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Yao XH, Shen F, Hao J, Huang L, Keng B. A review of Legionella transmission risk in built environments: sources, regulations, sampling, and detection. Front Public Health 2024; 12:1415157. [PMID: 39131570 PMCID: PMC11309999 DOI: 10.3389/fpubh.2024.1415157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 08/13/2024] Open
Abstract
The risk of Legionella transmission in built environments remains a significant concern. Legionella can spread within buildings through aerosol transmission, prompting the exploration of airborne transmission pathways and proposing corresponding prevention and control measures based on building characteristics. To this end, a comprehensive literature review on the transmission risk of Legionella in built environments was performed. Four electronic databases (PubMed, Web of Science, Google Scholar, and CNKI) were searched from inception to March 2024 for publications reporting the risk of Legionella transmission in built environments. Relevant articles and gray literature reports were hand-searched, and 96 studies were finally included. Legionella pollution comes from various sources, mainly originates in a variety of built environments in which human beings remain for extended periods. The sources, outbreaks, national standards, regulations, and monitoring techniques for Legionella in buildings are reviewed, in addition to increases in Legionella transmission risk due to poor maintenance of water systems and long-distance transmission events caused by aerosol characteristics. Air and water sampling using various analytical methods helps identify Legionella in the environment, recognize sources in the built environments, and control outbreaks. By comparing the standard regulations of national organizations globally, the authors further highlight gaps and deficiencies in Legionella surveillance in China. Such advancements offer essential insights and references for understanding and addressing Legionella transmission risk in the built environment, with the potential to contribute to safeguarding public health and building environment safety.
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Affiliation(s)
- Xiao Hui Yao
- Department of Environmental Health, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Fan Shen
- Department of Environmental Health, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Jing Hao
- Department of Environmental Health, Beijing Fengtai District Center for Disease Prevention and Control, Beijing, China
| | - Lu Huang
- Department of Environmental Health, Beijing Dongcheng District Center for Disease Prevention and Control, Beijing, China
| | - Bin Keng
- Department of Environmental Health, Beijing Huairou District Center for Disease Prevention and Control, Beijing, China
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2
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Fang Z, Zhou X, Liao H, Xu H. A meta-analysis of Legionella pneumophila contamination in hospital water systems. Am J Infect Control 2023; 51:1250-1262. [PMID: 37054892 DOI: 10.1016/j.ajic.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Legionella pneumophila is a common cause of community-acquired pneumonia. We aimed to determine the pooled rates of L pneumophila contamination in the water environment of the hospital. METHODS We searched PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, WangFang and Science Direct, The Cochrane Library, and Science Finder, for relevant studies published until December 2022. Stata 16.0 software was used to determine pooled contamination rates, publication bias, and subgroup analysis. RESULTS Forty-eight eligible articles with a total of 23,640 samples of water were evaluated, and the prevalence of L pneumophila was 41.6%. The results of the subgroup analysis showed that the pollution rate of L pneumophila in hot water (47.6%) was higher than that in other water bodies. The rates of L pneumophila contamination were higher in developed countries (45.2%), culture methods (42.3%), published between 1985 and 2015 (42.9%), and studies with a sample size of less than 100 (53.0%). CONCLUSIONS L pneumophila contamination in medical institutions is still very serious and should be paid attention to, especially in developed countries and hot water tanks.
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Affiliation(s)
- Zisi Fang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaocong Zhou
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hui Liao
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hong Xu
- Department of Environmental Health, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
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Ahmed OB. Evaluation of Drinking Water Quality From Water Coolers in Makkah, Saudi Arabia. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231163676. [PMID: 36908899 PMCID: PMC9998418 DOI: 10.1177/11786302231163676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The quality of drinking water is an important health issue in crowded cities, so that an adequate drinking water with good quality must be provided, hence over hundreds of water coolers are distributed in Makkah city to cope with the increasing demand for drinking water. The present study aimed to determine the chemical and microbial quality of drinking water from coolers in Makkah city. Sixty-three samples from randomly selected water coolers were tested for chemical and bacteriological quality. For all samples, the mean value of physiochemical tests of pH (7.12), TDS (152.7 ppm), turbidity (2.56 NTU), free chlorine (0.312 ppm), fluoride (0.112 ppm), chloride (25.7 ppm), bromide (0.123 ppm), nitrate (0.616 ppm), sulfate (8.36 ppm), lithium (0.134 ppm), sodium (17.6 ppm), potassium (1.42 ppm), magnesium (1.95 ppm), calcium (19.2 ppm), chromium (0.025 ppm), cadmium (0.0026 ppm), and lead (0.0244 ppm) did not exceed the reference values of the drinking water regulations. The total coliform count was detected in 3.2% of the water samples. For total coliform count, the MPN in the majority of water samples (96.8%) was excellent while for E. coli count, the MPN in all water samples (100%) was excellent. Bacteriological quality has shown that no Pseudomonas, Salmonellae, or Legionellae species contamination detected. It was concluded that, the drinking waters in coolers in Makkah city were complied with international standards and within the acceptable limit. It is worth to continue periodic inspection and maintenance for the drinking water coolers during mass gatherings.
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Affiliation(s)
- Omar B Ahmed
- Omar B Ahmed, Department of Environmental and Health Research, The Custodian of the Two Holy Mosques Institute for Hajj and Umrah Research, Umm Al-Qura University, Makkah 21955, Saudi Arabia.
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Doménech-Sánchez A, Laso E, Albertí S. Determination of Legionella spp. prevalence in Spanish hotels in five years. Are tourists really at risk? Travel Med Infect Dis 2022; 46:102269. [DOI: 10.1016/j.tmaid.2022.102269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
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Glažar Ivče D, Rončević D, Šantić M, Cenov A, Tomić Linšak D, Mićović V, Lušić D, Glad M, Ljubas D, Vukić Lušić D. Is a Proactive Approach to Controlling Legionella in the Environment Justified? Food Technol Biotechnol 2021; 59:314-324. [PMID: 34759763 PMCID: PMC8542184 DOI: 10.17113/ftb.59.03.21.7016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/24/2021] [Indexed: 11/29/2022] Open
Abstract
Research background Legionella are Gram-negative bacteria that are ubiquitous in the natural environment. Contaminated water in man-made water systems is a potential source of transmission of legionnaires’ disease. The aim of this study is to explore the prevalence of Legionella pneumophila in the drinking water distribution system (DWDS) of Primorje-Gorski Kotar (PGK) County, Croatia, for the period 2013-2019, coupled with the incidence of legionnaires’ disease. A number of L. pneumophila-positive samples (>100 CFU/L), serogroup distribution and the degree of contamination of specific facilities (health and aged care, tourism, and sports) were assessed. Based on the obtained results, the reasoning for the implementation of a mandatory Legionella environmental surveillance program was assessed. Experimental approach Sample testing for Legionella was carried out according to the standard method for enumeration of this bacterium. A heterotrophic plate count (HPC) and Pseudomonas aeruginosa number were analysed along with the basic physicochemical indicators of drinking water quality. The research period was divided into two parts, namely, the 2013-2018 period (before implementation of the prevention program, after the outbreak of legionnaires’ disease), and the year 2019 (proactive approach, no disease cases recorded). Results and conclusion During the 7-year observation period in PGK County, an increase in the number of samples tested for Legionella was found. An increase in Legionella-positive samples (particularly pronounced during the warmer part of the year) was recorded, along with a growing trend in the number of reported legionnaires’ disease cases. In addition to hot water systems, the risk of Legionella colonisation also applies to cold water systems. Health and aged care facilities appear to be at highest risk. In addition to the higher proportion of positive samples and a higher degree of microbiological load in these facilities, the highest proportion of L. pneumophila SGs 2-14 was identified. Due to the diagnostic limitations of the applied tests, the number of legionnaires’ disease cases is underdiagnosed. Novelty and scientific contribution The introduction of a mandatory preventive approach to monitoring Legionella in DWDS water samples, along with the definition of national criteria for the interpretation of the results will create the preconditions for diagnosis and adequate treatment of larger numbers of legionnaires’ disease cases.
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Affiliation(s)
- Daniela Glažar Ivče
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Dobrica Rončević
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia
| | - Marina Šantić
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Arijana Cenov
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Dijana Tomić Linšak
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Vladimir Mićović
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Dražen Lušić
- Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.,Center for Advanced Computing and Modelling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
| | - Marin Glad
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Davor Ljubas
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, Zagreb, Croatia
| | - Darija Vukić Lušić
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.,Center for Advanced Computing and Modelling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
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Salinas MB, Fenoy S, Magnet A, Vaccaro L, Gomes TD, Hurtado C, Ollero D, Valdivieso E, Del Águila C, Pozuelo MJ, Izquierdo F. Are pathogenic Legionella non-pneumophila a common bacteria in Water Distribution Networks? WATER RESEARCH 2021; 196:117013. [PMID: 33813251 DOI: 10.1016/j.watres.2021.117013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 05/22/2023]
Abstract
The present study analyzes at the national level, the presence of circulating Legionella in the artificial aquatic systems of different facilities of all of them state-owned centers throughout Spain for 12 months. 1754 water samples from various state-owned centers were collected from January to December 2014. Samples were collected from the cooling towers and evaporative condensers (CTC), and water distribution networks such as domestic hot water (DHW), cold water for human consumption (CW), sprinkler irrigation systems (SIS), fire sprinkler systems (FSS), and water from decorative fountains (DF). All these facilities are considered, according to current regulations, as potential amplifying systems for bacteria and possible sources of infection by the generation of droplets and aerosols. The isolation and counting of Legionella in water samples was carried out using microbiological culture following the international normative UNE-EN-ISO 11,731:2007 (ISO 11,731:1998) and UNE-EN ISO 8199:2008 (ISO 8199:2005).The quantification of Legionella colonization, the annual distribution, and the geographical distribution of the Legionella isolates recovered in the water were analyzed. Besides, molecular techniques were used for the characterization of the Legionella non-pneumophila isolates. Legionella was recovered from 15.79% of the analyzed water samples. High colonization was more frequently detected in water samples from CTC, DHW, CW, and DF. Regarding the geographic distribution, positive samples of Legionella were obtained in 14 of the 18 Spanish locations analyzed. Legionella non-pneumophila was the most prevalent and was isolated from water samples from 13 different geographical locations (72%). Legionella anisa and Legionella jordanis were the most frequently non-pneumophila species isolated. Legionella donaldsonii was isolated for the first time in the water distribution networks in Spain. Legionella pneumophila sg 2-14 was detected in 13 locations and Legionella pneumophila sg 1 in 11 locations. Therefore, our study concludes that the presence of Legionella pneumophila and Legionella non-pneumophila species in these systems can be a potential threat to public health and should be examined thoroughly with complementary techniques, such as molecular techniques as a screen for routine diagnosis.
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Affiliation(s)
- Mireya Beatriz Salinas
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Soledad Fenoy
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Angela Magnet
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Lucianna Vaccaro
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Thiago Ds Gomes
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Carolina Hurtado
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Dolores Ollero
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Elizabeth Valdivieso
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Carmen Del Águila
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - María José Pozuelo
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España
| | - Fernando Izquierdo
- Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Madrid, España.
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7
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Li S, Yang Z, Hu D, Cao L, He Q. Understanding building-occupant-microbiome interactions toward healthy built environments: A review. FRONTIERS OF ENVIRONMENTAL SCIENCE & ENGINEERING 2020; 15:65. [PMID: 33145119 PMCID: PMC7596174 DOI: 10.1007/s11783-020-1357-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/30/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Built environments, occupants, and microbiomes constitute a system of ecosystems with extensive interactions that impact one another. Understanding the interactions between these systems is essential to develop strategies for effective management of the built environment and its inhabitants to enhance public health and well-being. Numerous studies have been conducted to characterize the microbiomes of the built environment. This review summarizes current progress in understanding the interactions between attributes of built environments and occupant behaviors that shape the structure and dynamics of indoor microbial communities. In addition, this review also discusses the challenges and future research needs in the field of microbiomes of the built environment that necessitate research beyond the basic characterization of microbiomes in order to gain an understanding of the causal mechanisms between the built environment, occupants, and microbiomes, which will provide a knowledge base for the development of transformative intervention strategies toward healthy built environments. The pressing need to control the transmission of SARS-CoV-2 in indoor environments highlights the urgency and significance of understanding the complex interactions between the built environment, occupants, and microbiomes, which is the focus of this review.
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Affiliation(s)
- Shuai Li
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Zhiyao Yang
- Lyles School of Civil Engineering, Purdue University, West Lafayette, IN 47907 USA
| | - Da Hu
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Liu Cao
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Qiang He
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
- Institute for a Secure & Sustainable Environment, University of Tennessee, Knoxville, TN 37996 USA
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8
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Sharaby Y, Rodríguez-Martínez S, Höfle MG, Brettar I, Halpern M. Quantitative microbial risk assessment of Legionella pneumophila in a drinking water supply system in Israel. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 671:404-410. [PMID: 30933796 DOI: 10.1016/j.scitotenv.2019.03.287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
Legionella pneumophila cause human infections via inhalation of contaminated water aerosols, resulting in severe pneumonia. Legionella spp. prevalence was monitored in a drinking-water distribution system (DWDS) in Northern Israel. Five points (toilet faucets and showers) were sampled seasonally along a three years period. Toilet faucets and shower use, both generating aerosols, are known transmission routes for this pathogen and thus, present a potential health risk. Quantitative Microbial Risk Assessment (QMRA) was applied in order to assess the health risks posed by Legionella for these two exposure scenarios, while considering Legionella seasonality. The obtained results were compared with estimated tolerable risk levels of infection and of disease set by the USEPA and WHO. Both limits were expressed as Disability-Adjusted Life Years index (DALY) being 1 × 10-4 and 1 × 10-6, respectively. The QMRA revealed that the annual risk levels for both faucets and showers use exceeded the acceptable risk of infection with an average of 5.52 × 10-4 and 2.37 × 10-3 DALY'S per person per year, respectively. Annual risk levels were stable with no significant differences between the three years. Risk levels varied significantly between seasons by up to three orders of magnitude. Risk levels were highest during summer, autumn, and lowest during winter. The highest seasonal infection risk values were found in summer for both faucets and showers, which corresponded to 8.09 × 10-4 and 2.75 × 10-3 DALY'S per person per year, respectively. In conclusion, during summer and autumn there is a significant increase of the infection risk associated with exposure to Legionella-contaminated aerosols, in the studied water system. Public health assessment and prevention measures should focus on these seasons.
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Affiliation(s)
- Y Sharaby
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel.
| | - S Rodríguez-Martínez
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - M G Höfle
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - I Brettar
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - M Halpern
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel; Department of Biology and Environment, Faculty of Natural Sciences, University of Haifa, Oranim, Tivon, Israel
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9
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A Supervised Statistical Learning Approach for Accurate Legionella pneumophila Source Attribution during Outbreaks. Appl Environ Microbiol 2017; 83:AEM.01482-17. [PMID: 28821546 DOI: 10.1128/aem.01482-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/11/2017] [Indexed: 01/12/2023] Open
Abstract
Public health agencies are increasingly relying on genomics during Legionnaires' disease investigations. However, the causative bacterium (Legionella pneumophila) has an unusual population structure, with extreme temporal and spatial genome sequence conservation. Furthermore, Legionnaires' disease outbreaks can be caused by multiple L. pneumophila genotypes in a single source. These factors can confound cluster identification using standard phylogenomic methods. Here, we show that a statistical learning approach based on L. pneumophila core genome single nucleotide polymorphism (SNP) comparisons eliminates ambiguity for defining outbreak clusters and accurately predicts exposure sources for clinical cases. We illustrate the performance of our method by genome comparisons of 234 L. pneumophila isolates obtained from patients and cooling towers in Melbourne, Australia, between 1994 and 2014. This collection included one of the largest reported Legionnaires' disease outbreaks, which involved 125 cases at an aquarium. Using only sequence data from L. pneumophila cooling tower isolates and including all core genome variation, we built a multivariate model using discriminant analysis of principal components (DAPC) to find cooling tower-specific genomic signatures and then used it to predict the origin of clinical isolates. Model assignments were 93% congruent with epidemiological data, including the aquarium Legionnaires' disease outbreak and three other unrelated outbreak investigations. We applied the same approach to a recently described investigation of Legionnaires' disease within a UK hospital and observed a model predictive ability of 86%. We have developed a promising means to breach L. pneumophila genetic diversity extremes and provide objective source attribution data for outbreak investigations.IMPORTANCE Microbial outbreak investigations are moving to a paradigm where whole-genome sequencing and phylogenetic trees are used to support epidemiological investigations. It is critical that outbreak source predictions are accurate, particularly for pathogens, like Legionella pneumophila, which can spread widely and rapidly via cooling system aerosols, causing Legionnaires' disease. Here, by studying hundreds of Legionella pneumophila genomes collected over 21 years around a major Australian city, we uncovered limitations with the phylogenetic approach that could lead to a misidentification of outbreak sources. We implement instead a statistical learning technique that eliminates the ambiguity of inferring disease transmission from phylogenies. Our approach takes geolocation information and core genome variation from environmental L. pneumophila isolates to build statistical models that predict with high confidence the environmental source of clinical L. pneumophila during disease outbreaks. We show the versatility of the technique by applying it to unrelated Legionnaires' disease outbreaks in Australia and the UK.
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Springston JP, Yocavitch L. Existence and control of Legionella bacteria in building water systems: A review. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:124-134. [PMID: 27624495 DOI: 10.1080/15459624.2016.1229481] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Legionellae are waterborne bacteria which are capable of causing potentially fatal Legionnaires' disease (LD), as well as Pontiac Fever. Public concern about Legionella exploded following the 1976 outbreak at the American Legion conference in Philadelphia, where 221 attendees contracted pneumonia and 34 died. Since that time, a variety of different control methods and strategies have been developed and implemented in an effort to eradicate Legionella from building water systems. Despite these efforts, the incidence of LD has been steadily increasing in the U.S. for more than a decade. Public health and occupational hygiene professionals have maintained an active debate regarding best practices for management and control of Legionella. Professional opinion remains divided with respect to the relative merits of performing routine sampling for Legionella, vs. the passive, reactive approach that has been largely embraced by public health officials and facility owners. Given the potential risks and ramifications associated with waiting to assess systems for Legionella until after disease has been identified and confirmed, a proactive approach of periodic testing for Legionella, along with proper water treatment, is the best approach to avoiding large-scale disease outbreaks.
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11
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Legionella and risk management in hospitals—A bibliographic research methodology for people responsible for built environment and facility management. Int J Hyg Environ Health 2016; 219:890-897. [DOI: 10.1016/j.ijheh.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 01/06/2023]
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12
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Vaccaro L, Izquierdo F, Magnet A, Hurtado C, Salinas MA, Gomes TS, Angulo S, Salso S, Pelaez J, Tejeda MI, Alhambra A, Gómez C, Enríquez A, Estirado E, Fenoy S, del Aguila C. First Case of Legionnaire's Disease Caused by Legionella anisa in Spain and the Limitations on the Diagnosis of Legionella non-pneumophila Infections. PLoS One 2016; 11:e0159726. [PMID: 27442238 PMCID: PMC4956277 DOI: 10.1371/journal.pone.0159726] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/27/2016] [Indexed: 12/13/2022] Open
Abstract
Legionnaires' disease is a severe form of pneumonia, with worldwide relevance, caused by Legionella spp. Approximately 90% of all cases of legionellosis are caused by Legionella pneumophila, but other species can also be responsible for this infection. These bacteria are transmitted by inhalation of aerosols or aspiration of contaminated water. In Spain, environmental studies have demonstrated the presence of Legionella non-pneumophila species in drinking water treatment plants and water distribution networks. Aware that this evidence indicates a risk factor and the lack of routine assays designed to detect simultaneously diverse Legionella species, we analyzed 210 urine samples from patients presenting clinical manifestations of pneumonia using a semi-nested PCR for partial amplification of the 16S rDNA gene of Legionella and a diagnostic method used in hospitals for Legionella antigen detection. In this study, we detected a total of 15 cases of legionellosis (7.1%) and the first case of Legionnaires' disease caused by L. anisa in Spain. While the conventional method used in hospitals could only detect four cases (1.9%) produced by L. pneumophila serogroup 1, using PCR, the following species were identified: Legionella spp. (10/15), L. pneumophila (4/15) and L. anisa (1/15). These results suggest the need to change hospital diagnostic strategies regarding the identification of Legionella species associated with this disease. Therefore, the detection of Legionella DNA by PCR in urine samples seems to be a suitable alternative method for a sensitive, accurate and rapid diagnosis of Legionella pneumonia, caused by L. pneumophila and also for L. non-pneumophila species.
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Affiliation(s)
- Lucianna Vaccaro
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Fernando Izquierdo
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Angela Magnet
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Carolina Hurtado
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Mireya A. Salinas
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Thiago Santos Gomes
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
- CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | - Santiago Angulo
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Santiago Salso
- Hospital Universitario HM Monteprincipe, Boadilla del Monte, Madrid, Spain
| | - Jesús Pelaez
- Hospital Universitario HM Monteprincipe, Boadilla del Monte, Madrid, Spain
| | | | | | - Carmen Gómez
- Hospital Universitario HM Sanchinarro, Madrid, Madrid, Spain
| | - Ana Enríquez
- Hospital Universitario Carlos III, Madrid, Madrid, Spain
| | - Eva Estirado
- Hospital Universitario Carlos III, Madrid, Madrid, Spain
| | - Soledad Fenoy
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
| | - Carmen del Aguila
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo CEU, Alcorcón, Madrid, Spain
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13
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Oana K, Kobayashi M, Yamaki D, Sakurada T, Nagano N, Kawakami Y. Applicability assessment of ceramic microbeads coated with hydroxyapatite-binding silver/titanium dioxide ceramic composite earthplus™ to the eradication of Legionella in rainwater storage tanks for household use. Int J Nanomedicine 2015; 10:4971-9. [PMID: 26346201 PMCID: PMC4531045 DOI: 10.2147/ijn.s87350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Water environments appear to be the habitats of Legionella species. Legionellosis is considered as a preventable illness because bacterial reservoirs can be controlled and removed. Roof-harvested rainwater has attracted significant attention not only as a groundwater recharge but also as a potential alternative source of nonpotable water. We successfully developed ceramic microbeads coated with hydroxyapatite-binding silver/titanium dioxide ceramic composite earthplus™ using the thermal spraying method. The ceramic microbeads were demonstrated to have bactericidal activities against not only Legionella but also coliform and heterotrophic bacteria. Immersing the ceramic microbeads in household rainwater storage tanks was demonstrated to yield the favorable eradication of Legionella organisms. Not only rapid-acting but also long-lasting bactericidal activities of the ceramic microbead were exhibited against Legionella pneumophila. However, time-dependent attenuation of the bactericidal activities against Legionella were also noted in the sustainability appraisal experiment. Therefore, the problems to be overcome surely remain in constantly managing the Legionella-pollution by means of immersing the ceramic microbeads. The results of our investigation apparently indicate that the earthplus™-coated ceramic microbeads would become the favorable tool for Legionella measures in household rainwater storage tanks, which may become the natural reservoir for Legionella species. Our investigation would justify further research and data collection to obtain more reliable procedures to microbiologically regulate the Legionella in rainwater storage tanks.
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Affiliation(s)
- Kozue Oana
- Division of Infection Control and Microbiological Regulation, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan ; Division of Clinical Microbiology, Department of Biomedical Laboratory Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Michiko Kobayashi
- Division of Infection Control and Microbiological Regulation, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Dai Yamaki
- Shinshu Ceramics Co., Ltd., Kiso, Nagano, Japan
| | | | - Noriyuki Nagano
- Division of Infection Control and Microbiological Regulation, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan ; Division of Clinical Microbiology, Department of Biomedical Laboratory Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiyuki Kawakami
- Division of Infection Control and Microbiological Regulation, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine, Matsumoto, Japan ; Division of Clinical Microbiology, Department of Biomedical Laboratory Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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14
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Al-Matawah Q, Al-Zenki S, Al-Azmi A, Al-Waalan T, Al-Salameen F, Hejji AB. Legionella detection and subgrouping in water air-conditioning cooling tower systems in Kuwait. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:10235-10241. [PMID: 25701245 DOI: 10.1007/s11356-015-4226-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/09/2015] [Indexed: 06/04/2023]
Abstract
The main aim of the study was to test for the presence of Legionnaires' disease-causing microorganisms in air-conditioned buildings in Kuwait using molecular technologies. For this purpose, 547 samples were collected from 38 cooling towers for the analysis of Legionella pneumophila. These samples included those from water (n = 178), air (n = 231), and swabs (n = 138). Out of the 547 samples, 226 (41%) samples were presumptive positive for L. pneumophila, with L. pneumophila viable counts in the positive water samples ranging from 1 to 88 CFU/ml. Of the Legionella culture-positive samples, 204 isolates were examined by latex agglutination. These isolates were predominately identified as L. pneumophila serogroup (sg) 2-14. Using the Dresden panel of monoclonal antibodies, 74 representatives isolates were further serogrouped. Results showed that 51% of the isolates belonged to serogroup 7 followed by 1 (18%) and 3 (18%). Serogroups 4 (4%) and 10 (7%) were isolated at a lower frequency, and two isolates could not be assigned to a serogroup. These results indicate the wide prevalence of L. pneumophila serogroup 7 as the predominant serogroup at the selected sampling sites. Furthermore, the 74 L. pneumophila (sg1 = 13; sg3 = 13; sg4 = 3; sg7 = 38; sg10 = 5; sgX = 2) isolates were genotyped using the seven gene protocol sequence-based typing (SBT) scheme developed by the European Working Group for Legionella Infections (EWGLI). The results show that Legionella isolates were discriminated into nine distinct sequence typing (ST) profiles, five of which were new to the SBT database of EWGLI. Additionally, all of the ST1 serogroup 1 isolates were of the OLDA/Oxford subgroup. These baseline data will form the basis for the development of a Legionella environmental surveillance program and used for future epidemiological investigations.
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Affiliation(s)
- Qadreyah Al-Matawah
- Kuwait Institute for Scientific Research, Environment & Life Sciences Research Center, P. O. Box 24885, Safat, 13109, Kuwait,
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15
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Wang S, Huang J, Yang Y, Hui Y, Ge Y, Larssen T, Yu G, Deng S, Wang B, Harman C. First report of a Chinese PFOS alternative overlooked for 30 years: its toxicity, persistence, and presence in the environment. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2013; 47:10117-28. [PMID: 23952109 DOI: 10.1021/es402455r] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
This is the first report on the environmental occurrence of a chlorinated polyfluorinated ether sulfonate (locally called F-53B, C8ClF16O4SK). It has been widely applied as a mist suppressant by the chrome plating industry in China for decades but has evaded the attention of environmental research and regulation. In this study, F-53B was found in high concentrations (43-78 and 65-112 μg/L for the effluent and influent, respectively) in wastewater from the chrome plating industry in the city of Wenzhou, China. F-53B was not successfully removed by the wastewater treatments in place. Consequently, it was detected in surface water that receives the treated wastewater at similar levels to PFOS (ca. 10-50 ng/L) and the concentration decreased with the increasing distance from the wastewater discharge point along the river. Initial data presented here suggest that F-53B is moderately toxic (Zebrafish LC50-96 h 15.5 mg/L) and is as resistant to degradation as PFOS. While current usage is limited to the chrome plating industry, the increasing demand for PFOS alternatives in other sectors may result in expanded usage. Collectively, the results of this work call for future assessments on the effects of this overlooked contaminant and its presence and fate in the environment.
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Affiliation(s)
- Siwen Wang
- State Key Joint Laboratory of Environment Simulation and Pollution Control (SKJLESPC), School of Environment, POPs Research Centre, Tsinghua University , Beijing 100084, P.R. China
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16
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Diversity of legionellae strains from Tunisian hot spring water. Res Microbiol 2013; 164:342-50. [DOI: 10.1016/j.resmic.2013.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/16/2013] [Indexed: 11/22/2022]
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17
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Qin T, Yan G, Ren H, Zhou H, Wang H, Xu Y, Zhao M, Guan H, Li M, Shao Z. High prevalence, genetic diversity and intracellular growth ability of Legionella in hot spring environments. PLoS One 2013; 8:e59018. [PMID: 23527075 PMCID: PMC3601096 DOI: 10.1371/journal.pone.0059018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 02/09/2013] [Indexed: 11/18/2022] Open
Abstract
Background Legionella is the causative agent of Legionnaires' disease, and hot springs are a major source of outbreaks of this disease. It is important from a public health perspective to survey hot spring environments for the presence of Legionella. Methods Prospective surveillance of the extent of Legionella pollution was conducted at three hot spring recreational areas in Beijing, China in 2011. Pulsed-field gel electrophoresis (PFGE) and sequence-based typing (SBT) were used to describe the genetic polymorphism of isolates. The intracellular growth ability of the isolates was determined by interacting with J774 cells and plating the dilutions onto BCYE agar plates. Results Overall, 51.9% of spring water samples showed Legionella-positive, and their concentrations ranged from 1 CFU/liter to 2,218 CFU/liter. The positive rates of Legionella were significantly associated with a free chlorine concentration of ≥0.2 mg/L, urea concentration of ≥0.05 mg/L, total microbial counts of ≥400 CFU/ml and total coliform of ≥3 MPN/L (p<0.01). The Legionella concentrations were significantly associated with sample temperature, pH, total microbial counts and total coliform (p<0.01). Legionella pneumophila was the most frequently isolated species (98.9%), and the isolated serogroups included serogroups 3 (25.3%), 6 (23.4%), 5 (19.2%), 1 (18.5%), 2 (10.2%), 8 (0.4%), 10 (0.8%), 9 (1.9%) and 12 (0.4%). Two hundred and twenty-eight isolates were analyzed by PFGE and 62 different patterns were obtained. Fifty-seven L. pneumophila isolates were selected for SBT analysis and divided into 35 different sequence types with 5 main clonal groups. All the 57 isolates had high intracellular growth ability. Conclusions Our results demonstrated high prevalence and genetic polymorphism of Legionella in springs in Beijing, China, and the SBT and intracellular growth assay results suggested that the Legionella isolates of hot spring environments were pathogenic. Improved control and prevention strategies are urgently needed.
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Affiliation(s)
- Tian Qin
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
- * E-mail: (TQ); (ZS)
| | - Gebin Yan
- Changping District Center for Disease Control and Prevention, Changping, Beijing, China
| | - Hongyu Ren
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Huanxin Wang
- Changping District Center for Disease Control and Prevention, Changping, Beijing, China
| | - Ying Xu
- Changping District Center for Disease Control and Prevention, Changping, Beijing, China
| | - Mingqiang Zhao
- Changping District Center for Disease Control and Prevention, Changping, Beijing, China
| | - Hong Guan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Machao Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Zhujun Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
- * E-mail: (TQ); (ZS)
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Velonakis E, Karanika M, Mouchtouri V, Thanasias E, Katsiaflaka A, Vatopoulos A, Hadjichristodoulou C. Decreasing trend of Legionella isolation in a long-term microbial monitoring program in Greek hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2011; 22:197-209. [PMID: 22017573 DOI: 10.1080/09603123.2011.628644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Legionnaires' disease is a known cause of severe pneumonia in a nosocomial setting. This study examined Legionella isolation in Greek hospitals. Water samples and swabs of showerheads from 41 hospitals were collected over a four-year period (2004-2007) from hot and cold water systems and cooling towers in Greece. In total, 1058 samples were examined for the presence of Legionella. From the hot water samples examined, 166 out of 607 (27.3%) were positive for Legionella, including 111 (18.3%) positive for Legionella pneumophila sg1 samples. The temperature of hot water samples less than 55°C was statistically significant, associated with Legionella spp. isolation (RR 4.01, 95%CI 2.33-6.92). Ten out of 17 (58.8%) hospital cooling towers required remedial actions due to Legionella colonization. Reemergence of Legionella spp. colonization was evident in more than half of the hospitals where frequent monitoring and appropriate risk assessment plans were absent or lacking. Hospitals that were monitored continuously over the study period presented a decreasing trend of Legionella colonization. Environmental risk assessment together with Legionella isolation should be enforced systematically in hospitals.
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Affiliation(s)
- Emanouil Velonakis
- Department of Microbiology, National School of Public Health, Athens, Greece
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Lee HK, Shim JI, Kim HE, Yu JY, Kang YH. Distribution of Legionella species from environmental water sources of public facilities and genetic diversity of L. pneumophila serogroup 1 in South Korea. Appl Environ Microbiol 2010; 76:6547-54. [PMID: 20693456 PMCID: PMC2950455 DOI: 10.1128/aem.00422-10] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 07/06/2010] [Indexed: 01/19/2023] Open
Abstract
A total of 560 Legionella species were isolated from environmental water sources from public facilities from June to September 2008 throughout South Korea. The distribution of Legionella isolates was investigated according to geographical region, facility type, and sample type. The genetic diversity of 104 isolates of Legionella pneumophila serogroup 1 (sg 1) was analyzed by sequence-based typing (SBT). L. pneumophila was distributed broadly throughout Korea, accounting for 85.0% of the isolates, and L. pneumophila sg 1 predominated in all of the public facilities except for the springs. Legionella anisa and Legionella bozemanii predominated among non-L. pneumophila species (48.1% and 21.0%, respectively). The second most dominant strain differed depending on the facility type: L. anisa was the second most dominant strain in the buildings (10.8%), L. pneumophila sg 5 in public baths (21.6%), L. pneumophila sg 6 in factories (12.0%), and L. pneumophila sg 7 in hospitals (13.1%). In the SBT analysis, 104 L. pneumophila sg 1 isolates were differentiated into 26 sequence types (STs) and categorized into 3 clonal groups (CGs) and 10 singleton STs via the eBURST V3 program. ST1, a potential founder of major CG1, was commonly distributed (48.1%). The dominant ST in hot water was ST-K1 (7, 12, 17, 3, 35, 11, 11), which was designated in this study (36.1%). The second most dominant strain differed depending on the type of facility from which the samples were obtained. The unique allelic profile of ST-K1, obtained from hot water, was not found in the European Working Group for Legionella Infections (EWGLI) SBT database.
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Affiliation(s)
- Hae Kyung Lee
- Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Centers for Disease Control and Prevention, Seoul, Republic of Korea
| | - Jung Im Shim
- Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Centers for Disease Control and Prevention, Seoul, Republic of Korea
| | - Hye Eun Kim
- Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Centers for Disease Control and Prevention, Seoul, Republic of Korea
| | - Jae Yon Yu
- Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Centers for Disease Control and Prevention, Seoul, Republic of Korea
| | - Yeon Ho Kang
- Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Centers for Disease Control and Prevention, Seoul, Republic of Korea
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Rivera J, Granizo J, Aguilar L, Giménez M, Aguiar J, Mozota J, Vos-Arenilla A, Prieto J. Analysis of the impact of a new electro-chemical activation system for potable water disinfection on the Legionella pneumophila isolation rate in a Spanish hospital. J Infect Prev 2010. [DOI: 10.1177/1757177410362497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a field study comparing isolation rates pre- and post-installation of an electro-chemical activation system for Legionella pneumophila disinfection of potable hot water in a Spanish hospital, a total of 250 tap samples pre-installation and 113 post-installation were collected. Chlorine levels were higher ( p < 0.001) post-installation (0.55 ± 0.41 vs. 1.19 ± 0.44 ppm). Of 38.0% (138/363) samples positive for L. pneumophila, 111 (80.4%) were serogroups 2—14. Post-installation, the isolation rate was lower (46.8% vs. 18.6%; p < 0.001, odds ratio (OR) 0.26, 95% confidence interval (CI) 0.15—0.44) due to significant ( p < 0.001; OR 0.25, 95% CI 0.14—0.45) reduction in L. pneumophila serogroups 2—14 from 38.4% to 13.3%. Post-installation, isolation rates were lower in spring (44.4% vs. 0.0%; p < 0.001), summer (80.0% vs. 25.0%; p = 0.003) and autumn (72.0% vs. 28.9%; p = 0.018), but not in winter (18.5% vs. 11.8%; p = 0.688). The seasonal wave constructed with pre-installation data significantly decreased post-installation by decreasing isolation rates in summer and autumn to rates similar to those found in winter pre-installation.
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Affiliation(s)
- J.M. Rivera
- Preventive Medicine Department, School of Medicine, Universidad Complutense, Madrid, Spain, Bioseguridad Ambiental SL, Madrid, Spain
| | | | - L. Aguilar
- Microbiology Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain,
| | - M.J. Giménez
- Microbiology Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
| | | | - J. Mozota
- Preventive Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A. Vos-Arenilla
- Nursery Department, Nursery School, Universidad Complutense, Madrid, Spain
| | - J. Prieto
- Microbiology Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
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Rivera JM, Granizo JJ, Aguilar L, Giménez MJ, Aguiar JM, Prieto J. Is there a relationship between monthly rainfall and the isolation of Legionella in potable water systems in Spanish healthcare facilities? Infect Control Hosp Epidemiol 2009; 30:306-8. [PMID: 19215199 DOI: 10.1086/595981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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