RESEARCH PAPER
Persistent colonization of 2 hospital water supplies by L. pneumophila strains through 7 years – Sequence-based typing and serotyping as useful tools for complex risk analysis
 
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1
National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
 
2
Center of Oncology – Institute, Warsaw, Poland
 
 
Ann Agric Environ Med. 2013;20(4):687-694
 
KEYWORDS
ABSTRACT
Contamination with Legionella spp. of hot water system (HWS) in hospitals is a considerable problem and elimination of bacteria poses difficulties. Obligatory control of Legionella spp. in hospital HWS was implemented in Poland in 2008y. After that, Legionella spp. has been isolated repeatedly from HWS of the majority of hospitals. The aim of our study was to confirm the permanent colonization with Legionella spp. of 2 hospital HWSs based on the antigenic (serogroup/subgroups) and genetic properties (SBT, rtxA) of L.pneumophila strains isolated in 2004–2011. The dynamic of L.pneumophila population was also examined due to methods of disinfections applied during 7 years. Totally, 134 environmental samples were collected from two hospitals in 2004–2011 (118 from HWSs). During the study disinfection by chlorine dioxide was implemented in both hospitals, while thermal shock was added in the hospital A. Isolated L.pneumophila were serogrouped (105 strains) using Dresden MAb Panel, genotyped by sequence based typing (53) and by harboring of rtxA gene (58 isolates). Legionella spp. were still presented in both systems after 7 years. Exactly the same strains (ST1, ST87, ST114, ST992) were found in the hospital B. While changes of L.pneumophila population were observed in the hospital A: strains still occurred after 7 years (ST835 Sg6, ST114 Sg6); modified antigenic properties (ST835 – Sg12 vs. Sg6); eliminated or maybe not detected (ST81, ST838, ST959). Moreover, the majority of examined strains ST1 (Sg1, OLDA) harboured rtxA gene (hospital B). Our results and data in the EWGLI SBT base indicated higher risk of Legionella infection in the hospital B than A – because of heavy colonization with L.pneumophila ST1. The risk assessment of Legionella infection based only on technical parameters, extent of colonization/contamination level may be not completed. It should be supplemented with the additional examination: serotyping, genotyping and virulence testing of isolated strains.
 
REFERENCES (28)
1.
Boccia S, Laurenti P, Borella P, Moscato U, Capalbo G, Cambieri A, et al. Prospective 3-Year Surveillance for Nosocomial and Environmental Legionella pneumophila: Implications for Infection Control. Infect Control Hosp Epidemiol. 2006; 27: 459–465.
 
2.
Leoni E, Sacchetti R, Zanetti F, et al. Control of Legionella pneumophila contamination in respiratory hydrotherapy system with sulfurous spa water. Infect Control Hosp Epidemiol. 2006; 27: 716–721.
 
3.
O’Neill E, Humprhreys H. Surveillance of hospital water and primary Prevention of nosocomial legionellosis: what is the evidence? J Hosp Infect. 2005; 59: 273–279.
 
4.
Kool JL, Berguire-Sweat D, Butler JC, et al. Hospital characteristics associated with colonisation of water systems by Legionella and risk of nosocomial Legionnaires’ Disease: A cohort study of 15 hospitals. Infect Control Hosp Epidemiol. 1999; 20: 798–805.
 
5.
Stout EJ, Muder RR, Mietzner S, et al. Role of Environmental Surveillance in Determining the Risk of Hospital-Acquired Legionellosis: A National Surveillance Study With Clinical Correlations. Infect Control Hosp Epidemiol. 2007; 28: 818–824.
 
6.
Fields BS, Benson RF, Besser RE. Legionella and Legionnaires’ Disease: 25 years of investigation. Clin Microb Rev. 2002; 506–526.
 
7.
Butler JC, Breiman RF. Legionellosis. Bacterial Infection of Human. Epidemiology and Control. (ed.) Evans A.S., Barchman P.S. New York, London 1998; 18: 355–75.
 
8.
Pancer K, Matuszewska R. Bezpieczeństwo wody w zakładach opieki medycznej. W: A.Pawińska Profilaktyka zakażeń szpitalnych – bezpieczeństwo środowiska szpitalnego. α-medica press 2011: p.24–56.
 
9.
Turetgen I, Cotuk A. Monitoring of biofilm-associated L. pneumophila on different substrata in model cooling tower system. Environ Monit Assess. 2007; 125: 271–279.
 
10.
Stypułkowska-Misiurewicz H, Pancer K, Krogulska B, Matuszewska R. Ognisko choroby legionistów na oddziale okulistycznym. Szpitalne zakażenie Legionella pneumophila po raz pierwszy obserwowane w Polsce. Przegl Epidemiol. 2007; 61: 657–665.
 
11.
Pancer K, Napiórkowska A, Gut W, Stypułkowska-Misiurewicz H. Charakterystyka demograficzna zachorowań na legionelozę w Polsce w latach 2005–2009 w świetle danych gromadzonych przez European Working Group for Legionella Infections (EWGLI). Przegl Epidemiol. 2011; 65: 433–440.
 
12.
Joseph CA, Ricketts KD, on behalf of the European Working Group for Legionella Infections. Legionnaires’ disease in Europe 2007–2008. Euro Surveill. 2010;15(8):pii=19493. Available online: http://www. eurosurveillance.org/ViewArticle.aspx?ArticleId=19493.
 
13.
Hall KK, Gianetta ET, Getchell – White SI, et al. Ultraviolet light disinfection of hospital water for preventing nosocomial Legionella infection: a 13-year follow -up. Infect Control Hosp Epidemiol. 2003; 24: 580–583.
 
14.
Rozporządzenie Ministra Zdrowia z dnia 29 marca 2007 r. w sprawie jakości wody przeznaczonej do spożycia przez ludzi. (Dz.U. 2007, Nr. 61 poz. 417. z późn. zm.).
 
15.
PN-EN ISO 11173–2: 2008 Jakość wody. Wykrywanie i oznaczanie ilościowe bakterii z rodzaju Legionella. Część 2: Metodyka filtracji membranowej dla wód o małej liczbie bakterii.
 
16.
Helbig JH, Bernander S, Castellani Pastoris M, Etienne J, Gaia V, Lauwers S, et al. Pan-European Study on Culture-Proven Legionnaires’ Disease:Distribution of Legionella pneumophila Serogroups and Monoclonal Subgroups Eur J Clin Microbiol Infect Dis. 2002; 21: 710–716.
 
17.
Gaia V, Fry NK, Afshar B, Lück PC, Meugnier H, Etienne J, et al. Consensus Sequence-Based Scheme for Epidemiological Typing of Clinical and Environmental Isolates of Legionella pneumophila. J Clin Microbiol. 2005; 43(5): 2047–2052.
 
18.
Pancer K. Sequence-based typing of Legionella pneumophila strains isolated from hospital water distribution systems as a complementary element of risk assessment of legionellosis in Poland. Ann Agric Environ Med. 2013; 20(3): 436–440.
 
19.
Samrakandi MM, Cirillo SLG, Ridenour DA, Bermudez LE, Cirillo JD. Genetic and Phenotypic Differences between Legionella pneumophila Strains. J Clin Microbiol. 2002; 40: 1352–1362.
 
20.
Ustawa o zapobieganiu oraz zwalczaniu zakażeń i chorób zakaźnych u ludzi z 5 grudnia 2008 r. (Dz. U.2008, Nr 234 poz.1570).
 
21.
Pancer K, Rabczenko D, Krogulska B, Matuszewska R, Ozygała J, Stanisławska A et al. Mikrobiologiczna ocena zagrożenia legionelozą oraz zastosowanie metody eliminacji Legionella pneumophila z sieci wodnych budynków szpitalnych. Przegl Epidemiol. 2008; 62: 439–446.
 
22.
Svarrer CW, Luck C, Elverdal PE, Uldum SA. Immunochromatic kits Xpect Legionella and BinaxNOW Legionella for detection of Legionella pneumophila urinary antigen have low sensitivities for the diagnosis of Legionnaires’ disease. J Med Microbiol. 2012; 61: 213–217.
 
23.
Bram M, Diederen W, Peeters MF. Evaluation of Two New Immunochromatographic Assays (Rapid U Legionella Antigen Test and SD Bioline Legionella Antigen Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine. J Clin Microbiol. 2006; 8: 2991–2993.
 
24.
Helbig JH, Jacobs F, Lück C. Legionella pneumophila urinary antigen subtyping using monoclonal antibodies as a tool for epidemiological investigations. Eur J Clin Microbiol Infect Dis. 2012; 31: 1673–1677.
 
25.
Stojek NM, Wojcik-Fatla A, Dutkiewicz J. Efficacy of the detection of Legionella in hot and cold water samples by culture and PCR. II. Examination of native samples from various sources. Ann Agric Environ Med. 2012; 19(2): 295–298.
 
26.
EWGLI Technical guidelines for the Investigation, Control and Prevention of Travel Associated Legionnaires’ Disease. September 2011, Version 1.1. Available online: http://ecdc.europa.eu/en/activ... surveillance/ELDSNet/Documents/EWGLI-Technical-Guidelines.pdf.
 
27.
Moran-Gilad J, Lazarovitch T, Mentasti M, Harrison T, Weinberger M, Mordish Y et al. Humidifier-associated paediatric Legionnaires’ disease, Israel, February 2012. Euro Surveill. 2012;17(41):pii=20293. Available online: http://www.eurosurveillance.or.... aspx?ArticleId=20293.
 
28.
McCormick D, Thorn S, Milne D, Evans C, Stevenson J, Llano M, et al. on behalf of the Incident Management Team. Public health response to an outbreak of Legionnaires’ disease in Edinburgh, United Kingdom, June 2012. Euro Surveill. 2012;17(28):pii=20216. Available online: http:// www.eurosurveillance.org/ViewArticle.aspx?ArticleId=202166.
 
eISSN:1898-2263
ISSN:1232-1966
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