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Párraga-Niño N, Cortès-Tarragó R, Quero S, Garcia-Núñez M, Arqué E, Sabaté S, Ramirez D, Gavaldà L. Persistence of viable but nonculturable Legionella pneumophila state in hospital water systems: A hidden enemy? THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 927:172410. [PMID: 38608884 DOI: 10.1016/j.scitotenv.2024.172410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Abstract
There is little evidence of the long-term consequences of maintaining sanitary hot water at high temperatures on the persistence of Legionella in the plumbing system. The aims of this study were to describe the persistence and genotypic variability of L. pneumophila in a hospital building with two entirely independent hot water distribution systems, and to estimate the thermotolerance of the genotypic variants by studying the quantity of VBNC L. pneumophila. Eighty isolates from 55 water samples obtained between the years 2012-2017 were analyzed. All isolates correspond to L. pneumophila serogroup 6. The isolates were discriminated in four restriction patterns by pulsed-field gel electrophoresis. In one installation, pattern A + Aa predominated, accounting for 75.8 % of samples, while the other installation exhibited pattern B as the most frequent (81.8 % of samples; p < 0.001). The mean temperature of the isolates was: 52.6 °C (pattern A + Aa) and 55.0 °C (pattern B), being significantly different. Nine strains were selected as representative among patterns to study their thermotolerance by flow-cytometry after 24 h of thermic treatment. VBNC bacteria were detected in all samples. After thermic treatment at 50 °C, 52.0 % of bacteria had an intact membrane, and after 55 °C this percentage decreased to 23.1 %. Each pattern exhibited varying levels of thermotolerance. These findings indicate that the same hospital building can be colonized with different predominant types of Legionella if it has independent hot water installations. Maintaining a minimum temperature of 50 °C at distal points of the system would allow the survival of replicative L. pneumophila. However, the presence of Legionella in hospital water networks is underestimated if culture is considered as the standard method for Legionella detection, because VBNC do not grow on culture plates. This phenomenon can carry implications for the Legionella risk management plans in hospitals that adjust their control measures based on the microbiological surveillance of water.
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Affiliation(s)
- Noemí Párraga-Niño
- Clinical and environmental infectious diseases study group, Fundació Institut d'Investigació Germans Trias i Pujol, Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, Spain; Fundació Lluita contra les Infeccions, Carretera de Can Ruti, 08916 Badalona, Barcelona, Spain.
| | - Roger Cortès-Tarragó
- Clinical and environmental infectious diseases study group, Fundació Institut d'Investigació Germans Trias i Pujol, Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, Spain
| | - Sara Quero
- Clinical and environmental infectious diseases study group, Fundació Institut d'Investigació Germans Trias i Pujol, Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, Spain; Fundació Lluita contra les Infeccions, Carretera de Can Ruti, 08916 Badalona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Plaça Torre de l'Aigua, s/n, 08208 Sabadell, Barcelona, Spain
| | - Marian Garcia-Núñez
- Clinical and environmental infectious diseases study group, Fundació Institut d'Investigació Germans Trias i Pujol, Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, Spain
| | - Elisenda Arqué
- Clinical and environmental infectious diseases study group, Fundació Institut d'Investigació Germans Trias i Pujol, Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, Spain
| | - Sara Sabaté
- Agència de Salut Pública de Barcelona (ASPB), Plaza Lesseps 1, 08023 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
| | - Dolors Ramirez
- Department of Preventive Medicine-Hospital Hygiene. Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - Laura Gavaldà
- Department of Preventive Medicine-Hospital Hygiene. Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
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Hayatimehr S, Mirkalantari S, Amirmozafari N, Jazi FM, Moghadam MT. Virulence Genes and Biofilm Formation Among Legionella pneumophila Isolates Collected from Hospital Water Sources. Curr Microbiol 2024; 81:141. [PMID: 38625380 DOI: 10.1007/s00284-023-03609-1] [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: 09/19/2022] [Accepted: 12/29/2023] [Indexed: 04/17/2024]
Abstract
Legionella pneumophila can be transmitted to people, especially immunocompromised patients, via hospital water pipe systems and cause severe pneumonia. The aim of our study was to investigate the presence of major virulence factor genes, ability of biofilms formation, and correlation between presence of Legionella isolates and temperature, pH, and residual chlorine of water. Hundred water samples were collected from nine hospitals in Tehran, Iran. Temperature, pH, and residual chlorine were determined during sampling. Different virulence genes and the ability to form biofilms were subsequently analyzed among the L. pneumophila isolates. Results showed that 12 (12%) samples were positive in culture method and all of the isolates were positive as L. pneumophila species (mip). A correlation was found between Legionella culture positivity and temperature and pH of water, but there was no significant correlation between residual chlorine of water samples and the presence of Legionella. The isolation of Legionella rate in summer and spring was higher than winter and autumn. Twelve (100%) isolates were positive for mip genes, 9 (75%) for dot genes, 8 (66.66%) for hsp, 6 (50%) for lvh, and 4 (33.33%) for rtx. All of the isolates displayed strong ability for biofilm production every three days. Two of these isolates (16.6%) displayed weak ability to form biofilm on the first day of incubation. This study revealed that water sources in hospitals were colonized by virulent Legionella and should be continuously monitored to avoid elevated concentrations of Legionella with visible biofilm formation.
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Affiliation(s)
- Sara Hayatimehr
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shiva Mirkalantari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Nour Amirmozafari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faramarz Masjedian Jazi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Farina C, Cacciabue E, Averara F, Ferri N, Vailati F, Del Castillo G, Serafini A, Fermi B, Doniselli N, Pezzoli F. Water Safety Plan, Monochloramine Disinfection and Extensive Environmental Sampling Effectively Control Legionella and Other Waterborne Pathogens in Nosocomial Settings: The Ten-Year Experience of an Italian Hospital. Microorganisms 2023; 11:1794. [PMID: 37512966 PMCID: PMC10384652 DOI: 10.3390/microorganisms11071794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Legionella contamination control is crucial in healthcare settings where patients suffer an increased risk of disease and fatal outcome. To ensure an effective management of this health hazard, the accurate application of a hospital-specific Water Safety Plan (WSP), the choice of a suitable water disinfection system and an extensive monitoring program are required. Here, the ten-year experience of an Italian hospital is reported: since its commissioning, Legionellosis risk management has been entrusted to a multi-disciplinary Working Group, applying the principles of the World Health Organization's WSP. The disinfection strategy to prevent Legionella and other waterborne pathogens relies on the treatment of domestic hot water with a system ensuring the in situ production and dosage of monochloramine. An average of 250 samples/year were collected and analyzed to allow an accurate assessment of the microbiological status of water network. With the aim of increasing the monitoring sensitivity, in addition to the standard culture method, an optimized MALDI-ToF MS-based strategy was applied, allowing the identification of Legionella species and other relevant opportunistic pathogens. Data collected so far confirmed the effectiveness of this multidisciplinary approach: the fraction of positive samples never overcame 1% on a yearly basis and Legionnaires' Disease cases never occurred.
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Affiliation(s)
- Claudio Farina
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Eleonora Cacciabue
- Health Care Coordination Offices, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Franca Averara
- Department of Health Care Professions, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Nadia Ferri
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Francesca Vailati
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | | | | | - Beatrice Fermi
- Sanipur S.p.A., 25020 Flero, Italy
- ESCMID Study Group for Legionella Infections (ESGLI), 4001 Basel, Switzerland
| | - Nicola Doniselli
- Sanipur S.p.A., 25020 Flero, Italy
- ESCMID Study Group for Legionella Infections (ESGLI), 4001 Basel, Switzerland
| | - Fabio Pezzoli
- Health Care Coordination Offices, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
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Buse HY, Morris BJ, Gomez-Alvarez V, Szabo JG, Hall JS. Legionella Diversity and Spatiotemporal Variation in The Occurrence of Opportunistic Pathogens within a Large Building Water System. Pathogens 2020; 9:E567. [PMID: 32668779 PMCID: PMC7400177 DOI: 10.3390/pathogens9070567] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/22/2023] Open
Abstract
Understanding Legionella survival mechanisms within building water systems (BWSs) is challenging due to varying engineering, operational, and water quality characteristics unique to each system. This study aimed to evaluate Legionella, mycobacteria, and free-living amoebae occurrence within a BWS over 18-28 months at six locations differing in plumbing material and potable water age, quality, and usage. A total of 114 bulk water and 57 biofilm samples were analyzed. Legionella culturability fluctuated seasonally with most culture-positive samples being collected during the winter compared to the spring, summer, and fall months. Positive and negative correlations between Legionella and L. pneumophila occurrence and other physiochemical and microbial water quality parameters varied between location and sample types. Whole genome sequencing of 19 presumptive Legionella isolates, from four locations across three time points, identified nine isolates as L. pneumophila serogroup (sg) 1 sequence-type (ST) 1; three as L. pneumophila sg5 ST1950 and ST2037; six as L. feeleii; and one as Ochrobactrum. Results showed the presence of a diverse Legionella population with consistent and sporadic occurrence at four and two locations, respectively. Viewed collectively with similar studies, this information will enable a better understanding of the engineering, operational, and water quality parameters supporting Legionella growth within BWSs.
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Affiliation(s)
- Helen Y. Buse
- Homeland Security and Materials Management Division, Center for Environmental Solutions & Emergency Response (CESER), Office of Research and Development (ORD), US Environmental Protection Agency (USEPA), Cincinnati, OH 45268, USA; (J.G.S.); (J.S.H.)
| | - Brian J. Morris
- Pegasus Technical Services, Inc c/o US EPA, Cincinnati, OH 45268, USA;
| | - Vicente Gomez-Alvarez
- Water Infrastructure Division, Center for Environmental Solutions & Emergency Response (CESER), US Environmental Protection Agency (USEPA), Office of Research and Development (ORD), Cincinnati, OH 45268, USA;
| | - Jeffrey G. Szabo
- Homeland Security and Materials Management Division, Center for Environmental Solutions & Emergency Response (CESER), Office of Research and Development (ORD), US Environmental Protection Agency (USEPA), Cincinnati, OH 45268, USA; (J.G.S.); (J.S.H.)
| | - John S. Hall
- Homeland Security and Materials Management Division, Center for Environmental Solutions & Emergency Response (CESER), Office of Research and Development (ORD), US Environmental Protection Agency (USEPA), Cincinnati, OH 45268, USA; (J.G.S.); (J.S.H.)
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5
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A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program. Healthcare (Basel) 2019; 7:healthcare7010039. [PMID: 30857147 PMCID: PMC6473578 DOI: 10.3390/healthcare7010039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/16/2022] Open
Abstract
A proactive environmental monitoring program was conducted to determine the risk and prevent nosocomial waterborne infections of Legionella spp. in infants. Sink taps in a neonatal intensive care unit (NICU) and two obstetric clinics were monitored for Legionella spp. A total of 59 water samples were collected during a 3-year period and 20 of them were found colonized with Legionella pneumophila. Standard culture, molecular, and latex agglutination methods were used for the detection and identification of Legionella bacteria. Hospital personnel also proceeded with remedial actions (hyperchlorination and thermal shock treatment) in the event of colonization. The minimal inhibitory concentration (MIC) values of erythromycin, ciprofloxacin was determined for Legionella isolates using the e-test method. Our data indicate that the majority of neonatal sink-taps were colonized at least once during the study with Legionella spp. Among 20 isolates, 5 were considered as low-level resistant, 3 in erythromycin and 2 in ciprofloxacin, while no resistant strains were detected. Environmental surveillance in neonatal and obstetric units is suggested to prevent waterborne infections, and thus to reduce the risk of neonatal nosocomial infections.
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Rota MC, Bella A, Caporali MG, Nicolau A, Drasar V, Ricci ML, Scaturro M, Gumá M, Crespi S. Travel-associated Legionnaires' disease: would changing cluster definition lead to the prevention of a larger number of cases? Epidemiol Infect 2018; 147:e62. [PMID: 30501676 PMCID: PMC6518564 DOI: 10.1017/s0950268818003266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 11/15/2022] Open
Abstract
According to European Guidelines for Legionnaires' Disease prevention and control, travel-associated Legionnaires' disease (TALD) cases are managed differently if classified as sporadic or as part of a cluster and more stringent control measures are deployed after clusters are identified. In this study, we propose to modify the current cluster definition: 'two or more cases of Legionnaires' disease (LD) who stayed at, or visited, the same commercial accommodation site 2-10 days before onset of illness and whose onset is within the same 2-year period' with a new cluster definition, i.e. accommodation sites associated with multiple cases regardless of the time elapsed between them. TALD cases occurred in Italy and in the Balearic Islands between 2005 and 2015 were analysed applying the current European Legionnaires' Disease Surveillance Network (ELDSNet) cluster definition. In a sample of selected accommodation sites with multiple cases, a microbiological study was also conducted. Using the new definition, 63 additional sites (16.4% increase) and 225 additional linked cases (19.5% increase) were identified. Legionella pneumophila sg1 was isolated from 90.7% of the selected accommodation sites. The use of the here proposed TALD cluster definition would warrant a full investigation for each new identified case. This approach should therefore increase the number of sites that will require a risk assessment and, in the presence of an increased risk, the adoption of LD control measures to hopefully prevent additional cases.
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Affiliation(s)
- M. C. Rota
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - A. Bella
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - M. G. Caporali
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - A. Nicolau
- Conselleria de Salut i Consum, Palma de Mallorca, Spain
| | - V. Drasar
- Public Health Institute Ostrava, Vyskov, Czech Republic
| | - M. L. Ricci
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - M. Scaturro
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - M. Gumá
- Conselleria de Salut i Consum, Palma de Mallorca, Spain
| | - S. Crespi
- Biolinea Int., Palma de Mallorca, Spain
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Walker J, Moore G, Collins S, Parks S, Garvey MI, Lamagni T, Smith G, Dawkin L, Goldenberg S, Chand M. Microbiological problems and biofilms associated with Mycobacterium chimaera in heater-cooler units used for cardiopulmonary bypass. J Hosp Infect 2017; 96:209-220. [PMID: 28532976 DOI: 10.1016/j.jhin.2017.04.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/19/2017] [Indexed: 01/21/2023]
Abstract
The role of heater-cooler units (HCUs) in the transmission of Mycobacterium chimaera during open heart surgery has been recognized since 2013. Subsequent investigations uncovered a remarkable global outbreak reflecting the wide distribution of implicated devices. HCUs are an essential component of cardiopulmonary bypass operations and their withdrawal would severely affect capacity for life-saving cardiac surgery. However, studies have demonstrated that many HCUs are contaminated with a wide range of micro-organisms, including M. chimaera and complex biofilms. Whole genome sequencing of M. chimaera isolates recovered from one manufacturer's HCUs, worldwide, has demonstrated a high level of genetic similarity, for which the most plausible hypothesis is a point source contamination of the devices. Dissemination of bioaerosols through breaches in the HCU water tanks is the most likely route of transmission and airborne bacteria have been shown to have reached the surgical field even with the use of ultraclean theatre ventilation. Controlling the microbiological quality of the water circulating in HCUs and reducing biofilm formation has been a major challenge for many hospitals. However, enhanced decontamination strategies have been recommended by manufacturers, and, although they are not always effective in eradicating M. chimaera from HCUs, UK hospitals have not reported any new cases of M. chimaera infection since implementing these mitigation strategies. Water safety groups in hospitals should be aware that water in medical devices such as HCUs may act as a vector in the transmission of potentially fatal water-borne infections.
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Affiliation(s)
- J Walker
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - G Moore
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Collins
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Parks
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - M I Garvey
- Infection Prevention and Control Team, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - T Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Department, National Infection Service, Public Health England, Colindale, London, UK
| | - G Smith
- Public Health England National Mycobacterial Reference Service, Birmingham Public Health Laboratory, Birmingham, UK
| | - L Dawkin
- Estates and Facilities, University Hospitals Coventry and Warwickshire NHS Trust, Walsall, UK
| | - S Goldenberg
- Centre for Clinical Infection and Diagnostics Research, King's College, London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - M Chand
- Reference Microbiology, National Infection Service, Public Health England, Colindale, London, UK; Guy's & St Thomas' NHS Foundation Trust, London, UK; National Institute for Health Research, Health Protection Research Unit in Respiratory Infections, Imperial College, London, UK
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8
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Differential Proteome Between Patient-Related and Non-related Environmental Isolates of Legionella pneumophila. Curr Microbiol 2017; 74:344-355. [PMID: 28138785 DOI: 10.1007/s00284-017-1198-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
Molecular epidemiologic studies of Legionella have shown different molecular types coexisting in the same environment, with only one having the ability to trigger an outbreak. We therefore studied the proteome of isolates of these different molecular types in search of the proteins responsible for infection. In this study, we performed a differential proteomic analysis between patient-related and non-patient-related environmental isolates using two-dimensional difference gel electrophoresis (2D-DIGE) combined with mass spectrometry. Sixty-three spots were observed as being different between the two groups; 31 spots were identified corresponding to 23 different proteins. Patient-related isolates overexpressed proteins associated with metabolism, with enzymes of the tricarboxylic acid cycle and the degradation pathways being the most abundant proteins identified. However, the largest group of non-patient-related proteins was associated with stress response. Furthermore, the MOMP protein was located in different spots depending on their patient-related or non-patient-related origin, suggesting different post-translational modifications. According to these results, different bacterial adaptation pathways are activated in stress conditions which influence their ability to produce infection.
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Garcia-Nuñez M, Quero S, Pedro-Botet ML, Barrabeig I, Avarez J, Campoy I, Sala MR, Parraga-Niño N, Minguell S, Caylà J, Mateu L, Sabria M. Characterization of unrelated clinical Legionella pneumophila isolates in Catalonia by monoclonal subgrouping and sequence-based typing. Future Microbiol 2016; 11:865-75. [PMID: 27357520 DOI: 10.2217/fmb-2016-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To characterize the genetic diversity of unrelated Legionella pneumophila clinical isolates in Catalonia and compare with other European regions. METHODS 95 unrelated isolates were analyzed using monoclonal antibodies and sequence-based typing, 1989-2013. RESULTS The isolates showed a high diversity (IOD 0.964) with a predominance of some profiles (ST37-Phialdelphia, ST23-Philadelphia and ST1-OLDA). All regions had predominant sequence types (STs) that differed between regions, and only 3% of STs were shared between the three regions. CONCLUSION L. pneumophila clinical isolates from Catalonia presented a high diversity and can be used in epidemiological surveillance studies. The heterogeneous predominance of STs between European regions suggested a relationship between geographical distribution and virulence of some STs.
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Affiliation(s)
- Marian Garcia-Nuñez
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916.,Grupo de estudio de la Legionelosis, Autonomous University of Barcelona, Cerdanyola, Spain E-08913.,Ciber de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Sara Quero
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916.,Grupo de estudio de la Legionelosis, Autonomous University of Barcelona, Cerdanyola, Spain E-08913.,Ciber de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Maria Lluisa Pedro-Botet
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916.,Grupo de estudio de la Legionelosis, Autonomous University of Barcelona, Cerdanyola, Spain E-08913.,Ciber de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Irene Barrabeig
- Epidemiological Surveillance, Publich Health Agency of Catalonia, Barcelona, Spain E-08005
| | - Josep Avarez
- Epidemiological Surveillance, Publich Health Agency of Catalonia, Barcelona, Spain E-08005
| | - Irene Campoy
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916
| | - Maria Rosa Sala
- Epidemiological Surveillance, Publich Health Agency of Catalonia, Barcelona, Spain E-08005
| | - Noemí Parraga-Niño
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916.,Grupo de estudio de la Legionelosis, Autonomous University of Barcelona, Cerdanyola, Spain E-08913.,Ciber de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Sofia Minguell
- Epidemiological Surveillance, Publich Health Agency of Catalonia, Barcelona, Spain E-08005
| | - Joan Caylà
- Epidemiological Surveillance, Publich Health Agency of Catalonia, Barcelona, Spain E-08005.,Ciber de Salud Publica, Madrid, Spain, E-28029
| | - Lourdes Mateu
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916.,Grupo de estudio de la Legionelosis, Autonomous University of Barcelona, Cerdanyola, Spain E-08913.,Ciber de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Miquel Sabria
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Germans Trias i Pujol, Badalona, Spain E-08916.,Grupo de estudio de la Legionelosis, Autonomous University of Barcelona, Cerdanyola, Spain E-08913.,Ciber de Enfermedades Respiratorias, Madrid, Spain E-28029
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10
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Quero S, García-Núñez M, Párraga-Niño N, Barrabeig I, Pedro-Botet ML, de Simon M, Sopena N, Sabrià M. Discriminatory usefulness of pulsed-field gel electrophoresis and sequence-based typing in Legionella outbreaks. Future Microbiol 2016; 11:757-65. [DOI: 10.2217/fmb-2015-0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To compare the discriminatory power of pulsed-field gel electrophoresis (PFGE) and sequence-based typing (SBT) in Legionella outbreaks for determining the infection source. Materials & methods: Twenty-five investigations of Legionnaires’ disease were analyzed by PFGE, SBT and Dresden monoclonal antibody. Results: The results suggested that monoclonal antibody could reduce the number of Legionella isolates to be characterized by molecular methods. The epidemiological concordance PFGE–SBT was 100%, while the molecular concordance was 64%. Adjusted Wallace index (AW) showed that PFGE has better discriminatory power than SBT (AWSBT→PFGE = 0.767; AWPFGE→SBT = 1). The discrepancies appeared mostly in sequence type (ST) 1, a worldwide distributed ST for which PFGE discriminated different profiles. Conclusion: SBT discriminatory power was not sufficient verifying the infection source, especially in worldwide distributed STs, which were classified into different PFGE patterns.
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Affiliation(s)
- Sara Quero
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias I Pujol, Badalona, Spain E-08916
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
| | - Marian García-Núñez
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias I Pujol, Badalona, Spain E-08916
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Noemí Párraga-Niño
- Unitat de Malalties Infeccioses, Fundació Institut d'Investigació Germans Trias I Pujol, Badalona, Spain E-08916
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
| | - Irene Barrabeig
- Vigilancia Epidemiologica, Agencia de Salut Publica de Catalunya, Barcelona, Spain E-08005
| | - Maria L Pedro-Botet
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-08916
| | - Mercè de Simon
- Laboratori de l'Agència de Salut Pública de Barcelona, Barcelona, Spain E-08001
| | - Nieves Sopena
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-08916
| | - Miquel Sabrià
- Universitat Autònoma de Barcelona, Cerdanyola, Spain E-08193
- CIBER de Enfermedades Respiratorias, Madrid, Spain E-28029
- Unitat de Malalties Infeccioses, Hospital Universitari Germans Trias i Pujol, Badalona, Spain E-08916
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11
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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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12
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Kell D, Potgieter M, Pretorius E. Individuality, phenotypic differentiation, dormancy and 'persistence' in culturable bacterial systems: commonalities shared by environmental, laboratory, and clinical microbiology. F1000Res 2015; 4:179. [PMID: 26629334 PMCID: PMC4642849 DOI: 10.12688/f1000research.6709.2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 01/28/2023] Open
Abstract
For bacteria, replication mainly involves growth by binary fission. However, in a very great many natural environments there are examples of phenotypically dormant, non-growing cells that do not replicate immediately and that are phenotypically 'nonculturable' on media that normally admit their growth. They thereby evade detection by conventional culture-based methods. Such dormant cells may also be observed in laboratory cultures and in clinical microbiology. They are usually more tolerant to stresses such as antibiotics, and in clinical microbiology they are typically referred to as 'persisters'. Bacterial cultures necessarily share a great deal of relatedness, and inclusive fitness theory implies that there are conceptual evolutionary advantages in trading a variation in growth rate against its mean, equivalent to hedging one's bets. There is much evidence that bacteria exploit this strategy widely. We here bring together data that show the commonality of these phenomena across environmental, laboratory and clinical microbiology. Considerable evidence, using methods similar to those common in environmental microbiology, now suggests that many supposedly non-communicable, chronic and inflammatory diseases are exacerbated (if not indeed largely caused) by the presence of dormant or persistent bacteria (the ability of whose components to cause inflammation is well known). This dormancy (and resuscitation therefrom) often reflects the extent of the availability of free iron. Together, these phenomena can provide a ready explanation for the continuing inflammation common to such chronic diseases and its correlation with iron dysregulation. This implies that measures designed to assess and to inhibit or remove such organisms (or their access to iron) might be of much therapeutic benefit.
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Affiliation(s)
- Douglas Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancashire, M1 7DN, UK
| | - Marnie Potgieter
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
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13
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Kell D, Potgieter M, Pretorius E. Individuality, phenotypic differentiation, dormancy and 'persistence' in culturable bacterial systems: commonalities shared by environmental, laboratory, and clinical microbiology. F1000Res 2015; 4:179. [PMID: 26629334 DOI: 10.12688/f1000research.6709.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 01/28/2023] Open
Abstract
For bacteria, replication mainly involves growth by binary fission. However, in a very great many natural environments there are examples of phenotypically dormant, non-growing cells that do not replicate immediately and that are phenotypically 'nonculturable' on media that normally admit their growth. They thereby evade detection by conventional culture-based methods. Such dormant cells may also be observed in laboratory cultures and in clinical microbiology. They are usually more tolerant to stresses such as antibiotics, and in clinical microbiology they are typically referred to as 'persisters'. Bacterial cultures necessarily share a great deal of relatedness, and inclusive fitness theory implies that there are conceptual evolutionary advantages in trading a variation in growth rate against its mean, equivalent to hedging one's bets. There is much evidence that bacteria exploit this strategy widely. We here bring together data that show the commonality of these phenomena across environmental, laboratory and clinical microbiology. Considerable evidence, using methods similar to those common in environmental microbiology, now suggests that many supposedly non-communicable, chronic and inflammatory diseases are exacerbated (if not indeed largely caused) by the presence of dormant or persistent bacteria (the ability of whose components to cause inflammation is well known). This dormancy (and resuscitation therefrom) often reflects the extent of the availability of free iron. Together, these phenomena can provide a ready explanation for the continuing inflammation common to such chronic diseases and its correlation with iron dysregulation. This implies that measures designed to assess and to inhibit or remove such organisms (or their access to iron) might be of much therapeutic benefit.
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Affiliation(s)
- Douglas Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancashire, M1 7DN, UK
| | - Marnie Potgieter
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
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14
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Alexandropoulou IG, Ntougias S, Konstantinidis TG, Parasidis TA, Panopoulou M, Constantinidis TC. Environmental surveillance and molecular epidemiology of waterborne pathogen Legionella pneumophila in health-care facilities of Northeastern Greece: a 4-year survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:7628-7640. [PMID: 25712880 DOI: 10.1007/s11356-014-3740-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/17/2014] [Indexed: 06/04/2023]
Abstract
A 4-year proactive environmental surveillance of Legionella spp. in the water distribution and cooling systems of five health-care facilities was carried out as part of the strategy for the prevention of hospital-acquired Legionnaires' disease in Northeastern Greece. Legionella spp. were detected in 71 out of 458 collected samples. The majority of strains belonged to Legionella pneumophila serogroups 2-15 (75.0%), while all L. pneumophila serogroup 1 strains (23.6%) were isolated from a single hospital. The highest percentage of positive samples was found in distal sites (19.4%), while no Legionella strains were detected in cooling systems. Each hospital was colonized at least once with L. pneumophila, while remedial actions resulted in significant reduction of Legionella concentration. The molecular epidemiology of environmental L. pneumophila strains was also investigated using random amplified polymorphic DNA (RAPD) and multi-gene sequence-based analysis. Based on RAPD patterns, L. pneumophila serogroups 2-15 and serogroup 1 strains were classified into 24 and 9 operational taxonomic units (OTUs), respectively. Sequencing of housekeeping and diversifying pressure-related genes recommended by European Working Group for Legionella Infections (EWGLI) revealed not only a high intraspecies variability but also the circulation and persistence of one specific genotyping profile in the majority of hospitals. This study highlights the necessity for diachronic surveillance of Legionella in health-care facilities by adopting both cultural and molecular methods.
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Affiliation(s)
- Ioanna G Alexandropoulou
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Campus (Dragana) Building 5, 68100, Alexandroupolis, Greece,
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15
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Mercante JW, Winchell JM. Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev 2015; 28:95-133. [PMID: 25567224 PMCID: PMC4284297 DOI: 10.1128/cmr.00029-14] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic "blind spot" for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.
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Affiliation(s)
- Jeffrey W Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Distribution of sequence-based types of legionella pneumophila serogroup 1 strains isolated from cooling towers, hot springs, and potable water systems in China. Appl Environ Microbiol 2014; 80:2150-7. [PMID: 24463975 DOI: 10.1128/aem.03844-13] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Legionella pneumophila serogroup 1 causes Legionnaires' disease. Water systems contaminated with Legionella are the implicated sources of Legionnaires' disease. This study analyzed L. pneumophila serogroup 1 strains in China using sequence-based typing. Strains were isolated from cooling towers (n = 96), hot springs (n = 42), and potable water systems (n = 26). Isolates from cooling towers, hot springs, and potable water systems were divided into 25 sequence types (STs; index of discrimination [IOD], 0.711), 19 STs (IOD, 0.934), and 3 STs (IOD, 0.151), respectively. The genetic variation among the potable water isolates was lower than that among cooling tower and hot spring isolates. ST1 was the predominant type, accounting for 49.4% of analyzed strains (n = 81), followed by ST154. With the exception of two strains, all potable water isolates (92.3%) belonged to ST1. In contrast, 53.1% (51/96) and only 14.3% (6/42) of cooling tower and hot spring, respectively, isolates belonged to ST1. There were differences in the distributions of clone groups among the water sources. The comparisons among L. pneumophila strains isolated in China, Japan, and South Korea revealed that similar clones (ST1 complex and ST154 complex) exist in these countries. In conclusion, in China, STs had several unique allelic profiles, and ST1 was the most prevalent sequence type of environmental L. pneumophila serogroup 1 isolates, similar to its prevalence in Japan and South Korea.
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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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18
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Nontuberculous mycobacteria, fungi, and opportunistic pathogens in unchlorinated drinking water in The Netherlands. Appl Environ Microbiol 2012; 79:825-34. [PMID: 23160134 DOI: 10.1128/aem.02748-12] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The multiplication of opportunistic pathogens in drinking water supplies might pose a threat to public health. In this study, distributed unchlorinated drinking water from eight treatment plants in the Netherlands was sampled and analyzed for fungi, nontuberculous mycobacteria (NTM), and several opportunistic pathogens by using selective quantitative PCR methods. Fungi and NTM were detected in all drinking water samples, whereas Legionella pneumophila, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Aspergillus fumigatus were sporadically observed. Mycobacterium avium complex and Acanthamoeba spp. were not detected. Season had no influence on the occurrence of these organisms, except for NTM and S. maltophilia, which were present in higher numbers in the summer. Opportunistic pathogens were more often observed in premise plumbing water samples than in samples from the distribution system. The lowest number of these organisms was observed in the finished water at the plant. Thus, fungi, NTM, and some of the studied opportunistic pathogens can multiply in the distribution and premise plumbing systems. Assimilable organic carbon (AOC) and/or total organic carbon (TOC) had no clear effects on fungal and NTM numbers or on P. aeruginosa- and S. maltophilia-positive samples. However, L. pneumophila was detected more often in water with AOC concentrations above 10 μg C liter(-1) than in water with AOC levels below 5 μg C liter(-1). Finally, samples that contained L. pneumophila, P. aeruginosa, or S. maltophilia were more frequently positive for a second opportunistic pathogen, which shows that certain drinking water types and/or sampling locations promote the growth of multiple opportunistic pathogens.
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Boivin S, Lacombe MC, Lalancette L, Allard A, Bordeleau M, Laverdure G. Environmental factors associated with nosocomial legionellosis after anti-tumor necrosis factor therapy: case study. Am J Infect Control 2012; 40:470-3. [PMID: 21885158 DOI: 10.1016/j.ajic.2011.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/27/2011] [Accepted: 05/16/2011] [Indexed: 10/17/2022]
Abstract
In response to 2 reported cases of nosocomial legionellosis after anti-tumor necrosis factor (TNF) treatment, the environmental controls and testing facilities in a 221-bed acute care hospital were investigated. This investigation led to the implementation of a series of specific preventive measures adapted from protocols used to protect immunosuppressed patients. These 2 cases of legionellosis might be related to 2 concurrent events: treatment of hospitalized patients with anti-TNF drugs and secondary environmental changes related to major construction work. Patients undergoing anti-TNF treatment may be at increased risk for developing opportunistic infections during construction work, renovations, or water supply perturbations and require specific preventive measures.
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20
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Progress in the surveillance and control of Legionella infection in France, 1998–2008. Int J Infect Dis 2011; 15:e30-7. [DOI: 10.1016/j.ijid.2010.09.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/01/2010] [Accepted: 09/05/2010] [Indexed: 01/28/2023] Open
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Optimization of pulsed-field gel electrophoresis for Legionella pneumophila subtyping. Appl Environ Microbiol 2010; 76:1334-40. [PMID: 20061458 DOI: 10.1128/aem.01455-09] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A total of 32 strains of Legionella pneumophila were used to optimize pulsed-field gel electrophoresis (PFGE) for subtyping of L. pneumophila. Twenty-six isolates of L. pneumophila with various origins and 11 isolates from five different water systems were used as the panels. For optimization of electrophoretic parameters (EPs) of SfiI PFGE, 26 isolates were analyzed with SfiI digestion, using four EPs yielding the same D value. The EP of a switch time of 5 to 50 s for 21 h had the smallest similarity coefficients and was declared the optimal EP for SfiI PFGE of L. pneumophila. By software analysis and pilot study, AscI was chosen as another PFGE enzyme. AscI PFGE could cluster the isolates from each water system into the same or very similar patterns and had a high degree of typing concordance with other molecular methods. In evaluating the discriminatory power of AscI with the panel of 26 isolates, AscI PFGE gave one single pattern and a D value of 100%. AscI PFGE had a high discriminatory power and a high degree of consistency with epidemiological data and other molecular typing methods for L. pneumophila subtyping, and hence, AscI could be used as a restriction enzyme in PFGE subtyping of L. pneumophila.
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22
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Potentially pathogenic bacteria in shower water and air of a stem cell transplant unit. Appl Environ Microbiol 2009; 75:5363-72. [PMID: 19581474 DOI: 10.1128/aem.00658-09] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Potential pathogens from shower water and aerosolized shower mist (i.e., shower aerosol) have been suggested as an environmental source of infection for immunocompromised patients. To quantify the microbial load in shower water and aerosol samples, we used culture, microscopic, and quantitative PCR methods to investigate four shower stalls in a stem cell transplant unit at Barnes-Jewish Hospital in St. Louis, MO. We also tested membrane-integrated showerheads as a possible mitigation strategy. In addition to quantification, a 16S rRNA gene sequencing survey was used to characterize the abundant bacterial populations within shower water and aerosols. The average total bacterial counts were 2.2 x 10(7) cells/liter in shower water and 3.4 x 10(4) cells/m(3) in shower aerosol, and these counts were reduced to 6.3 x 10(4) cells/liter (99.6% efficiency) and 8.9 x 10(3) cells/m(3) (82.4% efficiency), respectively, after membrane-integrated showerheads were installed. Potentially pathogenic organisms were found in both water and aerosol samples from the conventional showers. Most notable was the presence of Mycobacterium mucogenicum (99.5% identity) in the water and Pseudomonas aeruginosa (99.3% identity) in the aerosol samples. Membrane-integrated showerheads may protect immunocompromised patients from waterborne infections in a stem cell transplant unit because of efficient capture of vast numbers of potentially pathogenic bacteria from hospital water. However, an in-depth epidemiological study is necessary to investigate whether membrane-integrated showerheads reduce hospital-acquired infections. The microbial load in shower aerosols with conventional showerheads was elevated compared to the load in HEPA-filtered background air in the stem cell unit, but it was considerably lower than typical indoor air. Thus, in shower environments without HEPA filtration, the increase in microbial load due to shower water aerosolization would not have been distinguishable from anticipated variations in background levels.
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Curtis LT. Prevention of hospital-acquired infections: review of non-pharmacological interventions. J Hosp Infect 2008; 69:204-19. [PMID: 18513830 PMCID: PMC7172535 DOI: 10.1016/j.jhin.2008.03.018] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 03/20/2008] [Indexed: 12/13/2022]
Abstract
Hospital-acquired (nosocomial) infections (HAIs) increase morbidity, mortality and medical costs. In the USA alone, nosocomial infections cause about 1.7 million infections and 99 000 deaths per year. HAIs are spread by numerous routes including surfaces (especially hands), air, water, intravenous routes, oral routes and through surgery. Interventions such as proper hand and surface cleaning, better nutrition, sufficient numbers of nurses, better ventilator management, use of coated urinary and central venous catheters and use of high-efficiency particulate air (HEPA) filters have all been associated with significantly lower nosocomial infection rates. Multiple infection control techniques and strategies simultaneously ('bundling') may offer the best opportunity to reduce the morbidity and mortality toll of HAIs. Most of these infection control strategies will more than pay for themselves by saving the medical costs associated with nosocomial infections. Many non-pharmacological interventions to prevent many HAIs will also reduce the need for long or multiple-drug antibiotic courses for patients. Lower antibiotic drug usage will reduce risk of antibiotic-resistant organisms and should improve efficacy of antibiotics given to patients who do acquire infections.
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Affiliation(s)
- L T Curtis
- Norwegian American Hospital, Chicago, Illinois, USA.
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