1
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Lombardi A, Borriello T, De Rosa E, Di Duca F, Sorrentino M, Torre I, Montuori P, Trama U, Pennino F. Environmental Monitoring of Legionella in Hospitals in the Campania Region: A 5-Year Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085526. [PMID: 37107807 PMCID: PMC10138562 DOI: 10.3390/ijerph20085526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
Legionella is a pathogen that colonizes soils, freshwater, and building water systems. People who are most affected are those with immunodeficiencies, so it is necessary to monitor its presence in hospitals. The purpose of this study was to evaluate the presence of Legionella in water samples collected from hospitals in the Campania region, Southern Italy. A total of 3365 water samples were collected from January 2018 to December 2022 twice a year in hospital wards from taps and showers, tank bottoms, and air-treatment units. Microbiological analysis was conducted in accordance with the UNI EN ISO 11731:2017, and the correlations between the presence of Legionella and water temperature and residual chlorine were investigated. In total, 708 samples (21.0%) tested positive. The most represented species was L. pneumophila 2-14 (70.9%). The serogroups isolated were 1 (27.7%), 6 (24.5%), 8 (23.3%), 3 (18.9%), 5 (3.1%), and 10 (1.1%). Non-pneumophila Legionella spp. represented 1.4% of the total. Regarding temperature, the majority of Legionella positive samples were found in the temperature range of 26.0-40.9 °C. An influence of residual chlorine on the presence of the bacterium was observed, confirming that chlorine disinfection is effective for controlling contamination. The positivity for serogroups other than serogroup 1 suggested the need to continue environmental monitoring of Legionella and to focus on the clinical diagnosis of other serogroups.
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Affiliation(s)
- Annalisa Lombardi
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Tonia Borriello
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Elvira De Rosa
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Fabiana Di Duca
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Michele Sorrentino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Ida Torre
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Paolo Montuori
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
| | - Ugo Trama
- General Directorate of Health, Campania Region, Centro Direzionale C3, 80143 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University “Federico II”, Via Sergio Pansini N° 5, 80131 Naples, Italy
- Correspondence:
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De Giglio O, D’Ambrosio M, Spagnuolo V, Diella G, Fasano F, Leone CM, Lopuzzo M, Trallo V, Calia C, Oliva M, Pazzani C, Iacumin L, Barigelli S, Petricciuolo M, Federici E, Lisena FP, Minicucci AM, Montagna MT. Legionella anisa or Legionella bozemanii? Traditional and molecular techniques as support in the environmental surveillance of a hospital water network. ENVIRONMENTAL MONITORING AND ASSESSMENT 2023; 195:496. [PMID: 36947259 PMCID: PMC10033568 DOI: 10.1007/s10661-023-11078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Understanding the actual distribution of different Legionella species in water networks would help prevent outbreaks. Culture investigations followed by serological agglutination tests, with poly/monovalent antisera, still represent the gold standard for isolation and identification of Legionella strains. However, also MALDI-TOF and mip-gene sequencing are currently used. This study was conducted to genetically correlate strains of Legionella non pneumophila (L-np) isolated during environmental surveillance comparing different molecular techniques. Overall, 346 water samples were collected from the water system of four pavilions located in a hospital of the Apulia Region of Italy. Strains isolated from the samples were then identified by serological tests, MALDI-TOF, and mip-gene sequencing. Overall, 24.9% of water samples were positive for Legionella, among which the majority were Legionella pneumophila (Lpn) 1 (52.3%), followed by Lpn2-15 (20.9%), L-np (17.4%), Lpn1 + Lpn2-15 (7.1%), and L-np + Lpn1 (2.3%). Initially, L-np strains were identified as L. bozemanii by monovalent antiserum, while MALDI-TOF and mip-gene sequencing assigned them to L. anisa. More cold water than hot water samples were contaminated by L. anisa (p < 0.001). PFGE, RAPD, Rep-PCR, and SAU-PCR were performed to correlate L. anisa strains. Eleven out of 14 strains identified in all four pavilions showed 100% of similarity upon PFGE analysis. RAPD, Rep-PCR, and SAU-PCR showed greater discriminative power than PFGE.
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Affiliation(s)
- Osvalda De Giglio
- Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marilena D’Ambrosio
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Medical School, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Valentina Spagnuolo
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Medical School, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giusy Diella
- Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Fabrizio Fasano
- Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carla Maria Leone
- Present Address: Section Hygiene - AOU Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marco Lopuzzo
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, Medical School, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Valeria Trallo
- Present Address: Section Hygiene - AOU Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carla Calia
- Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Marta Oliva
- Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Carlo Pazzani
- Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Lucilla Iacumin
- Department of Agricultural, Food, Environmental and Animal Science, University of Udine, Via Sondrio 2/a, 33100 Udine, Italy
| | - Sofia Barigelli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Maya Petricciuolo
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Ermanno Federici
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | | | - Anna Maria Minicucci
- Health Management, A.O.U. Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Teresa Montagna
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Interdisciplinary Department of Medicine, Section of Hygiene, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
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3
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Jereb G, Eržen I, Oder M, Poljšak B. Phosphate drinking water softeners promote Legionella growth. JOURNAL OF WATER AND HEALTH 2022; 20:1084-1090. [PMID: 35902990 DOI: 10.2166/wh.2022.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Phosphate-based drinking water softeners are commonly used to prevent scale formation in drinking water distribution infrastructure. The main reason for drinking water softening is primarily economic (protection of pipes and extension of equipment life), while the health aspect of such treatment is usually neglected. The aim of this work is to investigate the effects of phosphate-based drinking water softeners on growth stimulation of Legionella pneumophila. Bacterial growth was observed at two different phosphate concentrations. On average, an increase in growth of 1.19-1.28 log CFU/mL was observed in selected samples with added phosphates compared with the control. The results of the in vitro experiment confirmed that the added phosphates stimulate the growth of L. pneumophila; growth stimulation could therefore be expected in drinking water distribution systems (DWDS) when phosphates are used as well. The availability of phosphorus in DWDS may be a crucial limiting factor for biofouling control. Consequently, phosphate-based chemicals for drinking water should be avoided or used with prudence, especially in drinking water with high concentrations of other nutrients.
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Affiliation(s)
- Gregor Jereb
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia E-mail: ; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Ivan Eržen
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; The National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia
| | - Martina Oder
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia E-mail:
| | - Borut Poljšak
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia E-mail:
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4
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Girolamini L, Pascale MR, Mazzotta M, Spiteri S, Marino F, Salaris S, Grottola A, Orsini M, Cristino S. Combining Traditional and Molecular Techniques Supports the Discovery of a Novel Legionella Species During Environmental Surveillance in a Healthcare Facility. Front Microbiol 2022; 13:900936. [PMID: 35770167 PMCID: PMC9234573 DOI: 10.3389/fmicb.2022.900936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Legionella surveillance plays a significant role not only to prevent the risk of infection but also to study the ecology of isolates, their characteristics, and how their prevalence changes in the environment. The difficulty in Legionella isolation, identification, and typing results in a low notification rate; therefore, human infection is still underestimated. In addition, during Legionella surveillance, the special attention given to Legionella pneumophila leads to an underestimation of the prevalence and risk of infection for other species. This study describes the workflow performed during environmental Legionella surveillance that resulted in the isolation of two strains, named 8cVS16 and 9fVS26, associated with the genus Legionella. Traditional and novel approaches such as standard culture technique, MALDI-TOF MS, gene sequencing, and whole-genome sequencing (WGS) analysis were combined to demonstrate that isolates belong to a novel species. The strain characteristics, the differences between macrophage infectivity potential (mip), RNA polymerase β subunit (rpoB), and reference gene sequences, the average nucleotide identity (ANI) of 90.4%, and the DNA–DNA digital hybridization (dDDH) analysis of 43% demonstrate that these isolates belong to a new Legionella species. The finding suggests that, during the culture technique, special attention should be paid to the characteristics of the isolates that are less associated with the Legionella genus in order to investigate the differences found using more sensitive methods. The characterization of the two newly discovered isolates based on morphological, biochemical, and microscopic characteristics is currently underway and will be described in another future study.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental, and Materials Engineering, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Simona Spiteri
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Antonella Grottola
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Massimiliano Orsini
- Laboratory of Microbial Ecology and Genomics of Microorganisms, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- *Correspondence: Sandra Cristino
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5
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Girolamini L, Salaris S, Pascale MR, Mazzotta M, Cristino S. Dynamics of Legionella Community Interactions in Response to Temperature and Disinfection Treatment: 7 Years of Investigation. MICROBIAL ECOLOGY 2022; 83:353-362. [PMID: 34091718 PMCID: PMC8891097 DOI: 10.1007/s00248-021-01778-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 05/12/2023]
Abstract
In man-made water distribution systems, Legionella community interactions remain unknown, due to their ability to change from sessile to planktonic states or live in viable but non-culturable forms, in response to anthropic and environmental stress. During 7 years of hospital Legionella surveillance, in 191 hot water positive samples, the interactions among the Legionella species, temperature, and disinfection treatment were evaluated. Legionella was isolated following ISO 11731:2017, and identification was performed by mip gene sequencing and sequence-based typing (SBT) for L. anisa or L. rubrilucens and L. pneumophila, respectively. The species with the higher frequency of isolation was L. pneumophila serogroup 1 (78.53%; 4865.36 ± 25,479.11 cfu/L), followed by L. anisa (54.45%; 558.79 ± 2637.41 cfu/L) and L. rubrilucens (21.99%; 307.73 ± 1574.95 cfu/L), which were sometimes present together. Spearman's rho correlation test was conducted among the species with respect to temperature and disinfectant (H2O2/Ag+). The results showed a generally positive interaction among these species sharing the same environment, except for competition between L. anisa and L. rubrilucens. High temperature (48.83 ± 2.59 °C) and disinfection treatment (11.58 ± 4.99 mg/L) affected the presence of these species. An exception was observed with L. anisa, which showed disinfection treatment resistance. For the purposes of environmental surveillance, it is fundamental to better understand the interactions and dynamic of the Legionella community in man-made water systems in order to choose the proper physical or chemical treatments. The simultaneous presence of different Legionella species could result in an increased resistance to high temperature and disinfectant treatment, leading to changes in contamination level and species diversity.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
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6
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Pereira A, Silva AR, Melo LF. Legionella and Biofilms-Integrated Surveillance to Bridge Science and Real-Field Demands. Microorganisms 2021; 9:microorganisms9061212. [PMID: 34205095 PMCID: PMC8228026 DOI: 10.3390/microorganisms9061212] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Legionella is responsible for the life-threatening pneumonia commonly known as Legionnaires’ disease or legionellosis. Legionellosis is known to be preventable if proper measures are put into practice. Despite the efforts to improve preventive approaches, Legionella control remains one of the most challenging issues in the water treatment industry. Legionellosis incidence is on the rise and is expected to keep increasing as global challenges become a reality. This puts great emphasis on prevention, which must be grounded in strengthened Legionella management practices. Herein, an overview of field-based studies (the system as a test rig) is provided to unravel the common roots of research and the main contributions to Legionella’s understanding. The perpetuation of a water-focused monitoring approach and the importance of protozoa and biofilms will then be discussed as bottom-line questions for reliable Legionella real-field surveillance. Finally, an integrated monitoring model is proposed to study and control Legionella in water systems by combining discrete and continuous information about water and biofilm. Although the successful implementation of such a model requires a broader discussion across the scientific community and practitioners, this might be a starting point to build more consistent Legionella management strategies that can effectively mitigate legionellosis risks by reinforcing a pro-active Legionella prevention philosophy.
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Bourassa DV, Harris CE, Bartenfeld Josselson LN, Buhr RJ. Assessment of Stabilized Hydrogen Peroxide for Use in Reducing Campylobacter Levels and Prevalence on Broiler Chicken Wings. J Food Prot 2021; 84:449-455. [PMID: 33125047 DOI: 10.4315/jfp-20-356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/25/2020] [Indexed: 11/11/2022]
Abstract
ABSTRACT Poultry processing establishments use antimicrobial aids on broiler parts to minimize Campylobacter contamination. A silver-stabilized hydrogen peroxide (SHP) product was assessed for use as an antimicrobial processing aid. In a series of experiments, wing segments with skin were inoculated with 103 to 107 cells of Campylobacter coli, followed by treatment with SHP at 15,000 or 30,000 mg/L, peroxyacetic acid (PAA) at 300 or 3,000 mg/L (parts per million), or water. Each treatment was applied by either dip or spray. Rinsates from each wing segment were analyzed for direct counts and prevalence of Campylobacter. Treatment with SHP or PAA significantly reduced Campylobacter levels compared with water controls by up to 2.22 log CFU/mL. At high inoculum levels (106 to 107), SHP and PAA applied by dip had up to 1.27 log CFU/mL further reductions of Campylobacter levels compared with spray-treated wing segments. Additionally, wing drumettes were observed to retain higher levels and prevalence of Campylobacter recovery compared with wing flats at a low inoculation level (103). The results indicated that there was no carryover effect of SHP (same day versus 24 h) and dip treatment with SHP or PAA decreased Campylobacter recovery on broiler chicken wing segments compared with a water control. Although a 2-log reduction was modest, SHP had similar efficacy as the commonly used processing aid PAA. SHP shows potential for further investigation as an antimicrobial processing aid for use on poultry parts. HIGHLIGHTS
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Affiliation(s)
- D V Bourassa
- Department of Poultry Science, Auburn University, Auburn, Alabama 36849
| | - C E Harris
- Department of Poultry Science, University of Georgia, Athens, Georgia 30602.,Poultry Microbiological Safety and Processing Research Unit, U.S. National Poultry Research Center, Richard B. Russell Agricultural Research Center, U.S. Department of Agriculture, Agricultural Research Service, 950 College Station Road, Athens, Georgia 30605, USA
| | - L N Bartenfeld Josselson
- Poultry Microbiological Safety and Processing Research Unit, U.S. National Poultry Research Center, Richard B. Russell Agricultural Research Center, U.S. Department of Agriculture, Agricultural Research Service, 950 College Station Road, Athens, Georgia 30605, USA
| | - R J Buhr
- Poultry Microbiological Safety and Processing Research Unit, U.S. National Poultry Research Center, Richard B. Russell Agricultural Research Center, U.S. Department of Agriculture, Agricultural Research Service, 950 College Station Road, Athens, Georgia 30605, USA
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8
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Management of Microbiological Contamination of the Water Network of a Newly Built Hospital Pavilion. Pathogens 2021; 10:pathogens10010075. [PMID: 33467059 PMCID: PMC7829805 DOI: 10.3390/pathogens10010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/28/2022] Open
Abstract
The good installation, as well as commissioning plan, of a water network is a crucial step in reducing the risk of waterborne diseases. The aim of this study was to monitor the microbiological quality of water from a newly built pavilion before it commenced operation. Overall, 91 water samples were tested for coliforms, Escherichia coli, enterococci, Pseudomonas aeruginosa and Legionella at three different times: T0 (without any water treatment), T1 (after treatment with hydrogen peroxide and silver ions at initial concentration of 20 mg/L and after flushing of water for 20 min/day for seven successive days) and T2 (15 days later). Coliforms were detected in 47.3% of samples at T0, 36.3% at T1 and 4.4% at T2. E. coli was isolated in 4.4% of the samples only at T1, while enterococci appeared in 12.1% of the samples at T1 and in 2.2% at T2. P. aeruginosa was isolated in 50.5% of the samples at T0, 29.7% at T1 and 1.1% at T2. Legionella pneumophila serogroup 8 was isolated in 80.2% of the samples at T0, 36.3% at T1 and 2.2% at T2. Our results confirmed the need for a water safety plan in new hospital pavilions to prevent the risk of waterborne diseases.
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9
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Editorial Comments to the Special Issue: " Legionella Contamination in Water Environment". Pathogens 2020; 9:pathogens9121017. [PMID: 33276607 PMCID: PMC7761553 DOI: 10.3390/pathogens9121017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
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10
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How Molecular Typing Can Support Legionella Environmental Surveillance in Hot Water Distribution Systems: A Hospital Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228662. [PMID: 33233464 PMCID: PMC7700474 DOI: 10.3390/ijerph17228662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
In this study, we aimed to associate the molecular typing of Legionella isolates with a culture technique during routine Legionella hospital environmental surveillance in hot water distribution systems (HWDSs) to develop a risk map able to be used to prevent nosocomial infections and formulate appropriate preventive measures. Hot water samples were cultured according to ISO 11731:2017. The isolates were serotyped using an agglutination test and genotyped by sequence-based typing (SBT) for Legionella pneumophila or macrophage infectivity potentiator (mip) gene sequencing for non-pneumophila Legionella species. The isolates' relationship was phylogenetically analyzed. The Legionella distribution and level of contamination were studied in relation to temperature and disinfectant residues. The culture technique detected 62.21% of Legionella positive samples, characterized by L. pneumophila serogroup 1, Legionella non-pneumophila, or both simultaneously. The SBT assigned two sequence types (STs): ST1, the most prevalent in Italy, and ST104, which had never been isolated before. The mip gene sequencing detected L. anisa and L. rubrilucens. The phylogenetic analysis showed distinct clusters for each species. The distribution of Legionella isolates showed significant differences between buildings, with a negative correlation between the measured level of contamination, disinfectant, and temperature. The Legionella molecular approach introduced in HWDSs environmental surveillance permits (i) a risk map to be outlined that can help formulate appropriate disinfection strategies and (ii) rapid epidemiological investigations to quickly identify the source of Legionella infections.
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Mazzotta M, Girolamini L, Pascale MR, Lizzadro J, Salaris S, Dormi A, Cristino S. The Role of Sensor-Activated Faucets in Surgical Handwashing Environment as a Reservoir of Legionella. Pathogens 2020; 9:pathogens9060446. [PMID: 32516992 PMCID: PMC7350366 DOI: 10.3390/pathogens9060446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022] Open
Abstract
Surgical handwashing is a mandatory practice to protect both surgeons and patients in order to control Healthcare-Associated Infections (HAIs). The study is focused on Legionella and Pseudomonas aeruginosa contamination in Surgical Handwashing Outlets (SHWOs) provided by sensor-activated faucets with Thermostatic Mixer Valves (TMVs), as correlated to temperature, technologies, and disinfection used. Samples were analyzed by standard culture techniques, comparing hot- and cold-water samples. Legionella isolates were typed by an agglutination test and by mip sequencing. Legionella contamination showed the same distribution between hot and cold samples concerning positive samples and mean concentration: 44.5% and 1.94 Log10 cfu/L vs. 42.6% and 1.81 Log10 cfu/L, respectively. Regarding the distribution of isolates (Legionella pneumophila vs. Legionella non-pneumophila species), significant differences were found between hot- and cold-positive samples. The contamination found in relation to ranges of temperature showed the main positive samples (47.1%) between 45.1-49.6 °C, corresponding to high Legionella concentrations (2.17 Log10 cfu/L). In contrast, an increase of temperature (>49.6 °C) led to a decrease in positive samples (23.2%) and mean concentration (1.64 Log10 cfu/L). A low level of Pseudomonas aeruginosa was found. For SHWOs located in critical areas, lack of consideration of technologies used and uncorrected disinfection protocols may lead to the development of a high-risk environment for both patients and surgeons.
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Affiliation(s)
- Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Jessica Lizzadro
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
| | - Ada Dormi
- Department of Medical and Surgical Science, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy;
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (L.G.); (M.R.P.); (J.L.); (S.S.)
- Correspondence: ; Tel.: +39-051-209-4811; Fax: +39-051-209-4829
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Muzzi A, Cutti S, Bonadeo E, Lodola L, Monzillo V, Corbella M, Scudeller L, Novelli V, Marena C. Prevention of nosocomial legionellosis by best water management: comparison of three decontamination methods. J Hosp Infect 2020; 105:766-772. [PMID: 32389709 DOI: 10.1016/j.jhin.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Since 2000, the National Health System has adopted international guidelines for assessing Legionella spp. in hospital water systems. The control of water contamination by Legionella spp. is still a matter of research concerning the most effective method in preventing nosocomial infections. AIM To compare three different decontamination methods by monitoring colony-forming unit count and number of hospital-acquired legionellosis cases. A secondary objective was to evaluate the long-term effects of the preventive measures on the water pipes. METHODS A protocol was developed for the selection of high-risk sampling sites and for the testing of three disinfection methods over the course of 19 years: hyperchlorination and thermal shock (period A, 2000-2005); copper-silver ionization (period B, 2006-2010); and integration of pre-filtering, filtering, pipe-protecting products, and remote control with chlorine dioxide (ClO2) (period C, 2011-2018). FINDINGS The use of shock disinfection and hyperchlorination led to a decrease in contamination level immediately after the procedure, but then it rose again to the previous level in two months. Both copper-silver ionization and ClO2 disinfection showed a stable and durable decrease in contamination level. Throughout these three phases, six cases of Legionella spp. occurred during period A, six cases during period B, and three cases during period C. With regard to the damage of water pipes, effective copper-silver levels caused corrosion and calcification in water pipes. CONCLUSION Both copper-silver ionization and ClO2 properly controlled Legionella spp. contamination. ClO2 significantly reduced the number of positive sites (P < 0.001) without damaging the pipelines.
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Affiliation(s)
- A Muzzi
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - S Cutti
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Bonadeo
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Lodola
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Monzillo
- Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Corbella
- Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Scudeller
- Direzione Scientifica, Unitá di Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Novelli
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Marena
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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