A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program

Alexandropoulou, Ioanna; Parasidis, Theodoros A.; Konstantinidis, Theocharis; Panopoulou, Maria; Constantinidis, Theodoros C.

doi:10.3390/healthcare7010039

Cited by 8 publications

(7 citation statements)

References 28 publications

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“…The E-test method was the second most cited (19/89; 23.3%), with a slight difference from the Agar Dilution method (15/89; 21%) ( Figure 2 and Figure 3 ). It seems that the most recent publications (2000–2019) used the E-test method proposed by the EUCAST for the interpretation criteria (10/19 articles), yet there were still some articles using older citations for the applied method, such as Alexandropoulou et al (2013 and 2019) [ 25 , 26 ], Lai et al (2010) [ 70 ] and Shadoub et al (2015) [ 71 ] ( Table S1 raw data). None of the abovementioned articles (2000–2019) explained why they relied on using publications rather than the guidelines from the CLSI or EUCAST.…”

Section: Resultsmentioning

confidence: 99%

“…In deciding which antibiotics should be selected to work with, the following criteria were considered: (a) the most cited antibiotics in the revised articles included in the study ( Table S1 raw data), (b) the guidelines of the Sanford Guide to Antimicrobial Therapy [ 24 ], and (c) the antibiotics administered in Greece [ 25 , 26 , 27 , 28 ]. This process resulted in the inclusion of seven (7) antibiotics in the search, these being ciprofloxacin (CIP), erythromycin (ERM), azithromycin (AZM), doxycycline (DOX), levofloxacin (LEV), rifampicin (RIF) and clarithromycin (CL).…”

Section: Methodsmentioning

confidence: 99%

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Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates—A Systematic Review

Παππά

Chochlakis

Sandalakis

et al. 2020

IJERPH

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The current systematic review investigates the antibiotic susceptibility pattern of Legionella pneumophila isolates from the 1980s to the present day, deriving data from clinical and/or water samples from studies carried out all over the world. Eighty-nine papers meeting the inclusion criteria, i.e., “Legionella pneumophila” and “resistance to antibiotics”, were evaluated according to pre-defined validity criteria. Sixty articles referred to clinical isolates, and 18 articles reported water-related L. pneumophila isolates, while 11 articles included both clinical and water isolates. Several methods have been proposed as suitable for the determination of MICs, such as the E-test, broth and agar dilution, and disk diffusion methods, in vivo and in vitro, using various media. The E-test method proposed by the European Society of Clinical Microbiology and Infectious Diseases (EUCAST) seems to be the second most frequently used method overall, but it is the preferred method in the most recent publications (2000–2019) for the interpretation criteria. Erythromycin has been proved to be the preference for resistance testing over the years. However, in the last 19 years, the antibiotics ciprofloxacin (CIP), erythromycin (ERM), levofloxacin (LEV) and azithromycin (AZM) were the ones that saw an increase in their use. A decrease in the sensitivity to antibiotics was identified in approximately half of the reviewed articles.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates—A Systematic Review

Παππά

Chochlakis

Sandalakis

et al. 2020

IJERPH

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“…Specifically, eleven studies performed membrane filtration followed by plating onto selective agar media, nine of these studies used 0.45 µm pore diameter filters and two did not specify ( Table 1 ). Of those that specifically investigated Legionella spp., two studies referenced the International Organization for Standardization (ISO) 11731—water quality enumeration of Legionella [ 31 , 36 ]. One study investigating L. pneumophila followed Italian guidelines for prevention and the control of legionellosis [ 34 ] and two studies used other culturing techniques [ 35 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…International standards have been published for the processing of environmental water samples for organisms such as Legionella spp., P. aeruginosa and E. coli . However, of the publications reviewed in this study, only three referenced a specific ISO standard [ 31 , 36 , 43 ]. There was significant variation between sampling techniques and selective growth media used in publications that investigated water-related surfaces such as tap faucets and drain holes [ 32 , 33 , 39 , 40 , 41 , 43 , 47 , 48 , 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

et al. 2020

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Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.

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“…S2, a photo of the device that we used). Briefly, sink trap sludge samples (n=5) and manhole sewage samples (n=13) were collected from different places in our university, because Lp frequently colonizes in sinks or sewages [32][33][34][35][36]. The sample solutions, which were diluted in Page's amoeba saline (PAS) [37], were cultured with sterilized rice grains at room temperature for 2 weeks.…”

Section: Isolation Methods For Ciliatesmentioning

confidence: 99%

Wild ciliates differ in susceptibility to Legionella pneumophila JR32

et al. 2021

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We investigated how Legionella pneumophila (Lp) JR32 interacts with Anteglaucoma CS11A and Colpoda E6, two ciliates that we isolated from sewage and sink trap sludge, respectively, using a handmade maze device containing a 96-well crafting plate. Our 18S rDNA-based phylogenetic analysis showed that Anteglaucoma CS11A and Colpoda E6 formed distinct clades. Scanning electron microscopy showed that Anteglaucoma CS11A had a bigger-sized body than Colpoda E6 and, unlike Tetrahymena IB (the reference strain), neither ciliate produced pellets, which are extracellular vacuoles. Fluorescence microscopic observations revealed that although the intake amounts differed, all three ciliates rapidly ingested LpJR32 regardless of the presence or absence of the icm/dot virulence genes, indicating that they all interacted with LpJR32. In co-cultures with Anteglaucoma CS11A, the LpJR32 levels were maintained but fell dramatically when the co-culture contained the LpJR32 icm/dot deletion mutant instead. Anteglaucoma CS11A died within 2 days of co-culture with LpJR32, but survived co-culture with the deletion mutant. In co-cultures with Colpoda E6, LpJR32 levels were maintained but temporarily decreased independently of the virulence gene. Concurrently, the Colpoda E6 ciliates survived by forming cysts, which may enable them to resist harsh environments, and by diminishing the sensitivity of trophozoites to Lp. In the Tetrahymena IB co-cultures with LpJR32 or Δicm/dot, the Lp levels were maintained, albeit with temporal decreases, and the Tetrahymena IB levels were also maintained. We conclude that unlike Tetrahymena IB with pellet production, Anteglaucoma CS11A can be killed by LpJR32 infection, and Colpoda E6 can resist LpJR32 infection through cyst formation and the low sensitivity of trophozoites to Lp. Thus, the two ciliates that we isolated had different susceptibilities to LpJR32 infection.

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A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program

Cited by 8 publications

References 28 publications

Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates—A Systematic Review

Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates—A Systematic Review

Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

Wild ciliates differ in susceptibility to Legionella pneumophila JR32

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