Abstract
Pseudomonas aeruginosa is an important opportunistic pathogen in recreational waters and the primary cause of hot tub folliculitis and otitis externa. The aim of this surveillance study was to determine the background prevalence and antimicrobial resistance profile of P. aeruginosa in swimming pools and hot tubs. A convenience sample of 108 samples was obtained from three hot tubs and eight indoor swimming pools. Water and swab samples were processed using membrane filtration, followed by confirmation with polymerase chain reaction. Twenty-three samples (21%) were positive for P. aeruginosa, and 23 isolates underwent susceptibility testing using the microdilution method. Resistance was noted to several antibiotic agents, including amikacin (intermediate), aztreonam, ceftriaxone, gentamicin, imipenem, meropenem (intermediate), ticarcillin/clavulanic acid, tobramycin (intermediate), and trimethoprim/sulfamethoxazole. The results of this surveillance study indicate that 96% of P. aeruginosa isolates tested from swimming pools and hot tubs were multidrug resistant. These results may have important implications for cystic fibrosis patients and other immune-suppressed individuals, for whom infection with multidrug-resistant P. aeruginosa would have greater impact. Our results underlie the importance of rigorous facility maintenance, and provide prevalence data on the occurrence of antimicrobial resistant strains of this important recreational water-associated and nosocomial pathogen.
Highlights
Pseudomonas aeruginosa, an important Gram-negative opportunistic pathogen, is the primary cause of hot tub folliculitis, otitis externa, as well as the principal cause of morbidity and mortality in cystic fibrosis patients [1]
The findings of this study indicate that P. aeruginosa contamination is common in swimming pools and hot tubs, even where chlorine concentrations are well above recommended levels
The results of this study indicate that Pseudomonas aeruginosa can be regularly isolated from both swimming pools and hot tubs, with substantial prevalence
Summary
Pseudomonas aeruginosa, an important Gram-negative opportunistic pathogen, is the primary cause of hot tub folliculitis, otitis externa, as well as the principal cause of morbidity and mortality in cystic fibrosis patients [1]. P. aeruginosa frequently acquires additional resistance mechanisms (i.e., from plasmids) and routinely develops multidrug resistance throughout the course of a treatment regimen [4,5]. The overall prevalence of antibiotic resistant P. aeruginosa is increasing, with up to 10% of global isolates found to be multidrug-resistant [6]. This represents a major treatment challenge, as P. aeruginosa is the second leading cause of gram-negative nosocomial infections [7]
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