Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete

IntroductionWater distribution systems in hotels have been related to outbreaks caused by Legionella spp. Certain measures, including disinfection by chlorination, maintaining increased temperatures are usually undertaken to prevent Legionella outbreaks. However, these preventive strategies are not...

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Main Authors: Dimosthenis Chochlakis, Vassilios Sandalakis, Apostolos Ntoukakis, Maria-Olga Daskalaki, Thomas Loppinet, Niki Thalassinaki, Rena Makridaki, Christos Panoulis, Anna Psaroulaki
Format: Article
Language:English
Published: Frontiers Media S.A. 2023-12-01
Series:Frontiers in Cellular and Infection Microbiology
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Online Access:https://www.frontiersin.org/articles/10.3389/fcimb.2023.1214717/full
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author Dimosthenis Chochlakis
Dimosthenis Chochlakis
Vassilios Sandalakis
Apostolos Ntoukakis
Maria-Olga Daskalaki
Thomas Loppinet
Niki Thalassinaki
Rena Makridaki
Christos Panoulis
Anna Psaroulaki
Anna Psaroulaki
author_facet Dimosthenis Chochlakis
Dimosthenis Chochlakis
Vassilios Sandalakis
Apostolos Ntoukakis
Maria-Olga Daskalaki
Thomas Loppinet
Niki Thalassinaki
Rena Makridaki
Christos Panoulis
Anna Psaroulaki
Anna Psaroulaki
author_sort Dimosthenis Chochlakis
collection DOAJ
description IntroductionWater distribution systems in hotels have been related to outbreaks caused by Legionella spp. Certain measures, including disinfection by chlorination, maintaining increased temperatures are usually undertaken to prevent Legionella outbreaks. However, these preventive strategies are not always effective, since there are several factors (e.g., synergistic interactions with other microbes, physico-chemical factors, biofilm formation, availability of nutrients) that promote survival and proliferation of the pathogen in water pipes., Accordingly, there is a need of a holistic approach in development of preventive models for Legionella outbreaks associated with water distribution systems.MethodsWater samples were collected from hotel water systems and were tested for the presence of Legionella, E. coli, total coliforms, total mesophilic count and Pseudomonas. In each sample, temperature and chlorine were also tested. Other epidemiological factors were additionally recorded including number of rooms, stars, proximity of sampling point to the boiler, etc. Data were processed by generalized linear analysis, and modeling based on logistic regression analysis to identify independent predictive factors associated with the presence of Legionella in hotel water systems.ResultsAccording to the generalized linear model, temperature affected (p<0.05) the presence of Legionella regardless of the species or the water supply (hot or cold). Additionally, opportunistic (P. aeruginosa) or non-opportunistic (E. coli, coliforms) pathogens were significantly associated (p<0.05) with the presence of all Legionella species. Temperature also exhibited a positive effect to all pathogens tested except for Pseudomonas according to the linear model. Multivariate analysis showed that Pseudomonas, total coliforms, HPC and temperature had a statistically significant effect on the presence of Legionella. Based on a binomial model, cold water had a positive effect on Legionella. Type of sampling and proximity of the sample to the boiler seemed to pose different effect on Legionella depending on the cfu/L. The number of hotel stars and rooms did not appear to have any effect in all tested models.DiscussionCollectively, these results indicate the need for development of individualized water safety plans tailored by the presence of other microbiological agents, and unique physico-chemical factors, which could facilitate the survival of Legionella.in hotel water systems.
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spelling doaj.art-0f14e3140b3a44909fe56b915b58ba9f2023-12-22T04:29:20ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882023-12-011310.3389/fcimb.2023.12147171214717Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in CreteDimosthenis Chochlakis0Dimosthenis Chochlakis1Vassilios Sandalakis2Apostolos Ntoukakis3Maria-Olga Daskalaki4Thomas Loppinet5Niki Thalassinaki6Rena Makridaki7Christos Panoulis8Anna Psaroulaki9Anna Psaroulaki10Regional Laboratory of Public Health of Crete, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceRegional Laboratory of Public Health of Crete, School of Medicine, University of Crete, Heraklion, GreeceLaboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, GreeceIntroductionWater distribution systems in hotels have been related to outbreaks caused by Legionella spp. Certain measures, including disinfection by chlorination, maintaining increased temperatures are usually undertaken to prevent Legionella outbreaks. However, these preventive strategies are not always effective, since there are several factors (e.g., synergistic interactions with other microbes, physico-chemical factors, biofilm formation, availability of nutrients) that promote survival and proliferation of the pathogen in water pipes., Accordingly, there is a need of a holistic approach in development of preventive models for Legionella outbreaks associated with water distribution systems.MethodsWater samples were collected from hotel water systems and were tested for the presence of Legionella, E. coli, total coliforms, total mesophilic count and Pseudomonas. In each sample, temperature and chlorine were also tested. Other epidemiological factors were additionally recorded including number of rooms, stars, proximity of sampling point to the boiler, etc. Data were processed by generalized linear analysis, and modeling based on logistic regression analysis to identify independent predictive factors associated with the presence of Legionella in hotel water systems.ResultsAccording to the generalized linear model, temperature affected (p<0.05) the presence of Legionella regardless of the species or the water supply (hot or cold). Additionally, opportunistic (P. aeruginosa) or non-opportunistic (E. coli, coliforms) pathogens were significantly associated (p<0.05) with the presence of all Legionella species. Temperature also exhibited a positive effect to all pathogens tested except for Pseudomonas according to the linear model. Multivariate analysis showed that Pseudomonas, total coliforms, HPC and temperature had a statistically significant effect on the presence of Legionella. Based on a binomial model, cold water had a positive effect on Legionella. Type of sampling and proximity of the sample to the boiler seemed to pose different effect on Legionella depending on the cfu/L. The number of hotel stars and rooms did not appear to have any effect in all tested models.DiscussionCollectively, these results indicate the need for development of individualized water safety plans tailored by the presence of other microbiological agents, and unique physico-chemical factors, which could facilitate the survival of Legionella.in hotel water systems.https://www.frontiersin.org/articles/10.3389/fcimb.2023.1214717/fullLegionellawatermodelphysico-chemical agentsmicrobiological agents
spellingShingle Dimosthenis Chochlakis
Dimosthenis Chochlakis
Vassilios Sandalakis
Apostolos Ntoukakis
Maria-Olga Daskalaki
Thomas Loppinet
Niki Thalassinaki
Rena Makridaki
Christos Panoulis
Anna Psaroulaki
Anna Psaroulaki
Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete
Frontiers in Cellular and Infection Microbiology
Legionella
water
model
physico-chemical agents
microbiological agents
title Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete
title_full Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete
title_fullStr Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete
title_full_unstemmed Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete
title_short Multi-criterion analysis of the effect of physico-chemical microbiological agents on Legionella detection in hotel water distribution systems in Crete
title_sort multi criterion analysis of the effect of physico chemical microbiological agents on legionella detection in hotel water distribution systems in crete
topic Legionella
water
model
physico-chemical agents
microbiological agents
url https://www.frontiersin.org/articles/10.3389/fcimb.2023.1214717/full
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