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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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Filice S, Sciuto EL, Scalese S, Faro G, Libertino S, Corso D, Timpanaro RM, Laganà P, Coniglio MA. Innovative Antibiofilm Smart Surface against Legionella for Water Systems. Microorganisms 2022; 10:microorganisms10050870. [PMID: 35630315 PMCID: PMC9144790 DOI: 10.3390/microorganisms10050870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/20/2022] Open
Abstract
Legionella pneumophila contamination of water systems is a crucial issue for public health. The pathogen is able to persist in water as free-living planktonic bacteria or to grow within biofilms that adhere to and clog filters and pipes in a water system, reducing its lifespan and, in the case of hospital buildings, increasing the risk of nosocomial infections. The implementation of water management is considered to be the main prevention measure and can be achieved from the optimization of water system architecture, notably introducing new materials and strategies to contrast Legionella biofilm proliferation and so prolong the water system functionality. In this research, we propose a new smart surface against L. pneumophila biofilm formation. This is based on an innovative type of coating consisting of a sulfonated pentablock copolymer (s-PBC, commercially named Nexar™) deposited on top of a polypropylene (PP) coupon in a sandwich filter model. The covering of PP with s-PBC results in a more hydrophilic, acid, and negatively charged surface that induces microbial physiological inhibition thereby preventing adhesion and/or proliferation attempts of L. pneumophila prior to the biofilm formation. The antibiofilm property has been investigated by a Zone of Inhibition test and an in vitro biofilm formation analysis. Filtration tests have been performed as representative of possible applications for s-PBC coating. Results are reported and discussed.
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Affiliation(s)
- Simona Filice
- Istituto per la Microelettronica e Microsistemi-Consiglio Nazionale delle Ricerche (CNR-IMM), Ottava Strada 5, 95121 Catania, Italy; (S.F.); (S.S.); (S.L.); (D.C.); (M.A.C.)
| | - Emanuele Luigi Sciuto
- Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, Via S. Sofia 78, 95123 Catania, Italy;
- Correspondence:
| | - Silvia Scalese
- Istituto per la Microelettronica e Microsistemi-Consiglio Nazionale delle Ricerche (CNR-IMM), Ottava Strada 5, 95121 Catania, Italy; (S.F.); (S.S.); (S.L.); (D.C.); (M.A.C.)
| | - Giuseppina Faro
- Azienda Sanitaria Provinciale di Catania, Via S. Maria La Grande 5, 95124 Catania, Italy;
| | - Sebania Libertino
- Istituto per la Microelettronica e Microsistemi-Consiglio Nazionale delle Ricerche (CNR-IMM), Ottava Strada 5, 95121 Catania, Italy; (S.F.); (S.S.); (S.L.); (D.C.); (M.A.C.)
| | - Domenico Corso
- Istituto per la Microelettronica e Microsistemi-Consiglio Nazionale delle Ricerche (CNR-IMM), Ottava Strada 5, 95121 Catania, Italy; (S.F.); (S.S.); (S.L.); (D.C.); (M.A.C.)
| | - Rosario Manuel Timpanaro
- Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, Via S. Sofia 78, 95123 Catania, Italy;
| | - Pasqualina Laganà
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Torre Biologica 3p, AOU ‘G. Martino’, University of Messina, Via C. Valeria, S.N.C., 98125 Messina, Italy;
| | - Maria Anna Coniglio
- Istituto per la Microelettronica e Microsistemi-Consiglio Nazionale delle Ricerche (CNR-IMM), Ottava Strada 5, 95121 Catania, Italy; (S.F.); (S.S.); (S.L.); (D.C.); (M.A.C.)
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Via Sofia 87, 95123 Catania, Italy
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Talapko J, Frauenheim E, Juzbašić M, Tomas M, Matić S, Jukić M, Samardžić M, Škrlec I. Legionella pneumophila-Virulence Factors and the Possibility of Infection in Dental Practice. Microorganisms 2022; 10:microorganisms10020255. [PMID: 35208710 PMCID: PMC8879694 DOI: 10.3390/microorganisms10020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Legionella pneumophila is defined as a bacterium that can cause severe pneumonia. It is found in the natural environment and in water, and is often found in water tanks. It can be an integral part of biofilms in nature, and the protozoa in which it can live provide it with food and protect it from harmful influences; therefore, it has the ability to move into a sustainable but uncultured state (VBNC). L. pneumophila has been shown to cause infections in dental practices. The most common transmission route is aerosol generated in dental office water systems, which can negatively affect patients and healthcare professionals. The most common way of becoming infected with L. pneumophila in a dental office is through water from dental instruments, and the dental unit. In addition to these bacteria, patients and the dental team may be exposed to other harmful bacteria and viruses. Therefore, it is vital that the dental team regularly maintains and decontaminates the dental unit, and sterilizes all accessories that come with it. In addition, regular water control in dental offices is necessary.
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Affiliation(s)
- Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Erwin Frauenheim
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Martina Juzbašić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Matej Tomas
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Suzana Matić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia
| | - Melita Jukić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
- General Hospital Vukovar, Županijska 35, HR-32000 Vukovar, Croatia
| | - Marija Samardžić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (E.F.); (M.J.); (M.T.); (S.M.); (M.J.); (M.S.)
- Correspondence:
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Hase R, Miyoshi K, Matsuura Y, Endo Y, Nakamura M, Otsuka Y. Legionella pneumonia appeared during hospitalization in a patient with hematological malignancy confirmed by sputum culture after negative urine antigen test. J Infect Chemother 2018; 24:579-582. [PMID: 29373263 DOI: 10.1016/j.jiac.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/20/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Legionella pneumophila is recognized as a common causative organism for community-acquired pneumonia, but it is rarely a causative organism for hospital-acquired pneumonia, except in cases of hospital outbreak. Recently, most of the Legionella cases have been diagnosed using the urine antigen test. However, this test can reliably detect only L. pneumophila serogroup 1. Here we report a 63-year-old male patient who was recently diagnosed with acute leukemia and treated with chemotherapy and who developed pneumonia on hospital day 8 during the nadir phase. He was later diagnosed with Legionella pneumonia by culture despite a negative urine antigen test. This case suggests that Legionella pneumonia is an important differential diagnosis for pneumonia in inpatients in the early phase of hospitalization and that when Legionella infection is clinically suspected, culture using selective media or molecular tests should be performed even if the urine antigen test is negative.
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Affiliation(s)
- Ryota Hase
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan.
| | - Kazuyasu Miyoshi
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan
| | - Yasuhiro Matsuura
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan
| | - Yasunobu Endo
- Department of Laboratory Medicine, Japanese Red Cross Narita Hospital, 90-1 Iidacho, Narita, Chiba, Japan
| | - Masaki Nakamura
- Division of Bacteriology, Chiba Prefectural Institute of Public Health, 666-2 Nitonacho, Chiba Chuo-ku, Chiba, Japan
| | - Yoshihito Otsuka
- Department of Laboratory Medicine, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan
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Ito A, Ishida T, Washio Y, Yamazaki A, Tachibana H. Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system. BMC Pulm Med 2017; 17:211. [PMID: 29246145 PMCID: PMC5732474 DOI: 10.1186/s12890-017-0559-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background Because of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pneumonia caused by L. pneumophila serogroup 1. Methods We retrospectively analysed patients diagnosed with Legionella pneumonia due to non-L. pneumophila serogroup 1 between March 2001 and June 2016. We examined the clinical characteristics, including symptoms, laboratory findings, radiologic findings, pneumonia severity, initial treatment and prognosis. We also calculated scores using the six-point scoring system in these patients. Furthermore, we compared the clinical characteristics and six-point scores between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients among hospitalized community-acquired pneumonia patients enrolled prospectively between October 2010 and July 2016. Results Eleven patients had pneumonia due to non-L. pneumophila serogroup 1; their median age was 66 years and 8 patients (72.7%) were male. The most common pathogen was L. pneumophila serogroup 3 (6/11), followed by L. pneumophila serogroup 9 (3/11), L. pneumophila serogroup 6 (1/11) and L. longbeachae (1/11). Non-specific symptoms, such as fever and cough, were common. Six patients (54.5%) had liver enzyme elevation, but no patient developed hyponatraemia at <130 mEq/L. Nine patients (81.8%) showed lobar pneumonia and 7 patients (63.6%) manifested with consolidation and ground-glass opacity. Patients with mild to moderate severity comprised 10 (90.9%) by CURB-65 and 5 (45.5%) by the Pneumonia Severity Index. Of all patients, 4 were admitted to the intensive care unit and 3 died despite appropriate empiric therapy. The clinical characteristics were not significantly different between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients (n = 23). At a cut-off value of ≥ 2 points, the sensitivity of the six-point scoring system was 54.5% (6/11) for non-L. pneumophila serogroup 1 patients and 95.7% (22/23) for L. pneumophila serogroup 1 patients. Conclusions Cases of non-L. pneumophila serogroup 1 pneumonia varied in severity from mild to severe and the clinical characteristics were often non-specific. The six-point scoring system was not useful in predicting such Legionella pneumonia cases. Electronic supplementary material The online version of this article (10.1186/s12890-017-0559-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.,Department of Respiratory Medicine, Saiseikai Fukuoka General Hospital, Tenjinn 1-3-46, Chuoku, Fukuoka, Fukuoka, 810-0001, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.,Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Nakaashihara 11, Joyo, Kyoto, 610-0113, Japan
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