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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gamage SD, Jinadatha C, Coppin JD, Kralovic SM, Bender A, Ambrose M, Decker BK, DeVries AS, Goto M, Kowalskyj O, Maistros AL, Rizzo V, Simbartl LA, Watson RJ, Roselle GA. Factors That Affect Legionella Positivity in Healthcare Building Water Systems from a Large, National Environmental Surveillance Initiative. Environ Sci Technol 2022; 56:11363-11373. [PMID: 35929739 DOI: 10.1021/acs.est.2c02194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Legionella growth in healthcare building water systems can result in legionellosis, making water management programs (WMPs) important for patient safety. However, knowledge is limited on Legionella prevalence in healthcare buildings. A dataset of quarterly water testing in Veterans Health Administration (VHA) healthcare buildings was used to examine national environmental Legionella prevalence from 2015 to 2018. Bayesian hierarchical logistic regression modeling assessed factors influencing Legionella positivity. The master dataset included 201,146 water samples from 814 buildings at 168 VHA campuses. Overall Legionella positivity over the 4 years decreased from 7.2 to 5.1%, with the odds of a Legionella-positive sample being 0.94 (0.90-0.97) times the odds of a positive sample in the previous quarter for the 16 quarters of the 4 year period. Positivity varied considerably more at the medical center campus level compared to regional levels or to the building level where controls are typically applied. We found higher odds of Legionella detection in older buildings (OR 0.92 [0.86-0.98] for each more recent decade of construction), in taller buildings (OR 1.20 [1.13-1.27] for each additional floor), in hot water samples (O.R. 1.21 [1.16-1.27]), and in samples with lower residual biocide concentrations. This comprehensive healthcare building review showed reduced Legionella detection in the VHA healthcare system over time. Insights into factors associated with Legionella positivity provide information for healthcare systems implementing WMPs and for organizations setting standards and regulations.
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Affiliation(s)
- Shantini D Gamage
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
| | - Chetan Jinadatha
- Department of Medicine, Central Texas Veterans Health Care System, Temple, Texas 76504, United States
- College of Medicine, Texas A&M University, Bryan, Texas 77807, United States
| | - John D Coppin
- Department of Research, Central Texas Veterans Health Care System, Temple, Texas 76504, United States
| | - Stephen M Kralovic
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
- Cincinnati VA Medical Center, Cincinnati, Ohio 45220, United States
| | - Alan Bender
- Booz Allen Hamilton, McLean, Virginia 22102, United States
| | - Meredith Ambrose
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
| | - Brooke K Decker
- Division of Infectious Diseases, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, United States
| | - Aaron S DeVries
- Minneapolis VA Healthcare System, Minneapolis, Minnesota 55417, United States
| | - Michihiko Goto
- Iowa City VA Health Care System, Iowa City, Iowa 52246, United States
- University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, United States
| | - Oleh Kowalskyj
- Office of Healthcare Engineering, Healthcare Environment and Facilities Program, Veterans Health Administration, VA, Washington, D.C. 20571, United States
| | - Angela L Maistros
- VA Capitol Health Care Network, Veterans Integrated Service Network (VISN) 5, Linthicum, Maryland 21090, United States
| | - Vincent Rizzo
- Office of Healthcare Engineering, Healthcare Environment and Facilities Program, Veterans Health Administration, VA, Washington, D.C. 20571, United States
| | - Loretta A Simbartl
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
| | - Richard J Watson
- Occupational Health and Safety Program Office, Veterans Health Administration, VA, Washington, D.C. 20571, United States
| | - Gary A Roselle
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
- Cincinnati VA Medical Center, Cincinnati, Ohio 45220, United States
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Hayward C, Ross KE, Brown MH, Bentham R, Whiley H. The Presence of Opportunistic Premise Plumbing Pathogens in Residential Buildings: A Literature Review. Water 2022; 14:1129. [DOI: 10.3390/w14071129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Opportunistic premise plumbing pathogens (OPPP) are microorganisms that are native to the plumbing environment and that present an emerging infectious disease problem. They share characteristics, such as disinfectant resistance, thermal tolerance, and biofilm formation. The colonisation of domestic water systems presents an elevated health risk for immune-compromised individuals who receive healthcare at home. The literature that has identified the previously described OPPPs (Aeromonas spp., Acinetobacter spp., Helicobacter spp., Legionella spp., Methylobacterium spp., Mycobacteria spp., Pseudomonas spp., and Stenotrophomonas spp.) in residential drinking water systems were systematically reviewed. By applying the Preferred reporting items for systematic reviews and meta-analyses guidelines, 214 studies were identified from the Scopus and Web of Science databases, which included 30 clinical case investigations. Tap components and showerheads were the most frequently identified sources of OPPPs. Sixty-four of these studies detected additional clinically relevant pathogens that are not classified as OPPPs in these reservoirs. There was considerable variation in the detection methods, which included traditional culturing and molecular approaches. These identified studies demonstrate that the current drinking water treatment methods are ineffective against many waterborne pathogens. It is critical that, as at-home healthcare services continue to be promoted, we understand the emergent risks that are posed by OPPPs in residential drinking water. Future research is needed in order to provide consistent data on the prevalence of OPPPs in residential water, and on the incidence of waterborne homecare-associated infections. This will enable the identification of the contributing risk factors, and the development of effective controls.
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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. Microb Ecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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