Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T04:38:06.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Characteristics of Pseudomonas aeruginosa Isolated From Whirlpools and Bathers

Published online by Cambridge University Press:  02 January 2015

Anita K. Highsmith ,
Phuong Nhan Le ,
Rima F. Khabbaz  and
Van P. Munn
Anita K. Highsmith*
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Service, Atlanta, Georgia
Phuong Nhan Le
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Service, Atlanta, Georgia
Rima F. Khabbaz
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Service, Atlanta, Georgia
Van P. Munn
Affiliation:
Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Service, Atlanta, Georgia
*
Nosocomial Infections Laboratory Branch, Hospital Infections Program, Center for Infections Diseases, Centers for Disease Control, Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Pseudomonas aeruginosa is the most frequently isolated microorganism from whirlpool water and lesions associated with outbreaks of dermatitis and folliculitis related to whirlpool exposure. Strains were selected from 19 outbreaks of P. aeruginosa infections (1977 to 1983) associated with whirlpool use; they were examined to determine if the strains possessed unique virulence factors or characteristics that might aid in their selection in the environment.

P. aeruginosa, 011, was the predominant serotype isolated from whirlpool water as well as from bathers with dermatitis or folliculitis, followed by serotypes 09, 04, and 03. Antimicrobial susceptibility patterns were similar for all strains. Strains of P. aeruginosa from bathers and water demonstrated statistically significant differences in extracellular enzyme production compared with control strains. P. aeruginosa, serotypes 09 and 011, were found to be sensitive to low levels of chlorine. These data suggest that, if adequate levels of free available chlorine are maintained, P. aeruginosa should have little opportunity to persist in whirlpools.

A bather's risk of P. aeruginosa dermatitis or folliculitis appears to be affected primarily by three factors: 1) immersion in water colonized by P. aeruginosa, 2) skin hydration with altered skin flora, and 3) toxic reactions to extracellular enzyme or exotoxins produced by P. aeruginosa. Although a single virulence factor was not identified from the results of this study, there are some indications that the enzymes produced by these microorganisms play an important role in the pathogenesis of disease associated with whirlpool use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 10 , October 1985 , pp. 407 - 412
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. McCausland, WJ, Cox, PJ: Pseudomonas infection traced to motel whirlpool. J Environ Health 1975;37:455–459.Google Scholar
2. Spitalny, KC, Vogt, RL, Wilherall, LE: National survey on outbreaks associated with whirlpool spas. Am J Public Health 1978;74:725–720.CrossRefGoogle Scholar
3. Jacobson, JA: Pool-associated Pseudomonas aeruginosa dermatitis and other bathing associated infections. Infect Control 1985;6:398–401.CrossRefGoogle ScholarPubMed
4. Khabbaz, RE, McKinley, TW, Goodman, RA, et al: Pseudomonas aeruginosa Serotype 0:9: New cause of whirlpool-associated dermatitis. Am J Med 1983;74:73–77.CrossRefGoogle Scholar
5. Gustafson, TL, Band, JD, Hutcheson, RH Jr et al: Pseudomonas folliculitis: An outbreak and review. Rev Infect Dis 1983;5:1–8.CrossRefGoogle ScholarPubMed
6. Mangione, EJ, Remis, RS, Tait, MA, et al: An outbreak of Pontiac fever related to whirlpool use—Michigan. 1982. JAMA 1985;253:535–539.CrossRefGoogle ScholarPubMed
7. Wilherall, LE, Orciari, LA, Spitalny, KC, et al: Isolation of Legionella pneumophila from recreational whirlpool spas. J Environ Health 1983;40:77–80.Google Scholar
8. Rose, HD. Franson, TR, Sheth, NK, et al: Pseudomonas pneumonia associated with use of a home whirlpool spa. JAMA 1983;250:2027–2029.CrossRefGoogle ScholarPubMed
9. Salmen, P, Dwyer, DM, Vorse, H, et al: Whirlpool-associated Pseudomonas aeruginosa urinary trad infections. JAMA 1983;250:2025–2020.CrossRefGoogle Scholar
10. Weaver, RK, Tatum, WW, Hollis, DG: The identification of unusual pathogenic Gram-negative bacteria (Elizabeth O. King) 1975. CDC, Atlanta, GA.Google Scholar
11. Hugh, R, Gilardi, GL: Pseudomonas, in Lennette, EH, Balows, A, Hausler, WJ Jr Truant, JP (eds). Manual of Clinical Microbiology. Washington, DC: American Society of Microbiology, 1980; pp 288–317.Google Scholar
12. Highsmith, AK, McGowan, JE Jr Wachsmuth, IK, et al: Use of multiple typing systems for P. aeruginosa from endemic bacteriuria. Proc Ann Ming. New Orleans, LA; American Society of Microbiology, 1983: L.-1. p 100.Google Scholar
13. Lanyi, B, Bergan, T: Serological characteristics of Pseudomonas aeruginosa , in Bergan, T, Norris, JR (eds). Methods in Microbiology. New York, Academic Press, Inc. 10:92–102.Google Scholar
14. Brokopp, CD, Gomer-Luz, R, Farmer, JJ III: Serological typing of Pseudomonas aeruginosa: Use of commercial antisera and live antigens. J Clin Microbiol 1977;5:640–649.CrossRefGoogle ScholarPubMed
15. Difco Laboratories. 1976. Technical Bulletin 0380. Detroit, MI. pp 1–4.Google Scholar
16. Gilles, RR, Govan, JW: Typing of Pseudomonas pyocyanea by pyocin production. Journal of Pathology and Bacteriology 1900;91:339–345.CrossRefGoogle Scholar
17. Govan, JW: Pyocin typing of Pseudomonas aeruginosa , in Norris, JR. Bergan, T (eds). Methods in Microbiology. Vol. 10, New York, Academic Press.Google Scholar
18. Bauer, AW, Kirby, WM, Sherris, JC, et al: Antibiotic susceptibility testing by a standard single disc method. Am J Clin Pathol 1900;45:493–490.CrossRefGoogle Scholar
19. National Committee for Clinical Laboratory Standards. Performance Standards for antimicrobic discs susceptibility tests. 1979. Villanova, PA 19085.Google Scholar
20. National Committee for Clinical Laboratory Standards. First Supplement: M2-A25. Performance standards for antimicrobic discs susceptibility tests. Villanova, PA. 1981:1(6).Google Scholar
21. Bernheimer, AW: Cytolytic toxins of bacterial origin. Science 1968;45: 847–851.CrossRefGoogle Scholar
22. Fisher, E, Allen, JH: Mechanism of corneal destruction by Pseudomonas protease. Am J Ophthalmol 1958;40:249–255.CrossRefGoogle Scholar
23. Homma, JY: Roles of exoenzymes and endotoxin in the pathogenicity of Pseudomonas aeruginosa and the development of a new vaccine. Jpn J Exp Med 1980;14:55–60.Google Scholar
24. Janda, JM, Bottono, EJ: Pseudomonas aeruginosa enzyme profiling: Predictor of potential invasiveness and use as an epidemiological tool. J Clin Microbiol 1981;14:55–60.CrossRefGoogle ScholarPubMed
25. Johnson, GG, Morris, JM, Berk, RS: The role of extracellular protease from Pseudomonas aeruginosa in its pathogenesis. J Infect Dis 1966;116:112–116.Google Scholar
26. Liu, PV: Extracellular toxins of Pseudomonas aeruginosa . J Infect Dis 1974;130:S94–S90.CrossRefGoogle ScholarPubMed
27. Liu, PV: The roles of various fractions of Pseudomonas aeruginosa in its pathogenesis: Effects of lecithinase and protease in its pathogenesis. J Infect Dis 1966;112–110.CrossRefGoogle ScholarPubMed
28. Liu, PV: Survey of hemolysin production among species of Pseudomonas . J Bacteriol 1957;74:718–727.CrossRefGoogle Scholar
29. Sbarre, AJ, Gifellan, RF, Bardawil, WA: A plate assay of elastase. Nature (London) 1960;188:322–333.CrossRefGoogle Scholar
30. Smith, FR, Willett, NP: Rapid plate method for screening hyaluronidase and chondroitin sulfatase-producing microorganism. Applied Microbiology 1968;46:1434–1436.CrossRefGoogle Scholar
31. Sokol, PA, Ohman, DE, Iglewski, B: A more sensitive plate assay for the detection of protease production by Pseudomonas aeruginosa . J Clin Microbiol 1979;9:438–440.CrossRefGoogle Scholar
32. American Public Health Association, American Water Works Association. Water Pollution Control Federation. Standard Methods for the Examination of Water and Wastewater. 15 ed. Am Public Health Assn 1981, New York.Google Scholar
33. Favero, MS: Whirlpool spa-associated infections: Are we in really hot water? As J Public Health 1984;74:653–654.Google Scholar
34. Bobo, RA, Newton, EJ, Jones, LF. et al: Nursery outbreak of Pseudomonus aeruginosa: Epidemiological conclusions from five different typing methods. Applied Microbiology 1973;25:414–420.CrossRefGoogle Scholar
35. Centers for Disease Control. Suggested health and safety guidelines for public spas and hot tubs, DHHS-CDC #99-900 1981, revised 1985. United States Government Printing Office, Washington, DC.Google Scholar
36. Highsmith, AK, Favero, MS: Microbiologic aspects of public whirlpool, Clinical Microbiology Newsletter Jan. 15, 1985, pp 9–11.Google Scholar