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New immunomagnetic separation method to analyze risk factors for Legionella colonization in health care centres

Journal of Exposure Science & Environmental Epidemiology volume 32, pages 744–750 (2022)Cite this article

Abstract

Background

It’s pivotal to control the presence of legionella in sanitary structures. So, it’s important to determine the risk factors associated with Legionella colonization in health care centres. In recent years that is why new diagnostic techniques have been developed.

Objective

To evaluate risks factors for Legionella colonization using a novel and more sensitive Legionella positivity index.

Methods

A total of 204 one-litre water samples (102 cold water samples and 102 hot water samples), were collected from 68 different sampling sites of the hospital water system and tested for Legionella spp. by two laboratories using culture, polymerase chain reaction and a method based on immunomagnetic separation (IMS). A Legionella positivity index was defined to evaluate Legionella colonization and associated risk factors in the 68 water samples sites. We performed bivariate analyses and then logistic regression analysis with adjustment of potentially confounding variables. We compared the performance of culture and IMS methods using this index as a new gold standard to determine if rapid IMS method is an acceptable alternative to the use of slower culture method.

Results

Based on the new Legionella positivity index, no statistically significant differences were found neither between laboratories nor between methods (culture, IMS). Positivity was significantly correlated with ambulatory health assistance (p = 0.05) and frequency of use of the terminal points. The logistic regression model revealed that chlorine (p = 0.009) and the frequency of use of the terminal points (p = 0.001) are predictors of Legionella colonization. Regarding this index, the IMS method proved more sensitive (69%) than culture method (65.4%) in hot water samples.

Significance

We showed that the frequency of use of terminal points should be considered when examining environmental Legionella colonization, which can be better evaluated using the provided Legionella positivity index. This study has implications for the prevention of Legionnaires’ disease in hospital settings.

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Fig. 1: Hot water temperature range on different terminal points.

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Data availability

Data are available from the authors upon reasonable request and with permission from the Hospital Clínico Universitario de Valencia.

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Acknowledgements

The authors would like to thank the staff of the following laboratories for their help in offering us the resources in running the water assays: Ambientalys (Laboratory 1), Iproma (Laboratory 2) and Anticimex. No sources of funding required.

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Authors and Affiliations

  1. Research group on Public Health and Patient Safety, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain

    Rafael Manuel Ortí-Lucas

  2. Department of Preventive Medicine, Hospital Clínico Universitario de Valencia, Valencia, Spain

    Rafael Manuel Ortí-Lucas & Eugenio Luciano

  3. Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain

    Eugenio Luciano

Authors
  1. Rafael Manuel Ortí-Lucas
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  2. Eugenio Luciano
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Contributions

RO is the principal investigator of the Public Health and Patient Safety Research Group at the Catholic University of Valencia. He directed the meetings and the preparation of this document. EL is the Co-I of this working group. Both authors contributed to the writing of the text. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Rafael Manuel Ortí-Lucas or Eugenio Luciano.

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This manuscript was approved by the Hospital Clínico Universitario de Valencia (Spain).

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Ortí-Lucas, R.M., Luciano, E. New immunomagnetic separation method to analyze risk factors for Legionella colonization in health care centres. J Expo Sci Environ Epidemiol 32, 744–750 (2022). https://doi.org/10.1038/s41370-022-00421-0

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