Survey of legionella water resources contamination in Iran and foreign countries: A Systematic Review

Abstract

Background and Aims: Several studies were investigated legionella contamination in natural and man- made water resources. The aim of this research was systematically review of legionella water contamination in natural and man-made resources in Iran and foreign countries. Materials and methods: In this systematic review study, the required data was collected using suitable keywords through PubMed, Science direct, Springer link, Google scholar, SID, Iranmedex, Irandoc and Magiran databases. Background and Aim: Several studies were investigated legionella contamination in natural and man- made water resources. The aim of this research was systematically review of legionella water contamination in natural and man-made resources. Materials and Methods: In this systematic review study, the required data was collected using suitable keywords through PubMed, Science direct, Springer link, Google scholar, SID, Iranmedex, Irandoc and Magiran databases. The search was conducted without publication date limitation. Survey and selection of articles was conducted based on PRISMA checklist and Cochrane quality assessment standards. Out of 1386 articles, 56 articles were considered after excluding the remaining articles which were not related to the study objectives. Identification and isolation of legionella with PCR technique and culture in BCYE is one of the article selection criteria. The relevant data were classified in extracted table and analyzed manually. Excel 2007 software was used for to draw diagrams. Due to heterogeneity of data meta-analysis could not be conducted.       Results: Out of 56 articles, 9 and 47 articles were published in Iran and foreign countries respectively. In Iran, 5.7-70% of samples were contaminated. In Iran’s hospitals 2.85-41.75% of samples were contaminated by Legionella pneumophila. In foreign countries, 0-100% of samples were contaminated and in these countries’ hospitals Legionella pneumophila contamination was 17%-98.7%. Conclusion: Although in Iran legionella water contamination is lower than foreign countries but, based on WHO guideline (1CFU/L) for legionella, planning for control of this bacteria and relevance infectious is one of the health priorities.   The search was conducted without publication date limitation. Survey and selection of articles was conducted based on PRISMA checklist and Cochrane quality assessment standards. Out of 1386 articles, 56 articles were considered after excluding the remaining articles which were not related to the study objectives. Identification and isolation of legionella with PCR technique and culture in BCYE is one of the article selection criteria. The relevant data were classified in extracted table and analyzed manually. Excel 2007 software was used for to draw diagrams. Due to heterogeneity of data meta-analysis could not be conducted. Results: Out of 56 articles, 9 and 47 articles were published in Iran and foreign countries respectively. In Iran, 5.7 - 70% of samples were contaminated. In Iran’s hospitals 2.85-41. 75% of samples were contaminated by Legionella pneumophila. In foreign countries, 0-100% of samples were contaminated and in these countries’ hospitals Legionella pneumophila contamination was 17%-98. 7%. Conclusion: The results of this study revealed that the conventional water treatment processes were not effective for legionella elimination and eradication of this agent should be considered in point off-use with effective techniques