Browse > Article
http://dx.doi.org/10.7845/kjm.2013.3089

Meta-Analysis of Risk Factors for Contamination of Environmental Waters by Legionella  

Zo, Young-Gun (Department of Biology, Kyungsung University)
Publication Information
Korean Journal of Microbiology / v.49, no.4, 2013 , pp. 424-428 More about this Journal
Abstract
To identify risk factors for Legionella contamination, water quality variables routinely measured in examination of natural and city waters were meta-analyzed for significance of correlation to Legionella incidences. For evaluation of abundance of Escherichia coli as a risk factor, which is currently used as an indicator of Legionella contamination in an official guideline in Korea, odds ratio (OR) of above-cutoff total coliform counts for Legionella presence/absence was used as the effect size in the meta-analysis. The OR was estimated as 1.05 (0.36-3.12, 95% CI), and the probability of having identical odds reached 0.92. Also, ORs from individual studies showed significant heterogeneity (P=0.008), which contributed to 63% of total variance of the ORs. In the case of heterotrophic plate count (HPC), the OR for Legionella presence/absence was 2.72 (2.04-3.63) with highly significant deviation from identical odds (P<0.0001). ORs from different studies were seemingly homogeneous ($Q_{df=8}$=12.7, P=0.12). Turbidity and concentrations of chlorine, iron ion and cupper ion were other routine variables that could be considered as risk factors. However, statistical measures from different studies were not uniform enough to develop an appropriate effect size while the number of studies reporting the variables was also small (3-5). In conclusion, HPC appeared to be appropriate as indicator of Legionella contamination, rather than fecal bacteria contamination. HPC may imply abundance of habitats (amoebas and biofilms) of Legionella in water. This result warrants further studies for standardizing protocols and cutoff values to infer Legionella risks from HPC.
Keywords
Legionella; heterotrophic plate count; indicator; meta-analysis; water quality;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Kim, K.Y., Kim, Y.S., Song, J.C., Lee, S.J., Kim, S.U., Choi, T.Y., Park, W.S., and Lee, C.M. 2003. Comparison of methods for identification and the effects on Legionella pneumophila of the cooling towers in Seoul. J. Korean Soc. Occup. Environ. Hyg. 13, 1-19.
2 Lee, I.S. and Zo, Y.G. 2013. Quantitative microbiological risk analysis of Legionella infection of children from recreational activities in interactive fountains. Korean J. Microbiol. submitted.
3 Ministry of Environment Korea. 2010. Guideline for Management of Water Quality in Interactive Waterscape Facilities.
4 Mouchtouri, V., Velonakis, E., Tsakalof, A., Kapoula, C., Goutziana, G., Vatopoulos, A., Kremastinou, J., and Hadjichristodoulou, C. 2007. Risk factors for contamination of hotel water distribution systems by Legionella species. Appl. Environ. Microbiol. 73, 1489-1492.   DOI   ScienceOn
5 Park, H.K., Jung, E.Y., Jung, J.M., and Yu, P.J. 2007. Detection and distribution of bacterial pathogens in raw water and during water treatment process by polymerase chain reaction. J. Life Sci. (Korea) 17, 1374-1380.   과학기술학회마을   DOI   ScienceOn
6 Qin, T., Yan, G., Ren, H., Zhou, H., Wang, H., Xu, Y., Zhao, M., Guan, H., Li, M., and Shao, Z. 2013. High prevalence, genetic diversity and intracellular growth ability of Legionella in hot spring environments. PLoS One 8, e59018.   DOI
7 Reasoner, D.J. 2004. Heterotrophic plate count methodology in the United States. Int. J. Food Microbiol. 92, 307-315.   DOI   ScienceOn
8 Sartory, D.P. 2004. Heterotrophic plate count monitoring of treated drinking water in the UK: a useful operational tool. Int. J. Food Microbiol. 92, 297-306.   DOI   ScienceOn
9 Serrano-Suarez, A., Dellunde, J., Salvado, H., Cervero-Arago, S., Mendez, J., Canals, O., Blanco, S., Arcas, A., and Araujo, R. 2013. Microbial and physicochemical parameters associated with Legionella contamination in hot water recirculation systems. Environ. Sci. Pollut. Res. Int. 20, 5534-5544.   DOI   ScienceOn
10 Viechtbauer, W. 2010. Conducting meta-analyses in R with the metafor package. J. Stat. Software 36, 1-48.
11 Diederen, B.M.W. 2008. Legionella spp. and Legionnaires' disease. J. Infect. 56, 1-12.   DOI   ScienceOn
12 Allen, M.J., Edberg, S.C., and Reasoner, D.J. 2004. Heterotrophic plate count bacteria?-what is their significance in drinking water? Int. J. Food Microbiol. 92, 265-274.   DOI   ScienceOn
13 Bargellini, A., Marchesi, I., Righi, E., Ferrari, A., Cencetti, S., Borella, P., and Rovesti, S. 2011. Parameters predictive of Legionella contamination in hot water systems: association with trace elements and heterotrophic plate counts. Water Res. 45, 2315-2321.   DOI   ScienceOn
14 Borenstein, M., Hedges, L., Higgins, J., and Rothstein, H. 2005. Comprehensive Meta-Analysis. Biostat, Englewood, NJ, USA.
15 CDC Korea. 2012. Guideline for Management of Legionnaires' Disease. Center for Disease Control and Prevention, Korea, Osong, Korea.
16 Cho, K.S., Kim, S.B., Park, D.S., Ahn, T.Y., and Yu, B.C. 2011. Development of Surveillance Technology for Harmful Microorganisms in Environments under Climate Change. National Institute of Environemental Research Korea, Incheon, Korea.
17 Edagawa, A., Kimura, A., Doi, H., Tanaka, H., Tomioka, K., Sakabe, K., Nakajima, C., and Suzuki, Y. 2008. Detection of culturable and nonculturable Legionella species from hot water systems of public buildings in Japan. J. Appl. Microbiol. 105, 2104-2114.   DOI   ScienceOn
18 Hsu, B.M., Chen, C.H., Wan, M.T., and Cheng, H.W. 2006. Legionella prevalence in hot spring recreation areas of Taiwan. Water Res. 40, 3267-3273.   DOI   ScienceOn
19 Hsu, B.M., Lin, C.L., and Shih, F.C. 2009. Survey of pathogenic free-living amoebae and Legionella spp. in mud spring recreation area. Water Res. 43, 2817-2828.   DOI   ScienceOn
20 Huang, S.W., Hsu, B.M., Ma, P.H., and Chien, K.T. 2009. Legionella prevalence in wastewater treatment plants of Taiwan. Water Sci. Technol. 60, 1303-1310.   DOI   ScienceOn