Abstract
The number of patients colonized with antibiotic-resistant bacteria is increasing in health care facilities. Because transmission of antibiotic-resistant bacteria is feared, there exist reports that the affected patients are frequently excluded from hydrotherapy, which is a non-invasive and beneficial treatment used for patients with different diseases. Data from the literature suggest that deficient water disinfection measures exist, which are not always sufficient to kill all released bacteria. If the pool water is not disinfected properly, it may also infect the bathers. Immunocompromised patients are particularly susceptible to be infected with (antibiotic-resistant) bacteria. In order to determine the distribution of antibiotic-resistant bacteria in the pool water treatment system and the pool environment and to estimate the associated transmission risk we analyzed samples from eleven health care facilities. Antibiotic-resistant bacteria were found in the water and surface samples collected. One hundred and two antibiotic-resistant isolates from water samples and 307 isolates from surrounding surfaces were obtained, respectively. The majority of the isolates belonged to non-fermenting Gram-negative rods, like Pseudomonas spp. Some isolates were resistant to a wide range of the tested antibiotics. The results indicate a relation between the number of isolates in water samples and the number of patients using the pools in combination with deficiencies in water treatment. In the pool environment the highest number of isolates was obtained from barefoot areas and floor cleaning equipment.
Highlights
Emerging and increasing antibiotic microbial resistance (AMR) represents one major threat to human health in Europe and worldwide
Pool water and balance tank water samples were collected from a depth of 30 cm, at a point about 40 cm away from the basin edge, filtrate was taken from a sampling tap, and filter backwash water was taken directly before the drain
The filtrate should only be investigated in case of problems with the pool water
Summary
Emerging and increasing antibiotic microbial resistance (AMR) represents one major threat to human health in Europe and worldwide. Resistance to antibiotics is widely distributed among. Gram-positive and Gram-negative bacteria that may cause serious infections in humans, and AMR is increasing in the EU, especially among Gram-negative bacteria. The major drivers behind the occurrence and spread of AMR are the use of antimicrobial agents and the transmission of antibiotic-resistant microorganisms between humans; between animals; and between humans, animals, and the environment [1]. Bacteria that are resistant to three or more classes of antibiotics are called multidrug-resistant. Infections with these bacteria are associated with increased morbidity, mortality, length of hospitalization, and financial costs [2]. Methicillin-resistant Staphylococcus aureus (MRSA) have been the main point of concern in public health, but during the last couple of years extended-spectrum-ß-lactamase (ESBL)–producing bacteria have become a much more severe problem
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