Risk Assessment of Pseudomonas aeruginosa in Water

  • Kristina D. MenaEmail author
  • Charles P. Gerba
Part of the Reviews of Environmental Contamination and Toxicology book series (RECT, volume 201)


Pseudomonads are a large group of free-living bacteria that live primarily in soil, seawater, and fresh water. They also colonize plants and animals, and are frequently found in home and clinical settings. Pseudomonads are highly versatile and can adapt to a wide range of habitats, and can even grow in distilled water. This adaptability accounts for their constant presence in the environment. They have an extensive impact on ecology, agriculture, and commerce. They are responsible for food spoilage and degradation of petroleum products and materials. In agriculture, pseudomonads rank among the most important plant pathogens. In normal healthy humans, they are responsible for eye and skin diseases. They also cause serious life-threatening illnesses in burn and surgical patients and in immunocompromised individuals. Contamination of recreational waters and tap water has been associated with outbreaks of Pseudomonas; however, the relative role water plays in the transmission of this bacterium to humans is still unclear. The goal of this review is to assess existing literature on the potential risks associated with waterborne Pseudomonas aeruginosa.


Cystic Fibrosis Patient Skin Infection Swimming Pool Otitis Externa Recreational Water 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adlard PA, Kirov SM, Sanderson K, Cox GE (1998)Pseudomonas aeruginosa as a cause of infectious diarrhea. Epidemiol Infect 121:237–241.Google Scholar
  2. Agger WA, Mardan A (1995)Pseudomonas aeruginosa infections of intact skin. Clin Infect Dis 20:302–308.Google Scholar
  3. Aksamit TR (1992)Pseudomonas pneumonia and bacteremia in the immunocompromised patient. In: Fick R (ed)Pseudomonas aeruginosa– The opportunist pathogenesis and disease. CRC, Boston, MA, pp. 177–180.Google Scholar
  4. Allen MJ, Geldreich EE (1975) Bacteriological criteria for groundwater quality. Ground Water 13:45–52.Google Scholar
  5. Alonso JL, Garay E, Hernandez E (1989) Membrane filter procedure for enumeration of Pseudomonas aeruginosa in water. Water Res 23:1499–1502.Google Scholar
  6. Amromin GD, Solomon RD (1962) Necrotizing enteropathy a complication of treated leukemia or lymphoma patients. JAMA 182:23–29.Google Scholar
  7. Anaissie, EJ, Penzak SR, Dignani MC (2002) The hospital water supply as a source of nosocomial infections. Arch Intern Med 162:1483–1492.Google Scholar
  8. Angel C, Patrick CC, Lobe T, Rao B, Pui CH (1991) Management of anorectal/perineal infections caused by Pseudomonas aeruginosa in children with malignant diseases. J Pediatr Surg 26:487–492.Google Scholar
  9. Anon (1994)Pseudomonas. In: Holt JG, Krieg NR, Sneath PHA, Staley JT, Williams ST (eds) Bergey’s manual of determinative bacteriology, 9th Ed. Williams and Wilkins, Baltimore, MD, pp. 93–94.Google Scholar
  10. Artenstein A, Cross A (1993) Local and disseminate diseases caused by Pseudomonas aeruginosa. In: Campa M, Bendinelli M, Friedman H (eds)Pseudomonas aeruginosa as an opportunistic pathogen. Plenum, New York, NY, pp. 223–239.Google Scholar
  11. Asboe D, Gant V, Aucken HM (1998) Persistence of Pseudomonas aeruginosa strains in respiratory infection in AIDS patients. AIDS 12:1771–1775.Google Scholar
  12. Aspinall ST, Graham R (1989) Two sources of contamination of a hydrotherapy pool by environmental organisms. J Hosp Infect 14:285–292.Google Scholar
  13. Baumgartner A, Grand M (2006) Bacteriological quality of drinking water from dispensers (coolers) and possible control measures. J Food Protect 69:3043–3046.Google Scholar
  14. Berk R, Brown D, Coutinho I, Meyers D (1987) In vivo studies with two phospholipase C fractions from Pseudomonas aeruginosa. Infect Immun 55:1728–1730.Google Scholar
  15. Bert F, Maubec E, Bruneau B, Berry P, Lambert-Zeeovsky N (1998) Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 39:53–62.Google Scholar
  16. Bishop JF, Schimpff SC, Diggs CH, Wiernik PH (1981) Infections during intensive chemotherapy for non-Hodgkin’s lymphoma. Ann Intern Med 95:549–555.Google Scholar
  17. Bobo RA, Newton EJ, Jones LF (1973) Nursery outbreak of Pseudomonas aeruginosa: Epidemiological conclusions from five different typing methods. Appl Microbiol 25:414–420.Google Scholar
  18. Bodey G, Bolivar R, Fainstein V, Jadeja L (1983) Infections caused by Pseudomonas aeruginosa. Rev Infect Dis 5:279–313.Google Scholar
  19. Bodey GP, Jadeja L, Elting L (1985)Pseudomonas bacteremia: Retrospective analysis of 410 episodes. Arch Intern Med 145:1621–1629.Google Scholar
  20. Botzenhart K, Doring G (1993) Ecology and epidemiology of Pseudomonas aeruginsoa. In: Campa M, Bendinelli M, Friedman H (eds)Pseudomonas aeruginosa as an opportunistic pathogen. Plenum, New York, NY, pp. 3–8.Google Scholar
  21. Botzenhart K, Kufferath R (1976) On the growth of various Enterobacteriaceae, Pseudomonas aeruginosa, and Alkaligenes spp. in distilled water, de-ionized water, tap water and mineral salt solution. Zbl Bakt Hyg I Abt Orig B 163:470–485.Google Scholar
  22. Box JA, Sugden JK, Younis NMT (1982) The use of ultraviolet light to sterilize water. Pharm Acta Helv 57:330–333.Google Scholar
  23. Brett J, du Vivier A (1985)Pseudomonas aeruginosa and whirlpools. Br Med J 290:1024–1025.Google Scholar
  24. Broadbent C (1996) Guidence on water quality for heated spas. South Australian Health Commission, National Environmental Health Forum, Rundle Mall, South Australia.Google Scholar
  25. Bryan CS, Reynolds KL (1984) Bacteremic nosocomial pneumonia. Analysis of 172 episodes from a single metropolitan area. Am Rev Respir Dis 129:668–671.Google Scholar
  26. Buck AC, Cooke EM (1969) The fate of ingested Pseudomonas aeruginosa in normal persons. J Med Microbiol 2:521–525.Google Scholar
  27. Buttery JP, Alabaster SJ, Heine RG, Scott SM, Cruchfield, RA, Bigham A, Tabrizi SN, Garland SM (1998) Multiresistant Pseudomonas aeruginosa in a pediatric oncology ward related to bath toys. Pediatr Infect Dis 17:509–513.Google Scholar
  28. Calderon R, Mood EW (1982) An epidemiological assessment of water quality and swimmer’s ear. Arch Environ Health 37:300–305.Google Scholar
  29. Carson LA, Favero MS, Bond WW, Petersen NJ (1972) Factors affecting comparative resistance of naturally occurring and subcultured Pseudomonas aeruginosa to disinfectants. Appl Microbiol 23:863–869.Google Scholar
  30. Celis R, Torres A, Gatell J, Alnela M (1988) Nosocomial pneumonia: A multivariate analysis of risk and prognosis. Chest 93:318–322.Google Scholar
  31. Chaidez C, Rusia P, Naranjo J, Gerba CP (1999) Microbiological quality of water vending machines. Int J Environ Health Res 9:197–206.Google Scholar
  32. Chao WL, Ding RJ, Chen RS (1987) Survival of pathogenic bacteria in environmental microcosms. Chin J Microbial Immunol 20:339–348.Google Scholar
  33. Chernick N, Armstrong D, Posner JB (1973) Central nervous system infections in patients with cancer. Medicine 52:563–581.Google Scholar
  34. Clark JA, Burger CA, Sabatinos LE (1982) Characterization of indicator bacteria in municipal raw water, drinking water, and new main water samples. Can J Microbiol 28:1002–1013.Google Scholar
  35. Cliver DO, Newman RA, Cortruvo JA (1987) Drinking water microbiology. J Environ Pathol Toxicol Oncol 7:1–365.Google Scholar
  36. Craun GF, Calderon RL, Craun MF (2005) Outbreaks associated with recreational water in the United States. Int J Environ Health Res 15:243–262.Google Scholar
  37. Davies DG, Parsek MR, Pearson JP (1998) The involvement of cell-to-cell-signals in the development of a bacterial biofilm. Science 280:295–298.Google Scholar
  38. de Vicente A, Aviles M, Borrego JJ, Romero P (1988) Die-off and survival of Pseudomonas aeruginosa in freshwater. Zbl Bakt Hyg B 185:534–547.Google Scholar
  39. de Victoria J, Galvan M (2001)Pseudomonas aeruginosa as an indicator of health risk in water for human consumption. Water Sci Technol 43:49–52.Google Scholar
  40. Dembry LM, Zervos MJ, and Hierholzer WJ (1998) Nosocomial bacterial infections. In: Evans AS, Brachman PS (eds) Bacterial infections of humans: Epidemiology and control, 3rdEd. Plenum Medical Book Company, New York, NY, pp. 509–511.Google Scholar
  41. Dinapoli R, Thomas J (1971) Neurologic aspects of malignant external otitis: Report of three cases. Mayo Clin Proc 46:339–344.Google Scholar
  42. Doring G, Bareth H, Gairing A (1989) Genotyping of Pseudomonas aeruginosa sputum and stool isolates from cystic fibrosis patients: Evidence for intestinal colonization and spreading into toilets. Epidemiol Infect 103:555–564.Google Scholar
  43. Doring G, Ulrich M, Muller W (1991) Generation of Pseudomonas aeruginosa aerosols during hand washing from contaminated sink drains, transmission to hands of hospital personnel, and its prevention by use of a new heating device. Zbl Hyg 191:494–505.Google Scholar
  44. Doring G, Horz M, Ortelt J, Grupp H, Wolz C (1993) Molecular epidemiology of Pseudomonas aeruginosa in an intensive care unit. Epidemiol Infect 110:427–436.Google Scholar
  45. Duquino HH, Rosenberg FA (1986) Antibiotic-resistant Pseudomonas in bottled drinking water. Can J Microbiol 33:286–289.Google Scholar
  46. Eng R, Bishburg E, Smith S (1986) Bacteremia and fungemia in patients with acquired immune deficiency syndrome. Am J Clin Pathol 86:105–107.Google Scholar
  47. Ensign PR, Hunter CA (1946) An epidemic of diarrhea in the newborn nursery caused by a milk-borne epidemic in the community. J Pediatr 29:620–628.Google Scholar
  48. EU (1995) Proposal for Council Directive concerning the quality of water intended for human consumption. Com (94) 612 Final 131:5–24.Google Scholar
  49. Evans MR, Wilkinson EJ, Jones R, Mathias K, Lenartowicz P (2003) Presumed Pseudomonas folliculitis outbreak in children following an outdoor games event. Commun Dis Public Health 6:18–21.Google Scholar
  50. Faden H (1998) Monthly prevalence of Group A, B, and G i types E and F, and Pseudomonas aeruginosa nasopharyngeal colonization in the first two years of life. Pediatr Infect Dis J 17:255–256.Google Scholar
  51. Fagon JY, Cahstre J, Domart Y (1989) Nosocomial analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 139:877–884.Google Scholar
  52. Falcao DP, Leite CQF, Silva MJ (1993) Microbiological quality of recreational waters in Araraquara, SP, Brazil. Sci Total Environ 128:37–49.Google Scholar
  53. Farmer III JJ (1995) Enterobacteriaceae: Introduction and identification. In: Murray PR (editor-in-chief) Manual of clinical microbiology, 6th Ed. ASM, Washington, DC, p. 443.Google Scholar
  54. Farrell PM, Shen G, Splaingard M (1997) URL:
  55. Favero M, Carson L, Bond W, Petersen N (1971)Pseudomonas aeruginosa: Growth in distilled water from hospitals. Science 173:836–838.Google Scholar
  56. Fernandez RO, Pizarro RA (1996) Lethal effect induced in Pseudomonas aeruginosa exposed to ultraviolet-A radiation. Photochem Photobiol 64:334–339.Google Scholar
  57. Ferroni A, Nguyen L, Pron B, Quesne G, Brusset MC, Berche P (1998) Oubreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a pediatric surgical unit associated with tap-water contamination. J Hosp Infect 39:301–307.Google Scholar
  58. Fick RB (1992)Pseudomonas aeruginosa– the microbial hyena and its role in disease: An introduction. In: Fick R (ed)Pseudomonas aeruginosa– The opportunist pathogenesis and disease. CRC, Boston, MA, pp. 1–4.Google Scholar
  59. Fierer J, Taylor PM, Gezon HM (1967)Pseudomonas aeruginosa epidemic traced to delivery-room resuscitators. N Engl J Med 276:991–996.Google Scholar
  60. Fitzgerald G, DerVartanian M (1969)Pseudomonas aeruginosa for the evaluation of swimming pool chlorination and algicides. Appl Environ Microbiol 17:415–421.Google Scholar
  61. Fletcher EL, Fleiszig SMJ, Brennan NA (1993) Lipopolysaccharide in adherence of Pseudomonas aeruginosa to the cornea and contact lenses. Invest Ophthalmol Visual Sci 34:1930–1935.Google Scholar
  62. Flores G, Stavola JJ, Noel GJ (1993) Bacteremia due to Pseudomonas aeruginosa in children with AIDS. Clin Infect Dis 16:706–708.Google Scholar
  63. Fong I, Tomkins B (1985) Review of Pseudomonas aeruginosa meningitis with special treatment with ceftazidime. Rev Infect Dis 7:604–612.Google Scholar
  64. Fotedar R, Banerjee U, Shriniwas S (1993) Vector potential of the German cockroach in dissemination of Pseudomonas aeruginosa. J Hosp Infect 23:55–59.Google Scholar
  65. Friend PA, Newsom SWB (1986) Bacterial resistance to antiseptics and disinfectants. J Hosp Infect 7:213–225.Google Scholar
  66. Gambassini L, Sacco C, Lanciotti E (1990) Microbial quality of the water in the distribution system of Florence. Aqua 39:258–264.Google Scholar
  67. Garibaldi RA (1985) Epidemiology of community-acquired respiratory tract infections in adults. Am J Med 78(Suppl. 6B):32–37.Google Scholar
  68. Geldreich EE (1996) Microbial quality of water supply in distribution systems. CRC, Boca Raton, FL, NY, p. 293.Google Scholar
  69. George SE, Kohan MJ, Walsh DB, Claxton LD (1989a) Acute colonization study of polychlorinated biphenyl-degrading Pseudomonads in the mouse intestinal tract: Comparison of single and multiple exposures. Environ Toxicol Chem 8:123–131.Google Scholar
  70. George SE, Walsh DB, Stead AG, Claxton LD (1989b) Effect of ampicillin-induced alterations in murine intestinal microbiota on the survival and competition of environmentally released pseudomonads. Fund Appl Toxicol 13:670–680.Google Scholar
  71. George SE, Kohan MJ, Whitehouse DA (1991) Distribution, clearance, and mortality of environmental Pseudomonads in mice upon intranasal exposure. Appl Environ Microbiol 57:2420–2425.Google Scholar
  72. Gerba CP, Gerba P (1998) Outbreaks caused by Pseudomonas aeruginosa associated with whirlpool spas, hot tubs, and swimming pools. Proceedings of the second annual chemistry symposium national spa and pool institute. National spa and pool institute, Alexandria, VA, pp. 8–18.Google Scholar
  73. Gilligan P (1995)Pseudomonas and Burkholderia. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken, RH (eds) Manual of clinical microbiology, 6thEd. ASM, Washington, DC, pp. 509–519.Google Scholar
  74. Gilligan PH, Lum G, VanDamme PAR, Whittier S (2003)Burkholderia, Stenotrophomonas, Ralstonia, Brevundimonas, Comamonas, Delftia, Pandoraea, and Acidivorax. In: Murray PR, Baron EJ, Jorgesen JH (eds) Manual of clinical microbiology, 8th Ed. ASM, Washington, DC, pp. 729–748.Google Scholar
  75. Goldman M, Rosenfel-Yehoshua N, Lerner-Geva L, Lazarovitch T, Schwartz D, Grisaru-Soen G (2008) Clinical features of community-acquired Pseudomonas aeruginosa urinary tract infections in children. Pediatr Nephrol 23:765–768.Google Scholar
  76. Green SK, Schroth MN, Cho JJ, Kominos SD, Vitanza-Jack VB (1974) Agricultural plants and soil as a reservoir for Pseudomonas aeruginosa. Appl Microbiol 28:987–991.Google Scholar
  77. Greenman RL, Schein RMH, Martin MA (1991) A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 266:1097–1102.Google Scholar
  78. Gregory DW, Schaffner W (1987)Pseudomonas infections associated with hot tubs and other environments. Infect Dis Clinics North Am 1:635–648.Google Scholar
  79. Grundmann H, Kropec A, Hartung D, Berner R, Daschner F (1993)Pseudomonas aeruginosa in a neonatal intensive care unit: Reservoirs and ecology of the nosocomial pathogen. J Infect Dis 168:943–947.Google Scholar
  80. Hajjartabar M (2004) Poor-quality water in swimming pools associated with substantial risk of otitis externa due to Pseudomonas aeruginosa. Water Sci Technol 50:63–67.Google Scholar
  81. Hall J, Callaway J, Tindall J, Smith J (1968)Pseudomonas aeruginosa in dermatology. Arch Dermatol 97:312–323.Google Scholar
  82. Hambsch B, Sacre C, Wagner I (2004) Heterotrophic plate count and consumer’s health under special consideration of water softeners. Int J Food Microbiol 92:365–373.Google Scholar
  83. Hardalo C, Edberg SC (1997)Pseudomonas aeruginosa: Assessment of risk from drinking water. Clin Rev Microbiol 23:47–75.Google Scholar
  84. Hentges DJ, Stein AJ, Casey SW, Que JU (1985) Protective role of intestinal flora against infection with Pseudomonas aeruginosa in mice: Influence of antibiotics on colonization resistance. Infect Immun 47:118–122.Google Scholar
  85. Hewitt DJ, Weeks DA, Millner, Huss RG (2006) Industrial Pseudomonas folliculitis. Am J Ind Med 49:895–899.Google Scholar
  86. Highsmith AK, Abshire RL (1975) Evaluation of a most-probable-number technique for the enumeration of Pseudomonas aeruginosa. Appl Microbiol 30:596–601.Google Scholar
  87. Highsmith AK, Le PN, Khabbaz RF, Munn VP (1985) Characteristics of Pseudomonas aeruginosa isolated form whirlpools and bathers. Infect Control 6:407–412.Google Scholar
  88. Hoadley AW (1977) Potential health hazards associated with Pseudomonnas aeruginosa in water. In: Hoadley AW, Dutka BJ (eds) Bacterial indicators/health hazards associated with water. American Society of Testing Materials, Philadelphia, PA, pp. 80–114.Google Scholar
  89. Holder I (1993)Pseudomonas aeruginosa virulence-associated factors and their role in burn wound infections. In: Fick R (ed)Pseudomonas aeruginosa– The opportunist pathogenesis and disease. CRC, Boston, MA, p. 242.Google Scholar
  90. Hollyoak V, Boyd P, Freman R (1994) Whirlpool baths in nursing homes: Use, maintenance, and contamination with Pseudomonas aeruginosa. Commun Dis Rep CDR Rev 5:R102–R104.Google Scholar
  91. Hollyoak V, Allison D, Summers J (1995)Pseudomonas aeruginosa wound infection associated with a nursing home’s whirlpool bath. Commun Dis Rep CDR Rev 5:R100–R102.Google Scholar
  92. Hopkins RS, Abbott DO, Wallace LE (1981) Follicular dermatitis outbreak caused by Pseudomonas aeruginosa associated with a motel’s indoor swimming pool. Public Health Rep 96:246–249.Google Scholar
  93. Huang HI, Shih HY, Lee CM, Yang TC, Lay JJ, Lin YE (2008) In vitro efficacy of copper and silver ions in eradicating Pseudomonas aeruginosa, Stenotrophomonas maltophilat, and Acinetobacter baumannii: Implications for on-site disinfection for hospital infection control. Water Res 42:73–80.Google Scholar
  94. Hudson PJ, Vogt RL, Jillson DA (1985) Duration of whirlpool use as a risk factor for Pseudomonas dermatitis. Am J Epidemiol 122:915–917.Google Scholar
  95. Hunter CA, Ensign PR (1947) An epidemic of diarrhea in a new-born nursery caused by Pseudomonas aeruginosa. Am J Public Health 37:1166–1169.Google Scholar
  96. Insler MS, Gore H (1986)Pseudomonas keratitis and folliculitis from whirlpool exposure. Am J Ophthalmol 101:41–43.Google Scholar
  97. Jacobs RF, McCarthy RE, Elser JM (1989)Pseudomonas osteochondritis complicating puncture wounds of the foot in children: A 10-year evaluation. J Infect Dis 160:657–661.Google Scholar
  98. Jacobson JA (1985) Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections. Infect Control 6:398–401.Google Scholar
  99. Kersters K, Ludwig W, Vancanneyt M, De Vos P, Gillis M, Schleifer K-H (1996) Recent changes in the classification of the pseudomonads: An overview. Syst Appl Microbiol 19:465–477.Google Scholar
  100. Khabbaz RF, McKinley TW, Goodman RA, Hightower AW, Highsmith AK, Tait KA, Band JD (1983)Pseudomonas aeruginosa serotype 0:9 new cause of whirlpool-associated dermatitis. Am J Med 74:73–77.Google Scholar
  101. Kiehn TE (1989) Bacteremia and fungemia in the immunocompromised patient. Eur J Clin Microbiol Infect Dis 8:832–837.Google Scholar
  102. Kielhofner M, Atmar R, Hamill R, Musher D (1992) Life-threatening Pseudomonas aeruginosa infections in patients with human immunodeficiency virus infection. Clin Infect Dis 14:403–411.Google Scholar
  103. Kolter R, Losick R (1998) One for all and all for one. Science 280:226–227.Google Scholar
  104. Kominos SD, Copeland CE, Grosiak B, Postic B (1972) Introduction of Pseudomonas aeruginosa into a hospital via vegetables. Appl Microbiol 24:567–570.Google Scholar
  105. Kreger BE, Craven DE, Carling PC, McCabe WR (1980) Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med 68:332–343.Google Scholar
  106. Kush BJ, Hoadley AW (1980) A preliminary survey of the association of Pseudomonas aeruginosa with commercial whirlpool bath waters. Am J Pub Health 70:279–281.Google Scholar
  107. Lermi A, Cunha BA (1998)Pseudomonas aeruginosa arterial line infection. Am J Infect Control 26:538.Google Scholar
  108. Levesque B, Simard P, Gauvin D (1994) Comparison of the microbiological quality of water coolers and that of municipal water systems. Appl Environ Microbiol 60:1174–1178.Google Scholar
  109. Losonsky GA, Hasan JAK, Huq A (1994) Serum antibody responses of divers to waterborne pathogens. Clin Diag Lab Immunol 1:182–185.Google Scholar
  110. Manaia CM, Nunes OC, Morais PV, da Costa MS (1990) Heterotrophic plate counts and the isolation of bacteria from mineral waters on selective and enrichment media. J Appl Bacteriol 69:871–876.Google Scholar
  111. Marrie TJ (1994) Community-acquired pneumonia. Clin Infect Dis 18:501–515.Google Scholar
  112. Martins MT, Sato MIZ, Alves MN, Stoppe NC, Prado VM, Sanchez PS (1995) Assessment of microbiologic quality for swimming pools in South America. Water Res 29:2417–2420.Google Scholar
  113. McClausland, WJ, Cox PJ (1975) Pseudomonas infection traced to motel whirlpool. J Environ Health 37:455–459.Google Scholar
  114. McCubbin M, Fick RB (1992) Pathogenesis of Pseudomonas lung disease in cystic fibrosis. In: Fick R (ed)Pseudomonas aeruginosa– The opportunist pathogenesis and disease. CRC, Boston, MA, pp. 189–192.Google Scholar
  115. McGowan JE, Barnes MW, Finland M (1975) Bacteremia at Boston City Hospital: Occurrence and mortality during 12 selected years (1935–1972), with special reference to hospital acquired cases. J Infect Dis 132:316–335.Google Scholar
  116. McManus AT, Mason AD, McManus WF, Pruitt BA (1985) Twenty-five year review of Pseudomonas aeruginosa bacteremia in a burn center. Eur J Clin Microbiol 4:219–223.Google Scholar
  117. Mendelson M, Gurtman A, Szabo S, (1994)Pseudomonas aeruginosa bacteremia in patients with AIDS. Clin Infect Dis 18:886–895.Google Scholar
  118. MMWR (1979) Rash associated with use of whirlpools – Maine. Morb Mortal Wkly Rep 28:182–184.Google Scholar
  119. MMWR (1983) An outbreak of Pseudomonas folliculitis associated with a waterslide – Utah. Morb Mortal Wkly Rep 32:425–427.Google Scholar
  120. Molina DN, Colon M, Bermudez RH, Ramirez-Ronda CH (1991) Unusual presentation of Pseudomonas aeruginosa infections: A review. Bol Asoc Med P R 83:160–163.Google Scholar
  121. Moreira L, Agostinho P, Morals PV, da Costa MS (1994) Survival of allochthonous bacteria in still mineral water bottled in polyvinyl chloride (PVC) and glass. J Appl Bacteriol 77:334–339.Google Scholar
  122. Muyldermans G, de Smet F, Pierard D, Steenssens L, Stvens D, Bougatef A, Lauwers S (1998) Neonatal infections with Pseudomonas aeruginosa associated with a water-bath used to thaw fresh frozen plasma. J Hosp Infect 39:309–314.Google Scholar
  123. Noble RC, Overman SB (1994) Pseudomonas stutzeri infection. A review of the literature. Diagn Microbiol Infect Dis 19:51–56.Google Scholar
  124. Ollstein R, McDonald C (1980) Topical and systemic antimicrobial agents in burns. Ann Plast Surg 5:386–392.Google Scholar
  125. Papapetropoulou M, Iliopoulou J, Rodopoulou G (1994) Occurrence of antibiotic-resistance of Pseudomonas species isolated from drinking water in southern Greece. J Chemother 6:111–116.Google Scholar
  126. Payment P, Gamache F, Paquette G (1988) Microbiological and virological analysis of water from two water filtration plants and their distribution systems. Can J Microbiol 34:1304–1309.Google Scholar
  127. Pellett S, Bigley DV, Grimes DJ (1983) Distribution of Pseudomonas aeruginosa in a riverine ecosystem. Appl Environ Microbiol 45:328–332.Google Scholar
  128. Pollack M (1995)Pseudomonas aeruginosa. In: Mandell GL, Bennett JE, Colin R (eds) Principles and practice of infectious diseases, 4th Ed. Churchill Livingstone, New York, NY, pp. 1980–2003.Google Scholar
  129. Porco FV, Visconte EB (1995)Pseudomonas aeruginosa as a cause of infectious diarrhea successfully treated with oral ciprofloxacin. Ann Pharmacother 29:1122–1123.Google Scholar
  130. Price D, Ahearn D (1988) Incidence and persistence of Pseudomonas aeruginosa in whirlpools. J Clin Microbiol 26:1650–1654.Google Scholar
  131. Pyle B, McFeters G (1989) Iodine sensitivity of bacteria isolated from iodinated water systems. Can J Microbiol 35:520–523.Google Scholar
  132. Ramphal R, McNiece M, Pollack F (1981) Adherence of Pseudomonas aeruginosa to the injured cornea: A step in the pathogenesis of corneal infections. Ann Ophthalmol 13:421–425.Google Scholar
  133. Ratnam S, Hogan K, March SB, Butler RW (1986) Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: Report of an outbreak and review. J Clin Microbiol 23:655–659.Google Scholar
  134. Reid TMS, Porter IA (1981) An outbreak of otitis externa in competitive swimmers due to Pseudomonas aeruginosa. J Hyg Camb 86:357–362.Google Scholar
  135. Reisler RB, Blumberg H (1999) Community-acquired Pseudomonas stutzeri vertebral osteomyelitis in a previously healthy patient: Case report and review. Clin Infect Dis 29:667–669.Google Scholar
  136. Reitler R, Seligmann R (1957)Pseudomonas aeruginosa in drinking water. J Appl Bacteriol 20:145–150.Google Scholar
  137. Relai D, Rosati S (1994) Antibiotic susceptibility and serotyping of Pseudomonas aeruginosa strains isolated form surface waters, thermomineral waters and clinical specimens. Zbl Hyg 196:75–80.Google Scholar
  138. Remington J, Schimpff S (1981) Please don’t eat the salads. N Eng J Med 304:433–435.Google Scholar
  139. Restaino L, Frampton EW, Hemphill JB, Palnikar P (1995) Efficacy of ozonated water against various food-related microorganisms. Appl Environ Microbiol 61:3471–3475.Google Scholar
  140. Roberts LA, Collignon PJ, Cramp VB, Alexander S, McFarlane AE, Graham E, Fuller A, Sinickas V, Hellyar A (1990) An Australia-wide epidemic of Pseudomonas picketti bacteraemia due to contaminated “sterile” water for injection. Med J Aust 152:652–655.Google Scholar
  141. Rogues AM, Boulestreau H, Lasheras A, Boyer A, Gruson D, Merle C, Casting Y, Bebear CM, Gachie JP (2007) Contribution of tap water to patient colonization with Pseudomonas aeruginosa in a medical intensive care unit. J Hosp Infect 67:72–78.Google Scholar
  142. Rose HD, Franson TR, Sheth NK, (1983)Pseudomonas pneumonia associated with use of a home whirlpool spa. JAMA 250:2027–2031.Google Scholar
  143. Rusin PA, Rose JB, Haas CN, Gerba CP (1997) Risk assessment of opportunistic bacterial pathogens in drinking water. Rev Environ Contam Toxicol 152:57–83.Google Scholar
  144. Rusin P, Orosz-Coughlin P, Gerba C (1998) Reduction of faecal coliform, coliform and heterotrophic plate count bacteria in the household kitchen and bathroom by disinfection with hypochlorite cleaners. J Appl Microbiol 85:819–828.Google Scholar
  145. Salahuddin N, Madhavan T, Fisher E (1973)Pseudomonas osteomyelitis. Radiologic features. Radiology 109:41–47.Google Scholar
  146. Salmen P, Dwyer DM, Vorse H, Kruse W (1983) Whirlpool-associated Pseudomonas aeruginosa urinary tract infections. JAMA 250:2025–2026.Google Scholar
  147. Saroff A, Armstrong D, Johnson W (1973)Pseudomonas endocarditis. Am J Cardiol 32:234–237.Google Scholar
  148. Sausker WF (1978)Pseudomonas folliculitis acquired from a health spa whirlpool. JAMA 239:2362–2365.Google Scholar
  149. Schillinger J, Du Vall Knorr, S (2004) Drinking-water quality and issues associated with water vending machines in the city of Los Angeles. J Environ Health 66:25–31.Google Scholar
  150. Schimpff SC, Wiernik PH, Block JB (1972) Rectal abscesses in cancer patients. Lancet 2:844–847.Google Scholar
  151. Seyfried PL, Cook RJ (1984) Otitis externa infections related to Pseudomonas aeruginosa levels in five Ontario lakes. Can J Public Health 75:83–91.Google Scholar
  152. Shehabi AA, Masoud H, Maslamani FA (2005) Common antimicrobial resistance patterns, biotypes and serotypes found among Pseudomonas aeruginosa from patient’s stool and drinking water sources in Jordan. J Chemother 17:179–183.Google Scholar
  153. Shekar R, Rice T, Zierdt C, Kallick C (1985) Outbreak of endocarditis caused by Pseudomonas aeruginosa serotype 011 among pentazocine and tripelnnamine abusers in Chicago. J Infect Dis 151:203–208.Google Scholar
  154. Shelley AW, Deeth HC, MacRae IC (1987) A numerical taxonomy study of psychrotrophic bacteria associated with lipolytic spoilage of raw milk. J Appl Bacteriol 62:197–207.Google Scholar
  155. Shigemura K, Arakawa S, Sakai Y, Kinoshita S, Tanaka K, Fujisawa M (2006) Complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution (1999–2003). Int J Urol 13:538–542.Google Scholar
  156. Shooter RA (1971) Bowel colonization of hospital patients by Pseudomonas aeruginosa and Escherichia coli. Proc R Soc Med 64:27–28.Google Scholar
  157. Shooter RA, Gaya H, Cooke EM, Kumar P, Patel N (1969) Food and medicaments as possible sources of hospital strains of Pseudomonas aeruginosa. Lancet 1:1227–1229.Google Scholar
  158. Silvestry-Rodriquez N, Sicairos-Ruelas AE, Gerba CP, Bright KR (2007a) Silver as a disinfectant. Rev Environ Contam Toxicol 191:23–45.Google Scholar
  159. Silvestry-Rodriquez N, Bright KR, Uhlmann DR, Slack DC, Gerba CP (2007b) Inactivation of Pseudomonas aeruginosa and Aeromonas hydrophila by silver in tap water. J Environ Sci Health 42:1579–1584.Google Scholar
  160. Solomon SL (1985) Host factors in whirlpool-associated Pseudomonas aeruginosa skin disease. Infect Control 6:402–405.Google Scholar
  161. Springer GL, Shapiro ED (1985) Fresh water swimming as a risk factor for otitis externa: A case–control study. Arch Environ Health 40:202–206.Google Scholar
  162. Stone HH, Kolb LD, Geheber CE (1979) Bacteriologic considerations in perforated necrotizing enterocolitis. South Med J 72:1540–1543.Google Scholar
  163. Sundheim, Sletten GA, Dainty RH (1998) Identification of pseudomonads from fresh and chill-stored chicken carcasses. Int J Food Microbiol 39:185–194.Google Scholar
  164. Tamagnini LM, Gonzalez RD (1997) Bacteriological stability and growth kinetics of Pseudomonas aeruginosa in bottled water. J Appl Microbiol 83:91–94.Google Scholar
  165. Tancrede CH, Andremont AO (1985) Bacterial translocation and gram-negative bactremia in patients with hematological malignancies. J Infect Dis 152:99–103.Google Scholar
  166. Thomas P, Moore M, Bell E (1985)Pseudomonas dermatitis associated with a swimming pool. JAMA 253:1156–1159.Google Scholar
  167. Torres A, Aznar R, Gatell JM (1990) Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 142:523–528.Google Scholar
  168. Torres A, Serra-Batelles J, Ferrer A (1991) Severe community-acquired pneumonia. Am Rev Respir Dis 144:312–318.Google Scholar
  169. Traill ZC, Miller RF, Ali N, Shaw PJ (1996)Pseudomonas aeruginosa bronchopulmonary infection in patients with advanced human immunodeficiency virus disease. Br J Radiol 69:1099–1103.Google Scholar
  170. Trautmann M, Leppper PM, Haller M (2005) Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism. Am J Infect Control 33:S41–S49.Google Scholar
  171. Trautmann M, Halder S, Josef H, Hilde R Haller M (2008) Point-of-use water filtration reduces endemic Pseudomonas aeruginosa infections on a surgical intensive care unit. Am J Infect Control 36:421–429.Google Scholar
  172. Tredget EE, Shankowsky HA, Joffe AM, Inkson TI, Volpel K, Paranchych W, Kibsey PC, Alton JD, Burke JF (1992) Epidemiology of infections with Pseudomonas aeruginosa in burn patients: The role of hydrotherapy. Clin Infect Dis 15:941–949.Google Scholar
  173. van Asperen IA, de Rover CM, Schijven JF (1995) Risk of otitis externa after swimming in recreational fresh water lakes containing Pseudomonas aeruginosa. Br Med J 311:407–410.Google Scholar
  174. van der Kooij D, Oranje JP, Hijnen WAM (1982) Growth of Pseudomonas aeruginosa in tap water in relation to utilization of substrates at concentrations of a few micrograms per liter. Appl Environ Microbiol 44:1086–1095.Google Scholar
  175. Vanholder R, Vanhaecke E, Ringoir S (1990) Waterborne Pseudomonas septicemia. ASAIO Trans 36:M215–M216.Google Scholar
  176. Vess R, Anderson R, Carr J (1993) The colonization of solid PVC surfaces and the acquisition of resistance to germicides by water microorganisms. J Appl Bacteriol 74:215–221.Google Scholar
  177. Vianelli N, Giannini MB, Quarti C, Sabattini MAB, Fiacchini M, de Vivo A, Graldi P, Galli S, Nanetti, Baccarani M, Ricci P (2006) Resolution of Pseudomonas aeruginosa outbreak in a hematology unit with the use of disposable sterile water filters. Haematologica 91:983–985.Google Scholar
  178. Warburton DW, Dodds KL, Burke R (1992) A review of the microbiological quality of bottled water sold in Canada between 1981 and 1989. Can J Microbiol 38:12–19.Google Scholar
  179. Warburton DW, Bowen B, Konkle A (1994) The survival and recovery of Pseudomonas aeruginosa and its effect upon Salmonellae in water: Methodology to test bottled water in Canada. Can J Microbiol 40:987–992.Google Scholar
  180. Ward NR, Wolfe RL, Olson BH (1984) Effect of pH, application technique, and chlorine-to-nitrogen ratio on disinfectant activity of inorganic chloramines with pure culture bacteria. Appl Environ Microbiol 48:508–514.Google Scholar
  181. Washburn J, Jacobson JA, Marston E, Thorsen B (1976)Pseudomonas aeruginosa rash associated with a whirlpool. JAMA 235:2205–2207.Google Scholar
  182. Weber G, Werner HP, Matshnigg H (1971)Pseudomonas aeruginosa im Trinkwaqsser als Todesursache bei Neugeborenen. Zbl Bakt I Abt Orig 216:210–214.Google Scholar
  183. Whimbey E, Gold JWM, Polsky B (1986) Bacteremia and fungemia in patients with the acquired immunodeficiency syndrome. Ann Intern Med 104:511–514.Google Scholar
  184. Wiesseman G, Wood V, Kroll L (1973)Pseudomonas vertebral osteomyelitis in heroin addicts. Report of five cases. J Bone Joint Surg 55:1416–1424.Google Scholar
  185. Williams DE, Worley SD, Wheatley WB, Swango LJ (1985) Bactericidal properties of a new water disinfectant. Appl Environ Microbiol 49:637–643.Google Scholar
  186. Witt DJ, Craven DE, McCabe WR (1987) Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex. Am J Med 82:900–906.Google Scholar
  187. Wolfe RL (1990) Ultraviolet disinfection of potable water. Environ Sci Technol 24:768–773.Google Scholar
  188. Zichichi L, Asta G, Noto G (2000)Pseudomonas aeruginosa follicultis after shower/bath exposure. Int J Dematol 39:270–273.Google Scholar
  189. Ziegler EJ, Fisher CJ, Sprung CL (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against toxin. N Eng J Med 324:429–436.Google Scholar

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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.University of Texas – Houston School of Public HealthHoustonUSA

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