Antibiotic concentrations in raw hospital wastewater surpass minimal selective and minimum inhibitory concentrations of resistant Acinetobacter baylyi strains.

Antibiotics are essential for modern medicine, they are employed frequently in hospitals and, therefore, present in hospital wastewater. Even in concentrations, that are lower than the minimum inhibitory concentrations (MICs) of susceptible bacteria, antibiotics may exert an influence and select resistant bacteria, if they exceed the MSCs (minimal selective concentrations) of resistant strains. Here, we compare the MSCs of fluorescently labelled Acinetobacter baylyi strains harboring spontaneous resistance mutations or a resistance plasmid with antibiotic concentrations determined in hospital wastewater. Low MSCs in the µg/L range were measured for the quinolone ciprofloxacin (17 µg/L) and for the carbapenem meropenem (30 µg/L). A 24 h continuous analysis of hospital wastewater showed daily fluctuations of the concentrations of these antibiotics with distinctive peaks at 7-8 p.m. and 5-6 a.m. The meropenem concentrations were always above the MSC and MIC values of A. baylyi. In addition, the ciprofloxacin concentrations were in the range of the lowest MSC for about half the time. These results explain the abundance of strains with meropenem and ciprofloxacin resistance in hospital wastewater and drains.

Temporal and spatial variable in-stream attenuation of selected pharmaceuticals.

Organic micropollutants enter rivers mainly with discharges of wastewater treatment plants (WWTP) and pose a risk to aquatic ecosystems and water quality. A considerable knowledge gap exists for disentangling overlapping processes and driving conditions that control the fate of these pollutants. Thus, the aim of this study was to identify the driving parameters for attenuation of selected pharmaceuticals (carbamazepine, diclofenac, tramadol and venlafaxine) under field conditions. The presented study was performed at a small river (Ammer River, mean discharge 0.87 m3 s-1) which is hydrologically complex due to karstification, numerous artificial discharges, and engineered modifications of the channel. We applied a Lagrangian sampling scheme at two sequential river reaches. In general, for the investigated compounds and over the length of the tested reaches, the absolute net attenuation representative for 24 h was low (≤ 23% net attenuation), yet calculated half-lives were comparable to literature. Photodegradation is specifically relevant for the first river reach characterized by a higher net attenuation of the photosensitive compound diclofenac (14.5% ±11.3%) compared to the second section (9.8% ±13.7%). This is likely due to a spatial difference in canopy shading, which is supported by significant correlations (R2 ≥ 0.8) of the temporally changing 'temperature' and 'solar radiation' with time-specific degradation rate constants of photosensitive compounds for consecutive hourly water parcels. In general, the presented spatially and temporally resolved approach is a suitable tool to determine the attenuation of organic micropollutants and to narrow down the interpretation of net attenuation to a few reasonable processes.

ADAMTS-13 Activity Predicts Outcome in Acute Ischaemic Stroke Patients Undergoing Endovascular Treatment.

BACKGROUND: Endovascular treatment improves outcome in patients with acute ischaemic stroke due to large vessel occlusion in general. But outcome in some of these patients is jeopardized by recanalization failure or bleeding. OBJECTIVES: This study aimed to determine a possible association of mediators of inflammation and haemostasis (C-reactive protein, interleukin-6, matrix metalloproteinase-9, monocyte chemoattractant protein-1, asymmetric dimethylarginine [ADMA], symmetric dimethylarginine, von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 [ADAMTS-13]) with the post-intervention grade of reperfusion, complications and clinical outcome in patients who underwent endovascular treatment of ischaemic stroke. PATIENTS/METHODS: Forty-one patients with acute ischaemic stroke due to large vessel occlusion were prospectively enrolled into the study. Peripheral venous blood was taken prior to treatment and 24 hours and 3, 7 and 90 days after symptom onset. The post-intervention grade of reperfusion was determined using the modified Treatment in Cerebral Infarction (mTICI) score. Clinical outcome on day 90 was assessed using the modified Rankin's scale (mRS). RESULTS: Low ADAMTS-13 activity (p = 0.009) and missing of statin therapy (p = 0.038) on admission were independently associated with unfavourable outcome (mRS: 5-6). Patients with unsuccessful reperfusion (mTICI: 0-1) showed higher ADMA levels on admission (p = 0.018). However, this association could not be confirmed in the binary logistic regression analysis. CONCLUSION: Low ADAMTS-13 activity is a predictor of unfavourable outcome in patients with ischaemic stroke undergoing endovascular therapy. Further studies are warranted to elucidate the clinical and potential therapeutic role of ADAMTS-13 in acute ischaemic stroke.