Quality of drinking water

A Systematic Review and Meta-Analysis of Fecal Contamination and Inadequate Treatment of Packaged Water

BACKGROUND

Packaged water products provide an increasingly important source of water for consumption. However, recent studies raise concerns over their safety.

OBJECTIVES

To assess the microbial safety of packaged water, examine differences between regions, country incomes, packaged water types, and compare packaged water with other water sources.

METHODS

We performed a systematic review and meta-analysis. Articles published in English, French, Portuguese, Spanish and Turkish, with no date restrictions were identified from online databases and two previous reviews. Studies published before April 2014 that assessed packaged water for the presence of Escherichia coli, thermotolerant or total coliforms were included provided they tested at least ten samples or brands.

RESULTS

A total of 170 studies were included in the review. The majority of studies did not detect fecal indicator bacteria in packaged water (78/141). Compared to packaged water from upper-middle and high-income countries, packaged water from low and lower-middle-income countries was 4.6 (95% CI: 2.6-8.1) and 13.6 (95% CI: 6.9-26.7) times more likely to contain fecal indicator bacteria and total coliforms, respectively. Compared to all other packaged water types, water from small bottles was less likely to be contaminated with fecal indicator bacteria (OR = 0.32, 95%CI: 0.17-0.58) and total coliforms (OR = 0.10, 95%CI: 0.05, 0.22). Packaged water was less likely to contain fecal indicator bacteria (OR = 0.35, 95%CI: 0.20, 0.62) compared to other water sources used for consumption.

CONCLUSIONS

Policymakers and regulators should recognize the potential benefits of packaged water in providing safer water for consumption at and away from home, especially for those who are otherwise unlikely to gain access to a reliable, safe water supply in the near future. To improve the quality of packaged water products they should be integrated into regulatory and monitoring frameworks.

Risk assessment of heterotrophic bacteria from bottled drinking water sold in Indian markets

One hundred and five samples of bottled drinking water belonging to 30 different brands, collected from six different states of India have been analysed for total heterotrophic bacterial (THB) load and coliforms. Almost all bottlers used multiple treatment procedures such as microfiltration, reverse osmosis and ozonization to treat the water. Around 40% of the samples exceeded the limit of 100 cfu/ml set by the department of health as well as Bureau of Indian Standards (BIS), Government of India. Fourteen percent and 44% of the samples with THB loads between 100 and 1000 cfu/ml or 1000 cfu/ml tested positive for coliforms indicating a linear relationship between THB and coliform bacteria. Gram-positive genera such as Kurthia and Corynebacterium were found to be dominant genera, while members of the family enterobacteriaceae contributed to 7%. Risk assessment of the heterotrophic bacteria revealed that the majority of the strains acquired resistance against ampicillin, nalidixic acid, novobiocin and oxytetracycline. As bottled drinking water is a ready to drink commodity, the high load of heterotrophic bacteria with multiple drug resistance poses significant health hazards to the consumers, especially to immunocompromised individuals.

Microbiological evaluation of bottled uncarbonated mineral water in Taiwan

The microbiological quality of 136 samples of bottled uncarbonated mineral water, including 88 domestic and 48 imported samples, was investigated. The numbers of samples with heterotrophic plate count (HPC) over the maximum level legally permitted in Taiwan (200 colony forming units ml-1) were 45 (51.1%) and 29 (60.4%) for domestic and imported samples, respectively. Coliforms and faecal streptococci were not detectable in the samples tested. Two of the domestic samples were contaminated with Aeromonas hydrophila and four with Pseudomonas aeruginosa. Bacteria isolated from water samples were identified as species of Pseudomonas, Aeromonas, Flavobacterium, Pasteurella, Xanthomonas, and Staphylococcus. Mold and yeast were detected in 38.6% and 18.8% of domestic and imported samples, respectively. The HPC of bottled mineral water stored at 25 degrees C increased quickly to 10(4)-10(5) colony forming units ml-1. In inoculation studies both A. hydrophila and Escherichia coli grew very well and mutualistic growth for both organisms was observed in mineral water at 25 degrees C.

Nutritional support in HIV infection and AIDS

Weight loss and wasting are common features of HIV infection and AIDS. Patterns of weight loss can be acute or chronic which appear to be related primarily to systemic infections and gastrointestinal pathology, respectively. However, weight loss is not inevitable. and periods of weight stability and weight gain have been documented. Reduced food intake appears to be a major cause of weight loss in HIV infection. Since time of death has been associated with degree of wasting, it seems reasonable to suggest that nutritional support may contribute to enhancing survival and quality of life. All patients should have early access to a qualified dietitian such that assessment of individual situations can be made and appropriate dietary advice given, within a multi-disciplinary approach. Choice of nutritional therapy should be made based on an assessment of the causes of weight loss and an assessment of gut function. Treating infections and alleviating symptoms is vital for ensuring effective nutritional support. Enhancing the energy and protein density of foods and use of oral supplements should be considered if a normal diet alone cannot meet nutritional requirements. Unnecessary dietary restrictions should be avoided. Enteral feeding is indicated for patients unable to meet their needs via the oral route, and in cases of inadequate gut function, parenteral nutrition may be necessary. There is currently insufficient clinical evidence to justify the need for special enteral formulae specifically for patients with HIV infection.