Rolando
Soto Garita, Claudio
Araya Valverde, Emanuel
Cambronero Heinrichs, Juan Carlos
Sànchez Melsió, Alexandre
Briceño Guevara, Susana
Méndez Rivera, Michael
Balcázar, José Luis
author Rodríguez Rodríguez, Carlos E.
author_facet Rodríguez Rodríguez, Carlos E.
Ramírez Morales, Didier Daniel
Masís Mora, Mario Alberto
Montiel Mora, José Rolando
Soto Garita, Claudio
Araya Valverde, Emanuel
Cambronero Heinrichs, Juan Carlos
Sànchez Melsió, Alexandre
Briceño Guevara, Susana
Méndez Rivera, Michael
Balcázar, José Luis
author_role author
author2 Ramírez Morales, Didier Daniel
Masís Mora, Mario Alberto
Montiel Mora, José Rolando
Soto Garita, Claudio
Araya Valverde, Emanuel
Cambronero Heinrichs, Juan Carlos
Sànchez Melsió, Alexandre
Briceño Guevara, Susana
Méndez Rivera, Michael
Balcázar, José Luis
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.es_ES.fl_str_mv COSTA RICA
SEWAGE WATER
HOSPITAL
RISK
PHARMACEUTICAL PRODUCTS
EVALUATION
topic COSTA RICA
SEWAGE WATER
HOSPITAL
RISK
PHARMACEUTICAL PRODUCTS
EVALUATION
description This work aims to determine the occurrence, hazard and prioritization of pharmaceuticals from hospital wastewater in Costa Rica through the monitoring of 70 compounds and assessing their environmental risk through a hazard quotient approach (HQ). Moreover, the quantification of selected antibiotic resistance genes (ARGs) was conducted for the first time in this matrix in this geographical location. Thirty-four pharmaceuticals were detected, being caffeine, 1,7-dimethylxanthine, acetaminophen, ibuprofen, naproxen, ciprofloxacin and ketoprofen the most frequent (>50% of the samples). Eighteen pharmaceuticals exhibited high hazard (HQ ≥ 1), while five more showed medium hazard (1 > HQ ≥ 0.1). Prioritization, which also included frequency parameters, revealed caffeine, lovastatin, diphenhydramine, acetaminophen, ibuprofen, ciprofloxacin, and sildenafil as the compounds of major concern. Similarly, cumulative hazard per sample (ΣHQ) estimated high hazard towards aquatic organisms in every sample. All selected ARGs, except mcr-1 (polymyxin resistance), were detected. Among genes conferring resistance to beta-lactams, blaCTX-M and blaKPC were the most abundant, related to resistance to cephalosporins and carbapenems. Ecotoxicological evaluation showed mostly low toxicity towards Daphnia magna and Vibrio fischeri, contrary to the marked effect observed towards Lactuca sativa. These findings provide relevant and novel information on the risk posed by hospital wastewater and their pharmaceutical content in the Latin American environmental context.
publishDate 2023
dc.date.issued.none.fl_str_mv 2023
dc.date.accessioned.none.fl_str_mv 2024-04-09T14:15:02Z
dc.date.available.none.fl_str_mv 2024-04-09T14:15:02Z
dc.type.es_ES.fl_str_mv artículo original
dc.type.none.fl_str_mv http://purl.org/coar/resource_type/c_2df8fbb1
info:eu-repo/semantics/article
format article
dc.identifier.citation.es_ES.fl_str_mv https://www.sciencedirect.com/science/article/abs/pii/S0045653523020131?via%3Dihub
dc.identifier.issn.none.fl_str_mv 0045-6535
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/10669/91154
dc.identifier.doi.none.fl_str_mv https://doi.org/10.1016/j.chemosphere.2023.139746
dc.identifier.codproyecto.none.fl_str_mv 802-B7A09
802-B8510
802-B8144
802-B8145
802-C1034
url https://www.sciencedirect.com/science/article/abs/pii/S0045653523020131?via%3Dihub
https://hdl.handle.net/10669/91154
https://doi.org/10.1016/j.chemosphere.2023.139746
identifier_str_mv 0045-6535
802-B7A09
802-B8510
802-B8144
802-B8145
802-C1034
dc.language.iso.es_ES.fl_str_mv eng
language eng
dc.rights.es_ES.fl_str_mv acceso abierto
dc.rights.none.fl_str_mv http://purl.org/coar/access_right/c_abf2
info:eu-repo/semantics/openAccess
rights_invalid_str_mv acceso abierto
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.source.es_ES.fl_str_mv Chemosphere, vol.339.
dc.source.none.fl_str_mv reponame:Kérwá
instname:Universidad de Costa Rica
instacron:UCR
instname_str Universidad de Costa Rica
instacron_str UCR
institution UCR
reponame_str Kérwá
collection Kérwá
bitstream.url.fl_str_mv https://www.kerwa.ucr.ac.cr/bitstreams/73a2ffa3-879a-4f58-9997-d5b92cfcd148/download
https://www.kerwa.ucr.ac.cr/bitstreams/e04106a3-99f0-4b03-a62d-cd0b62daaefe/download
https://www.kerwa.ucr.ac.cr/bitstreams/746f7cda-2180-4a43-aeb8-ee53bfd3fe86/download
https://www.kerwa.ucr.ac.cr/bitstreams/900d761f-c128-462f-af80-281ac53591f6/download
bitstream.checksum.fl_str_mv b39c1930822b6ee5a194051b92f3a43e
fa98eaad6b85bd205cddb776be180605
e3f9538c9827d1e695045867935e86ea
d872ecc34f8144b8c71670c817f048b3
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
repository.name.fl_str_mv Kérwá - Universidad de Costa Rica
repository.mail.fl_str_mv meilyn.garro@ucr.ac.cr
_version_ 1849325788993683456
spelling Rodríguez Rodríguez, Carlos E.0e425b9d-7052-467c-8b34-46941b5263a4600Ramírez Morales, Didier Daniel2c074358-bea9-4373-9443-c8a69931fe6c600Masís Mora, Mario Albertoe8f1736c-baa3-410e-b161-63bab89cb055600Montiel Mora, José Rolando652107c4-fa88-4e63-a5fd-aa243e160171600Soto Garita, Claudio4099b9bc-eb22-4067-b46e-17486d437289600Araya Valverde, Emanuelbe31de8a-0eb6-4007-948e-4d3149c1be3f600Cambronero Heinrichs, Juan Carlos709b9743-77d0-4c65-92a6-d64aac7e8b00600Sànchez Melsió, Alexandrea7218720-b4dc-48eb-905c-9ab6aee4ffe5Briceño Guevara, Susana3d251fa5-b6fb-40bf-b59e-938ba76aac2c600Méndez Rivera, Michael2627d367-a9fa-4a9c-a8b2-d5f267da92af600Balcázar, José Luis917b7f81-e92d-41d1-9daa-f57cad1219d32024-04-09T14:15:02Z2024-04-09T14:15:02Z2023https://www.sciencedirect.com/science/article/abs/pii/S0045653523020131?via%3Dihub0045-6535https://hdl.handle.net/10669/91154https://doi.org/10.1016/j.chemosphere.2023.139746802-B7A09802-B8510802-B8144802-B8145802-C1034This work aims to determine the occurrence, hazard and prioritization of pharmaceuticals from hospital wastewater in Costa Rica through the monitoring of 70 compounds and assessing their environmental risk through a hazard quotient approach (HQ). Moreover, the quantification of selected antibiotic resistance genes (ARGs) was conducted for the first time in this matrix in this geographical location. Thirty-four pharmaceuticals were detected, being caffeine, 1,7-dimethylxanthine, acetaminophen, ibuprofen, naproxen, ciprofloxacin and ketoprofen the most frequent (>50% of the samples). Eighteen pharmaceuticals exhibited high hazard (HQ ≥ 1), while five more showed medium hazard (1 > HQ ≥ 0.1). Prioritization, which also included frequency parameters, revealed caffeine, lovastatin, diphenhydramine, acetaminophen, ibuprofen, ciprofloxacin, and sildenafil as the compounds of major concern. Similarly, cumulative hazard per sample (ΣHQ) estimated high hazard towards aquatic organisms in every sample. All selected ARGs, except mcr-1 (polymyxin resistance), were detected. Among genes conferring resistance to beta-lactams, blaCTX-M and blaKPC were the most abundant, related to resistance to cephalosporins and carbapenems. Ecotoxicological evaluation showed mostly low toxicity towards Daphnia magna and Vibrio fischeri, contrary to the marked effect observed towards Lactuca sativa. These findings provide relevant and novel information on the risk posed by hospital wastewater and their pharmaceutical content in the Latin American environmental context.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro en Investigación en Contaminación Ambiental (CICA)UCR::Vicerrectoría de Docencia::Salud::Facultad de Microbiologíaengacceso abiertohttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessChemosphere, vol.339.reponame:Kérwáinstname:Universidad de Costa Ricainstacron:UCRCOSTA RICASEWAGE WATERHOSPITALRISKPHARMACEUTICAL PRODUCTSEVALUATIONOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Ricaartículo originalhttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleLICENSElicense.txtlicense.txttext/plain; charset=utf-83584https://www.kerwa.ucr.ac.cr/bitstreams/73a2ffa3-879a-4f58-9997-d5b92cfcd148/downloadb39c1930822b6ee5a194051b92f3a43eMD52falseAnonymousREADORIGINALOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica - ScienceDirect.pdfOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica - ScienceDirect.pdfapplication/pdf453470https://www.kerwa.ucr.ac.cr/bitstreams/e04106a3-99f0-4b03-a62d-cd0b62daaefe/downloadfa98eaad6b85bd205cddb776be180605MD51trueAnonymousREAD2150-01-01TEXTOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica - ScienceDirect.pdf.txtOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica - ScienceDirect.pdf.txtExtracted texttext/plain15658https://www.kerwa.ucr.ac.cr/bitstreams/746f7cda-2180-4a43-aeb8-ee53bfd3fe86/downloade3f9538c9827d1e695045867935e86eaMD53falseAnonymousREAD2150-01-01THUMBNAILOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica - ScienceDirect.pdf.jpgOccurrence and risk assessment of pharmaceuticals in hospital wastewater in Costa Rica - ScienceDirect.pdf.jpgIM Thumbnailimage/jpeg8798https://www.kerwa.ucr.ac.cr/bitstreams/900d761f-c128-462f-af80-281ac53591f6/downloadd872ecc34f8144b8c71670c817f048b3MD54falseAnonymousREAD2150-01-0110669/911542025-10-15 14:10:25.046embargo2150-01-01oai:kerwa.ucr.ac.cr:10669/91154https://www.kerwa.ucr.ac.crInstitucionalhttp://www.kerwa.ucr.ac.crUniversidadhttp://www.ucr.ac.crhttps://kerwa.ucr.ac.cr/oai/requestmeilyn.garro@ucr.ac.crCosta RicaNo aplicaNo aplicaNo aplicaopendoar:18712025-10-15T20:10:25Kérwá - Universidad de Costa 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
score 15,812455

Similares en LA Referencia