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Applied and Environmental Microbiology, October 2005, p. 5805-5813, Vol. 71, No. 10
0099-2240/05/$08.00+0     doi:10.1128/AEM.71.10.5805-5813.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Legionella Contamination in Hot Water of Italian Hotels

Paola Borella,^1* Maria Teresa Montagna,² Serena Stampi,³ Giovanna Stancanelli,⁴ Vincenzo Romano-Spica,⁵ Maria Triassi,⁶ Isabella Marchesi,¹ Annalisa Bargellini,¹ Daniela Tatò,² Christian Napoli,² Franca Zanetti,³ Erica Leoni,³ Matteo Moro,⁴ Stefania Scaltriti,⁴ Gabriella Ribera D'Alcalà,⁶ Rosalba Santarpia,⁶ and Stefania Boccia⁷

Department of Hygiene, Microbiology and Biostatistics, University of Modena and Reggio E, Modena,¹ Department of Internal Medicine and Public Health, University of Bari, Bari,² Department of Public Medicine and Health, University of Bologna, Bologna,³ S. Raffaele Hospital, Milan,⁴ Department of Health Sciences, University Institute of Movement Sciences, Rome,⁵ Hygiene and Preventive Medicine Institute, University Federico II of Naples, Naples,⁶ Hygiene Institute, Catholic University in Rome, Rome, Italy⁷

Received 25 January 2005/ Accepted 13 May 2005

A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of 10³ CFU liter^–1, and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.

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* Corresponding author. Mailing address: Department of Hygiene and Microbiology, Via Campi, 287, I-41100 Modena, Italy. Phone: 39 059 2055474. Fax: 39 059 2055483. E-mail: borella.paola{at}unimore.it.

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Applied and Environmental Microbiology, October 2005, p. 5805-5813, Vol. 71, No. 10
0099-2240/05/$08.00+0     doi:10.1128/AEM.71.10.5805-5813.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

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