A risk assessment of Pseudomonas aeruginosa in swimming pools: a review

Opportunistic Pathogens in Drinking Water Distribution Systems-A Review

In contrast to "frank" pathogens, like Salmonella entrocolitica, Shigella dysenteriae, and Vibrio cholerae, that always have a probability of disease, "opportunistic" pathogens are organisms that cause an infectious disease in a host with a weakened immune system and rarely in a healthy host. Historically, drinking water treatment has focused on control of frank pathogens, particularly those from human or animal sources (like Giardia lamblia, Cryptosporidium parvum, or Hepatitis A virus), but in recent years outbreaks from drinking water have increasingly been due to opportunistic pathogens. Characteristics of opportunistic pathogens that make them problematic for water treatment include: (1) they are normally present in aquatic environments, (2) they grow in biofilms that protect the bacteria from disinfectants, and (3) under appropriate conditions in drinking water systems (e.g., warm water, stagnation, low disinfectant levels, etc.), these bacteria can amplify to levels that can pose a public health risk. The three most common opportunistic pathogens in drinking water systems are Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa. This report focuses on these organisms to provide information on their public health risk, occurrence in drinking water systems, susceptibility to various disinfectants, and other operational practices (like flushing and cleaning of pipes and storage tanks). In addition, information is provided on a group of nine other opportunistic pathogens that are less commonly found in drinking water systems, including Aeromonas hydrophila, Klebsiella pneumoniae, Serratia marcescens, Burkholderia pseudomallei, Acinetobacter baumannii, Stenotrophomonas maltophilia, Arcobacter butzleri, and several free-living amoebae including Naegleria fowleri and species of Acanthamoeba. The public health risk for these microbes in drinking water is still unclear, but in most cases, efforts to manage Legionella, mycobacteria, and Pseudomonas risks will also be effective for these other opportunistic pathogens. The approach to managing opportunistic pathogens in drinking water supplies focuses on controlling the growth of these organisms. Many of these microbes are normal inhabitants in biofilms in water, so the attention is less on eliminating these organisms from entering the system and more on managing their occurrence and concentrations in the pipe network. With anticipated warming trends associated with climate change, the factors that drive the growth of opportunistic pathogens in drinking water systems will likely increase. It is important, therefore, to evaluate treatment barriers and management activities for control of opportunistic pathogen risks. Controls for primary treatment, particularly for turbidity management and disinfection, should be reviewed to ensure adequacy for opportunistic pathogen control. However, the major focus for the utility's opportunistic pathogen risk reduction plan is the management of biological activity and biofilms in the distribution system. Factors that influence the growth of microbes (primarily in biofilms) in the distribution system include, temperature, disinfectant type and concentration, nutrient levels (measured as AOC or BDOC), stagnation, flushing of pipes and cleaning of storage tank sediments, and corrosion control. Pressure management and distribution system integrity are also important to the microbial quality of water but are related more to the intrusion of contaminants into the distribution system rather than directly related to microbial growth. Summarizing the identified risk from drinking water, the availability and quality of disinfection data for treatment, and guidelines or standards for control showed that adequate information is best available for management of L. pneumophila. For L. pneumophila, the risk for this organism has been clearly established from drinking water, cases have increased worldwide, and it is one of the most identified causes of drinking water outbreaks. Water management best practices (e.g., maintenance of a disinfectant residual throughout the distribution system, flushing and cleaning of sediments in pipelines and storage tanks, among others) have been shown to be effective for control of L. pneumophila in water supplies. In addition, there are well documented management guidelines available for the control of the organism in drinking water distribution systems. By comparison, management of risks for Mycobacteria from water are less clear than for L. pneumophila. Treatment of M. avium is difficult due to its resistance to disinfection, the tendency to form clumps, and attachment to surfaces in biofilms. Additionally, there are no guidelines for management of M. avium in drinking water, and one risk assessment study suggested a low risk of infection. The role of tap water in the transmission of the other opportunistic pathogens is less clear and, in many cases, actions to manage L. pneumophila (e.g., maintenance of a disinfectant residual, flushing, cleaning of storage tanks, etc.) will also be beneficial in helping to manage these organisms as well.

Pseudomonas spp. in Canine Otitis Externa

Canine otitis externa (OE) is a commonly diagnosed condition seen in veterinary practice worldwide. In this review, we discuss the mechanisms of the disease, with a particular focus on the biological characteristics of Pseudomonas aeruginosa and the impact that antibiotic resistance has on successful recovery from OE. We also consider potential alternatives to antimicrobial chemotherapy for the treatment of recalcitrant infections. P. aeruginosa is not a typical constituent of the canine ear microbiota, but is frequently isolated from cases of chronic OE, and the nature of this pathogen often makes treatment difficult. Biofilm formation is identified in 40-95% of P. aeruginosa from cases of OE and intrinsic and acquired antibiotic resistance, especially resistance to clinically important antibiotics, highlights the need for alternative treatments. The role of other virulence factors in OE remains relatively unexplored and further work is needed. The studies described in this work highlight several potential alternative treatments, including the use of bacteriophages. This review provides a summary of the aetiology of OE with particular reference to the dysbiosis that leads to colonisation by P. aeruginosa and highlights the need for novel treatments for the future management of P. aeruginosa otitis.

Environmental surveillance of Pseudomonas aeruginosa in recreational waters in tourist facilities of the Balearic Islands, Spain (2016-2019)

BACKGROUND

Pseudomonas aeruginosa is a major opportunistic human pathogen commonly connected with recreational water activities. Spain is a tourist destination where most of the establishments have swimming pool. Nevertheless, the prevalence of P. aeruginosa in public swimming pools in our country is unknown. This works aimed to survey the P. aeruginosa presence in tourist Spanish recreational waters.

METHOD

Tourist recreational water in hotels in the Balearic Islands were visited for four years (2016-2019). The levels of selected parameters were determined, and their correlation with P. aeruginosa contamination investigated.

RESULTS

We evaluated 11,014 samples from 254 facilities. Unacceptable levels of at least one legislated parameter were detected in 30.7% of cases, implicating closure in 15.9%, being P. aeruginosa the leading cause of closure. The prevalence of the pathogen was 14.2%, with lower presence in outer swimming pools. Disinfectant levels influence P. aeruginosa contamination, and bromine-maintained pools were more often contaminated than those treated with chlorine. Prevalence remained constant over the years, although it increased in 2019.

CONCLUSIONS

P. aeruginosa prevalence in our recreational waters is similar to other countries, and the contamination rates depend on the installations and type and disinfectant levels. Corrective measures are still needed to improve pathogen control.

Assessing the impact of the COVID‑19 pandemic health protocols on the hygiene status of swimming pools of hotel units

With the onset of the coronavirus disease 2019 (COVID-19) pandemic, numerous countries imposed strict lockdown measures and travel bans, resulting in the closure of hotels. Over time, the opening of hotel units was gradually allowed, and new strict regulations and protocols were issued to ensure the hygiene and safety of swimming pools in the era of COVID-19. The present study aimed to evaluate the implementation of strict health COVID-19-related protocols in hotel units during the 2020 summer tourist season concerning microbiological hygiene and physicochemical parameters of water, and to compare the data with those from the 2019 tourist season. For this reason, 591 water samples from 62 swimming pools were analyzed, of which 381 samples were for the 2019 tourist season and 210 samples were for the 2020 tourist season. To examine the presence of Legionella spp, 132 additional samples were taken from 14 pools, of which 49 in 2019 and 83 in 2020. In 2019, 2.89% (11/381) of the samples were out of legislative limits (0/250 mg/l) regarding the presence of Escherichia coli (E. coli), 9.45% (36/381) were out of acceptable limits (0/250 mg/l) regarding the presence of Pseudomonas aeruginosa (P. aeruginosa) and 8.92% (34/381) had residual chlorine levels <0.4 mg/l. In 2020, 1.43% (3/210) of the samples were out of the legislative limits as regards the presence of E. coli, 7.14% (15/210) were out of acceptable limits regarding the presence of P. aeruginosa and 3.33% (7/210) of the samples measured residual chlorine levels <0.4 mg/l. The risk ratio (RR) in relation to the presence of E. coli due to incorrect compliance with the requirements for residual chlorine was calculated for 2019 at 8.50, while in 2020 it was calculated at 14.50 (P=0.008). The RR of the presence of P. aeruginosa due to inappropriate residual chlorine requirements was calculated in 2019 at 2.04 (P=0.0814), while in 2020 it was calculated at 2.07 (P=0.44). According to the microbiological hygiene and physicochemical parameters of the water samples studied, there was a significant improvement due to the strict protocols for the swimming pools in the summer season of 2020 compared to the tourist season of 2019, namely 72.72% (E. coli), 58.33% (P. aeruginosa), 79.41% (of residual chlorine <0.4 mg/l) in the three main parameters studied. Finally, an increased colonization by Legionella spp. detected in the internal networks of the hotels due to the non-operation of the hotels during the lockdown, the improper disinfection and stagnant water in the internal water supply networks. Specifically, in 2019, 95.92% (47/49) of the samples tested negative and 4.08% (2/49) tested positive (≥50 CFU/l) for Legionella spp., compared to 2020 where 91.57% (76/83) of the samples tested negative and 8.43% (7/83) tested positive.

ADMS simulation and influencing factors of bioaerosol diffusion from BRT under different aeration modes in six wastewater treatment plants

Bioaerosols produced by municipal wastewater treatment plants (MWTP) can spread in air, thereby polluting the atmosphere and causing safety hazards to workers and surrounding residents. In this study, the biological reaction tanks (BRTs) of six MWTPs undergoing typical processes in North China, Yangtze River Delta, and the Greater Bay Area were selected to set up sampling points and investigate the production characteristics of bioaerosols. The Atmospheric Dispersion Modelling System method was used to simulate the diffusion of bioaerosols in the MWTPs. The concentrations of bacteria and, specifically, intestinal bacteria in the bioaerosols ranged from 389 CFU/m³ to 1,536 CFU/m³ and 30 CFU/m³ to 152 CFU/m³, respectively, and the proportion of the intestinal bacteria was 8.85%. The concentration of soluble chemicals (SCs) in the bioaerosols was 18.36 μg/m³-82.19 μg/m³, and the main SCs found were Mg²⁺, Ca²⁺, and SO₄^2-. The proportion of intestinal bacteria (75.79%) produced via surface aeration by a BRT attached to large-sized bioaerosol particles was higher than that of a BRT undergoing the bottom aeration process (37.28%). The main microorganisms found in the bioaerosols included Moraxellaceae, Escherichia-Shigella, Psychrobacter, and Cyanobacteria. The generation of bioaerosols exhibited regional characteristics. The wastewater treatment scale, wastewater quality, and aeration mode were the main factors influencing bioaerosol production. Model simulation showed that, after 1 h, the diffusion distance of bioaerosol was 292 m-515 m, and the affected area was 42,895 m²-91,708 m². The diffusion distance and range of the bioaerosols were significantly correlated with the concentration at the bioaerosol source and the aeration mode adopted by the BRTs. Wind speed and direction were two environmental factors that affected the diffusion of bioaerosols. With an increase in the diffusion distance, the concentration of microorganisms, intestinal bacteria, ions, and fine particles in the bioaerosols decreased significantly, resulting in a corresponding reduction in the exposure risk. This study provides new insights to help predict bioaerosol risks at MWTPs and identify safe areas around MWTPs. The study also provides a basis for selecting safe MWTP sites and reducing bioaerosol pollution risks.

Burdock-Derived Composites Based on Biogenic Gold, Silver Chloride and Zinc Oxide Particles as Green Multifunctional Platforms for Biomedical Applications and Environmental Protection

Green nanotechnology is a rapidly growing field linked to using the principles of green chemistry to design novel nanomaterials with great potential in environmental and health protection. In this work, metal and semiconducting particles (AuNPs, AgClNPs, ZnO, AuZnO, AgClZnO, and AuAgClZnO) were phytosynthesized through a "green" bottom-up approach, using burdock (Arctium lappa L.) aqueous extract. The morphological (SEM/TEM), structural (XRD, SAED), compositional (EDS), optical (UV-Vis absorption and FTIR spectroscopy), photocatalytic, and bio-properties of the prepared composites were analyzed. The particle size was determined by SEM/TEM and by DLS measurements. The phytoparticles presented high and moderate physical stability, evaluated by zeta potential measurements. The investigation of photocatalytic activity of these composites, using Rhodamine B solutions' degradation under solar light irradiation in the presence of prepared powders, showed different degradation efficiencies. Bioevaluation of the obtained composites revealed the antioxidant and antibacterial properties. The tricomponent system AuAgClZnO showed the best antioxidant activity for capturing ROS and ABTS•⁺ radicals, and the best biocidal action against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The "green" developed composites can be considered potential adjuvants in biomedical (antioxidant or biocidal agents) or environmental (as antimicrobial agents and catalysts for degradation of water pollutants) applications.

Solution-Based Ultra-Sensitive Surface-Enhanced Raman Scattering Detection of the Toxin Bacterial Biomarker Pyocyanin in Biological Fluids Using Sharp-Branched Gold Nanostars

There is a critical need for sensitive rapid point-of-care detection of bacterial infection biomarkers in complex biological fluids with minimal sample preparation, which can improve early-stage diagnosis and prevent several bacterial infections and fatal diseases. A solution-based surface-enhanced Raman scattering (SERS) detection platform has long been sought after for low cost, rapid, and on-site detection of analyte molecules, but current methods still exhibit poor sensitivity. In this study, we have tuned the morphology of the surfactant-free gold nanostars (GNSs) to achieve sharp protruding spikes for maximum SERS enhancement. We have controlled the GNS spike morphologies and optimized SERS performance in the solution phase using para-mercaptobenzoic acid as an SERS probe. To illustrate the potential for point-of-care applications, we have utilized a portable Raman instrument for measurements. For pathogenic agent sensing applications, we demonstrated rapid and sensitive detection of the toxin biomarker pyocyanin (PYO) used as the bacterial biomarker model system. Pyocyanin is a toxic compound produced and secreted by the common water-borne Gram-negative bacterium Pseudomonas aeruginosa, a pathogen known for advanced antibiotic resistance and association with serious diseases such as ventilator-associated pneumonia and cystic fibrosis. The limit of detection (LOD) achieved for PYO was 0.05 nM using sharp branched GNSs. Furthermore, as a proof of strategy, this SERS detection of PYO was performed directly in drinking water, human saliva, and human urine without any sample treatment pre-purification, achieving an LOD of 0.05 nM for drinking water and 0.4 nM for human saliva and urine. This work provides a proof-of-principle demonstration for the high sensitivity detection of the bacterial toxin biomarker with minimal sample preparation: the "mix and detect" detection of the GNS platform is simple, robust, and rapid, taking only 1-2 min for each measurement. Overall, our SERS detection platform shows great potential for point-of-need sensing and point-of-care diagnostics in biological fluids.

Effect of UV Light and Sodium Hypochlorite on Formation and Destruction of Pseudomonas fluorescens Biofilm In Vitro

Pseudomonas fluorescens is one of the first colonizers of bacterial biofilm in water systems and a member of opportunistic premise plumbing pathogens (OPPPs). The aim of this study was to examine the effect of UV light and sodium hypochlorite on the formation and destruction of mature P. fluorescens biofilm on ceramic tiles. Planktonic bacteria or bacteria in mature biofilm were exposed to UV light (254 nm) for 5, 20 s. and to 0.4 mg/L sodium hypochlorite for 1 min. Mature biofilm was also exposed to increased concentration of sodium hypochlorite of 2 mg/L for 0.5, 1 and 2 h and combined with UV. Prolonged action of sodium hypochlorite and an increase in its concentration in combination with UV gave the best results in the inhibition of biofilm formation after the pre-treatment and destruction of mature biofilm. The effect of hyperchlorination in combination with UV radiation shows better results after a long exposure time, although even after 120 min there was no completely destroyed biofilm. Furthermore, the mechanism of the effect of combined methods should be explored as well as the importance of mechanical cleaning that is crucial in combating bacterial biofilm in swimming pools.

Risk Analysis of Otitis Externa (Swimmer’s Ear) in Children Pool Swimmers: A Case Study from Greece

Otitis is an ear inflammation characterized by an accumulation of polluted fluids in the ear, inflating the drum, causing ear pain, and draining the mucous membrane (pus) into the ear canal if the drum is perforated. Swimmer’s otitis, also known as acute external otitis, is a medical condition that frequently affects competitive swimmers. The risk factor analysis study was based on data obtained between May 2018 and May 2019 from four public swimming pools in Patras, Achaia. A checklist was created to evaluate the pools’ operational conditions, and it included information on the pools’ sanitation as well as swimming pool hygiene guidelines. In addition, a questionnaire was devised to collect data on pool swimmers’ use of the pools. Microbiological testing of the pool water was done ahead of time, and data on external otitis cases from hospitals was gathered. Based on this information, a risk factor analysis was conducted. Gender, weight, and age do not appear to have an impact on the number of otitis media cases that occur because of swimming in the pools. There is also no statistically significant link between episodes and the frequency of otitis events in locker rooms, restrooms, or swimming pools. The frequency with which swimmers utilize the pool, rather than the pool’s microbial burden, is the most significant determinant in otitis episodes. Furthermore, there is no statistically significant link between chlorine odor and otitis episodes. Additionally, several abnormalities in the ear or the child’s history do not appear to affect otitis episodes. More research is needed to determine whether infections are linked to microbial load or if other factors are responsible for the emergence of waterborne infections.

Disinfection of Therapeutic Spa Waters: Applicability of Sodium Hypochlorite and Hydrogen Peroxide-Based Disinfectants

The microbial water quality of therapeutic pools operating without disinfection is recurrently compromised, posing a risk to bathers’ health. The complex composition of such waters and the sensitivity of their therapeutic components hinder the use of traditional chlorine-based disinfectants. The present study aimed to investigate the applicability of a hydrogen peroxide-based disinfectant in therapeutic water in comparison with hypochlorite. Disinfection efficacy, byproduct formation, and the fate of therapeutic components were tested for both disinfectants under laboratory conditions, applying different doses and contact times. Disinfection efficacy was found to be matrix-dependent, especially that of hydrogen peroxide against Pseudomonas aeruginosa (a 10- to 1000-fold difference). Hypochlorite treatment presented a significant chemical risk through the generation of byproducts, mainly brominated and iodinated compounds and combined chlorine. Of the alleged therapeutic components, sulfide ions were eliminated (≥86% loss) by both disinfectants, and hypochlorite reacted with iodide ions as well (≥70% removal). Based on their composition, only 2% of Hungarian therapeutic waters can be treated by chlorination due to high concentrations of ammonia and/or organic compounds. Hydrogen peroxide is applicable to 82% of the waters, as the presence of sulfide ions is the only limiting factor. Due to the matrix effect, close control of residual disinfectant concentration is necessary to ensure microbial safety.

Disinfection of therapeutic water - balancing risks against benefits: case study of Hungarian therapeutic baths on the effects of technological steps and disinfection on therapeutic waters

Thermal therapeutic pools in most countries are operated in a manner similar to swimming pools: with water circulation, filtration and disinfection. However, in some countries, including Hungary, therapeutic pools are traditionally not treated this way, in order to preserve the therapeutic qualities of the water. However, dilution and frequent water replacement applied in these pools are often insufficient to ensure adequate microbial water quality, posing a risk of infection to the bathers. In the present case study, the impact of water treatment (including chemical disinfection by hypochlorite or hydrogen peroxide) was investigated on the therapeutic components of the water in seven Hungarian spas of various water composition. Microbial quality was improved by both disinfectants, but hypochlorite reduced the concentration of the therapeutic components sulfide, bromide, and iodide ions by 40-99%, and high levels of disinfection by-products were observed. Hydrogen peroxide only affected sulfide ion (91% reduction). Other technological steps (e.g., transport or cooling by dilution) were found to have significant impact on composition, often outweighing the effect of disinfection. The current case study demonstrated that thermal waters may be treated and disinfected with minimal loss of the therapeutic compounds, if an adequate treatment procedure is selected based on the water composition.

Occurrence of P. aeruginosa in Water Intended for Human Consumption and in Swimming Pool Water

Considering the fact that water is a basic need of every living being, it is important to ensure its safety. In this work, the data on the presence of the opportunistic pathogen P. aeruginosa in drinking water (n = 4171) as well as in pool water (n = 5059) in Primorje-Gorski Kotar County in Croatia in the five-year period (2016–2020) were analysed. In addition, the national criteria were compared with those of neighboring countries and worldwide. The proportion of P. aeruginosa-positive samples was similar for drinking water (3.9%) and pool water (4.6%). The prevalence of this bacterium was most pronounced in the warmer season. P. aeruginosa-positive drinking water samples were mostly collected during building commissioning, while pool samples were from entertainment and spa/hydromassage pools. Outdoor pools showed a higher percentage of positive samples than indoor pools, as well as the pools filled with freshwater rather than seawater. The highest P. aeruginosa load was found in rehabilitation pools. Croatia, Serbia and Montenegro are countries that have included P. aeruginosa in their national regulations as an indicator of the safety of water for human consumption as well as for bottled water, while Slovenia and Bosnia and Herzegovina have limited this requirement to bottled water only. In the case of swimming pool water, this parameter is mandatory in all countries considered in this study.

Phage Biocontrol of Pseudomonas aeruginosa in Water

Bacteriophage control of harmful or pathogenic bacteria has aroused growing interest, largely due to the rise of antibiotic resistance. The objective of this study was to test phages as potential agents for the biocontrol of an opportunistic pathogen Pseudomonas aeruginosa in water. Two P. aeruginosa bacteriophages (vB_PaeM_V523 and vB_PaeM_V524) were isolated from wastewater and characterized physically and functionally. Genomic and morphological characterization showed that both were myoviruses within the Pbunavirus genus. Both had a similar latent period (50-55 min) and burst size (124-134 PFU/infected cell), whereas there was variation in the host range. In addition to these environmental phages, a commercial Pseudomonas phage, JG003 (DSM 19870), was also used in the biocontrol experiments. The biocontrol potential of the three phages in water was tested separately and together as a cocktail against two P. aeruginosa strains; PAO1 and the environmental strain 17V1507. With PAO1, all phages initially reduced the numbers of the bacterial host, with phage V523 being the most efficient (>2.4 log10 reduction). For the environmental P. aeruginosa strain (17V1507), only the phage JG003 caused a reduction (1.2 log10) compared to the control. The cocktail of three phages showed a slightly higher decrease in the level of the hosts compared to the use of individual phages. Although no synergistic effect was observed in the host reduction with the use of the phage cocktail, the cocktail-treated hosts did not appear to acquire resistance as rapidly as hosts treated with a single phage. The results of this study provide a significant step in the development of bacteriophage preparations for the control of pathogens and harmful microbes in water environments.

Environmental risks of Pseudomonas aeruginosa-What to advise patients and parents

Pseudomonas aeruginosa (PsA) is commonly found in soil and water so is impossible to avoid completely. Parents/carers of children with cystic fibrosis (CF) are concerned about them acquiring PsA from the environment, and different families view risk differently. Our ethos is to enable children with CF to take part as much as possible in educational and fun home activities, in order to maintain their quality of life (and their family's), and not have them feel different from other children. This review presents advice for families as to what they must definitely avoid, what they must take precautions with but can allow, and what they must not avoid. It is mostly evidence-based, but where evidence is lacking it a consensus view from the Paediatric CF Unit at the Royal Brompton Hospital.

Hot Tub-Associated Pseudomonas Folliculitis: A Case Report and Review of Host Risk Factors

Pseudomonas aeruginosa folliculitis is an infection of the skin commonly associated with swimming pool and hot tub use. It often presents as outbreaks affecting multiple individuals using the same contaminated public water facility. We present a case report of a 50-year-old woman who developed pseudomonal folliculitis after using a hot tub with multiple family members. No other family member developed folliculitis. Factors contributing to susceptibility to P. aeruginosa infection are reviewed.

Comparative study on the microbial quality in the swimming pools disinfected by the ozone-chlorine and chlorine processes in Tabriz, Iran

Applying a desirable disinfestation process is necessary to control the pathogenic microorganisms in the swimming pools and prevent both dermal and intestinal effects. Therefore, the present study was conducted to compare the bacterial community and diversity in the two swimming pools disinfected by the chlorine and ozone (O₃)-chlorine processes. A total of 24 samples were taken from the two swimming pools in three distinct seasons to analyze the bacterial and physico-chemical indicators. Culture and molecular methods were used to evaluate the microbial quality. Two sets of sample taken from the pools with the maximum swimmer load in the summer were investigated by the next-generation sequencing (NGS) technique. In total, 410 and 406 bacterial species were identified in the chlorine- and ozone-chlorine-disinfected pools, respectively. Among the eight dominant bacterial species in each swimming pool, Pseudomonas alcaliphila, Pseudomonas stutzeri, and Pseudomonas acnes were common species between the two studied pools. Oleomonas sagaranensis (350 reads/18593), Staphylococcus caprae (302 reads /18593), and Anaerococcus octavius (110 reads/18593) were among the dominant bacteria in the chlorine-disinfected pool. Bacterial diversity was lower in the ozone-chlorine-disinfected pool than the other one, and the highest bacterial sequencing belonged to the genus Pseudomonas (85.79%). Results showed that water quality of in O₃-chlorine-disinfected pool was more desirable than the chlorine-disinfected pool. Molecular methods along with conventional culture methods would be advantageous for microbial assessment in the swimming pools.

Propidium monoazide-quantitative polymerase chain reaction (PMA-qPCR) assay for rapid detection of viable and viable but non-culturable (VBNC) Pseudomonas aeruginosa in swimming pools

Lack of culturability in the viable but non-culturable (VBNC) bacteria and the ability to regain infectivity in favourable conditions is one of the new challenges of public health providers for Pseudomonas aeruginosa monitoring in environmental samples. Propidium monoazide quantitative polymerase chain reaction (PMA-qPCR) is one of the promising methods for timely detection of VBNC pathogens in environmental samples. We developed and used a method for the first time to detection of VBNC P. aeruginosa in swimming pool water samples using a membrane filter (MF). Moreover, the dominant model of the distribution of colonies on the MF and the effect of the culture medium and MF type on colony recovery by MF were evaluated. Swimming pool samples were subjected to conventional culture-based, qPCR and PMA-qPCR methods and the results were compared for the presence of VBNC P. aeruginosa in the samples. The positivity rate was 21% and 75% for P. aeruginosa in water samples as confirmed by standard culture-based and qPCR methods, respectively. Furthermore, of 24 samples, 9 (37.5%) were positive for VBNC P. aeruginosa. The developed qPCR/PMA-qPCR assay can detect the VBNC bacteria directly from aquatic samples and may result in better monitoring of recreational waters.

Occurrence of Antibiotic-Resistant Bacteria in Therapy Pools and Surrounding Surfaces

The number of patients colonized with antibiotic-resistant bacteria is increasing in health care facilities. Because transmission of antibiotic-resistant bacteria is feared, there exist reports that the affected patients are frequently excluded from hydrotherapy, which is a non-invasive and beneficial treatment used for patients with different diseases. Data from the literature suggest that deficient water disinfection measures exist, which are not always sufficient to kill all released bacteria. If the pool water is not disinfected properly, it may also infect the bathers. Immunocompromised patients are particularly susceptible to be infected with (antibiotic-resistant) bacteria. In order to determine the distribution of antibiotic-resistant bacteria in the pool water treatment system and the pool environment and to estimate the associated transmission risk we analyzed samples from eleven health care facilities. Antibiotic-resistant bacteria were found in the water and surface samples collected. One hundred and two antibiotic-resistant isolates from water samples and 307 isolates from surrounding surfaces were obtained, respectively. The majority of the isolates belonged to non-fermenting Gram-negative rods, like Pseudomonas spp. Some isolates were resistant to a wide range of the tested antibiotics. The results indicate a relation between the number of isolates in water samples and the number of patients using the pools in combination with deficiencies in water treatment. In the pool environment the highest number of isolates was obtained from barefoot areas and floor cleaning equipment.

Assessment of Microbiological Safety of Water in Public Swimming Pools in Guangzhou, China

This study assessed microbiological safety of water from public swimming pools in Guangzhou, China. Water samples from 39 outdoor municipal swimming pools were collected from late June to early September, 2013 and subjected to detection of protozoa (Giardia and Cryptosporidium) and bacteria (Pseudomonas aeruginos, total coliforms, E. coli, E. coli O157, Shigella, and Salmonella). Cryptosporidium and Giardia were both detected in 5 (12.8%) swimming pools. Total coliforms were detected in 4 (10.3%) samples with concentrations ranging from 1.3 to 154.0 MPN/100 mL while E. coli was detected in 4 (10.3%) samples with concentrations ranging from 0.5 to 5.3 MPN/100 mL. P. aeruginosa was detected in 27 (69.2%) samples but E. coli O157, Shigella and Salmonella were not detected. Among these swimming pools, 9 (23%) met the Chinese National Standard of residual chlorine levels and 24 (62%) were tested free of residual chlorine at least once. The multi-locus sequence typing (MLST) analysis showed that all P. aeruginosa isolates belonged to new sequence types (STs) with dominant ST-1764 and ST-D distributed in different locations within the area. Some P. aeruginosa strains were resistant to medically important antibiotics. Results indicate potential public health risks due to the presence of microbiological pathogens in public swimming pools in this area.

The presence of biofilm forming microorganisms on hydrotherapy equipment and facilities

Hydrotherapy equipment provides a perfect environment for the formation and growth of microbial biofilms. Biofilms may reduce the microbiological cleanliness of hydrotherapy equipment and harbour opportunistic pathogens and pathogenic bacteria. The aims of this study were to investigate the ability of microorganisms that colonize hydrotherapy equipment to form biofilms, and to assess the influence of temperature and nutrients on the rate of biofilm formation. Surface swab samples were collected from the whirlpool baths, inhalation equipment and submerged surfaces of a brine pool at the spa center in Ciechocinek, Poland. We isolated and identified microorganisms from the swab samples and measured their ability to form biofilms. Biofilm formation was observed at a range of temperatures, in both nutrient-deficient and nutrient-rich environments. We isolated and identified microorganisms which are known to form biofilms on medical devices (e.g. Stenotrophomonas maltophilia). All isolates were classified as opportunistic pathogens, which can cause infections in humans with weakened immunity systems. All isolates showed the ability to form biofilms in the laboratory conditions. The potential for biofilm formation was higher in the presence of added nutrients. In addition, the hydrolytic activity of the biofilm was connected with the presence of nutrients.

Pseudomonas aeruginosa in Swimming Pool Water: Evidences and Perspectives for a New Control Strategy

Pseudomonas aeruginosa is frequently isolated in swimming pool settings. Nine recreational and rehabilitative swimming pools were monitored according to the local legislation. The presence of P. aeruginosa was correlated to chlorine concentration. The ability of the isolates to form a biofilm on plastic materials was also investigated. In 59.5% of the samples, microbial contamination exceeded the threshold values. P. aeruginosa was isolated in 50.8% of these samples. The presence of P. aeruginosa was not correlated with free or total chlorine amount (R² < 0.1). All the isolates were moderate- to strong-forming biofilm (Optical Density O.D.570 range 0.7-1.2). To control biofilm formation and P. aeruginosa colonization, Quantum FreeBioEnergy© (QFBE, FreeBioEnergy, Brisighella, Italy), has been applied with encouraging preliminary results. It is a new, promising control strategy based on the change of an electromagnetic field which is responsible for the proliferation of some microorganisms involved in biofilm formation, such as P. aeruginosa.

Health-Related Behaviors in Swimming Pool Users: Influence of Knowledge of Regulations and Awareness of Health Risks

Background: Swimming pool attendance exposes users to infection and chemical risks that could be largely reduced with the adoption of healthy behaviors. This study aims to investigate if the knowledge of swimming pool regulations and awareness of health risks can be associated with users’ health-related behaviors. Methods: A cross-sectional study was conducted using self-administered questionnaires to collect data from two different target groups of swimming users: 184 adults and 184 children/adolescents. The association between specific variables and patterns of behaviors and knowledge was assessed through multivariate logistic regression models. Results: Although more than 80% of both groups declared they knew the regulations, compliance with healthy behaviors was often unsatisfactory, especially in adolescents and youth. In the children/adolescents group, healthy behaviors significantly increased with the frequency of attendance per week. In both groups, compliance increased with educational level (of parents for children/adolescents), while no positive association was observed between viewing the regulations and adopting appropriate behaviors. In the adult group, a higher knowledge/awareness of health risks was related to decreased odds of at least one unhealthy behavior. Conclusions: Guaranteeing the public display of regulations in swimming facilities is not sufficient to promote and change health-related behaviors. Much more attention should be given to educational interventions aimed to increase knowledge of health risks and the awareness that bathers are directly responsible for their own well-being.

Dose-response algorithms for water-borne Pseudomonas aeruginosa folliculitis

We developed two dose-response algorithms for P. aeruginosa pool folliculitis using bacterial and lesion density estimates, associated with undetectable, significant, and almost certain folliculitis. Literature data were fitted to Furumoto & Mickey's equations, developed for plant epidermis-invading pathogens: N l = A ln(1 + BC) (log-linear model); P inf = 1-e(-r c C) (exponential model), where A and B are 2.51644 × 107 lesions/m2 and 2.28011 × 10-11 c.f.u./ml P. aeruginosa, respectively; C = pathogen density (c.f.u./ml), N l = folliculitis lesions/m2, P inf = probability of infection, and r C = 4·3 × 10-7 c.f.u./ml P. aeruginosa. Outbreak data indicates these algorithms apply to exposure durations of 41 ± 25 min. Typical water quality benchmarks (≈10-2 c.f.u./ml) appear conservative but still useful as the literature indicated repeated detection likely implies unstable control barriers and bacterial bloom potential. In future, culture-based outbreak testing should be supplemented with quantitative polymerase chain reaction and organic carbon assays, and quantification of folliculitis aetiology to better understand P. aeruginosa risks.

Pseudomonas aeruginosadose response and bathing water infection

Pseudomonas aeruginosais the opportunistic pathogen mostly implicated in folliculitis and acute otitis externa in pools and hot tubs. Nevertheless, infection risks remain poorly quantified. This paper reviews disease aetiologies and bacterial skin colonization science to advance dose-response theory development. Three model forms are identified for predicting disease likelihood from pathogen density. Two are based on Furumoto & Mickey's exponential ‘single-hit’ model and predict infection likelihood and severity (lesions/m2), respectively. ‘Third-generation’, mechanistic, dose-response algorithm development is additionally scoped. The proposed formulation integrates dispersion, epidermal interaction, and follicle invasion. The review also details uncertainties needing consideration which pertain to water quality, outbreaks, exposure time, infection sites, biofilms, cerumen, environmental factors (e.g. skin saturation, hydrodynamics), and whetherP. aeruginosais endogenous or exogenous. The review's findings are used to propose a conceptual infection model and identify research priorities including pool dose-response modelling, epidermis ecology and infection likelihood-based hygiene management.

First report of a Chinese PFOS alternative overlooked for 30 years: its toxicity, persistence, and presence in the environment

This is the first report on the environmental occurrence of a chlorinated polyfluorinated ether sulfonate (locally called F-53B, C8ClF16O4SK). It has been widely applied as a mist suppressant by the chrome plating industry in China for decades but has evaded the attention of environmental research and regulation. In this study, F-53B was found in high concentrations (43-78 and 65-112 μg/L for the effluent and influent, respectively) in wastewater from the chrome plating industry in the city of Wenzhou, China. F-53B was not successfully removed by the wastewater treatments in place. Consequently, it was detected in surface water that receives the treated wastewater at similar levels to PFOS (ca. 10-50 ng/L) and the concentration decreased with the increasing distance from the wastewater discharge point along the river. Initial data presented here suggest that F-53B is moderately toxic (Zebrafish LC50-96 h 15.5 mg/L) and is as resistant to degradation as PFOS. While current usage is limited to the chrome plating industry, the increasing demand for PFOS alternatives in other sectors may result in expanded usage. Collectively, the results of this work call for future assessments on the effects of this overlooked contaminant and its presence and fate in the environment.

Antibiotic resistance profiles and quorum sensing-dependent virulence factors in clinical isolates of pseudomonas aeruginosa

Pseudomonas aeruginosa produces multiple virulence factors that have been associated with quorum sensing. The aim of this study was to evaluate the prevalence of drug resistant profiles and quorum sensing related virulence factors. Pseudomonas aeruginosa were collected from different patients hospitalized in China, the isolates were tested for their susceptibility to different common antimicrobial drugs and detected QS-related virulence factors. We identified 170 isolates displaying impaired phenotypic activity, approximately 80 % of the isolates were found to exhibit the QS-dependent phenotypes, among them, 12 isolates were defective in AHLs production, and therefore considered QS-deficient strains. Resistance was most often observed to Cefazolin (81.2 %), followed by trimethoprim-sulfamethoxazole (73.5 %), ceftriaxone (62.4 %) and Cefotaxime, Levofloxacin, Ciprofloxacin (58.8 %), and to a lesser extent Meropenem (20.0 %), Cefepime (18.8 %), and Cefoperazone/sulbactam (2.4 %) The QS-deficient isolates that were negative for virulence factor production were generally less susceptible to the antimicrobials. The results showed a high incidences of antibiotic resistance and virulence properties in P. aeruginosa, and indicate that the clinical use of QS-inhibitory drugs that appear superior to conventional antimicrobials by not exerting any selective pressure on resistant strains.