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Int. J. Environ. Res. Public Health 2018, 15(12), 2666;

Occurrence of Antibiotic-Resistant Bacteria in Therapy Pools and Surrounding Surfaces

Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764 Oberschleißheim, Germany
Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
Author to whom correspondence should be addressed.
Received: 4 October 2018 / Revised: 13 November 2018 / Accepted: 21 November 2018 / Published: 27 November 2018
(This article belongs to the Special Issue Recreational Water Illnesses)
PDF [1617 KB, uploaded 27 November 2018]


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. View Full-Text
Keywords: antibiotic resistance; hydrotherapy; pool; water; treatment; transfer antibiotic resistance; hydrotherapy; pool; water; treatment; transfer

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Koeck, D.E.; Huber, S.; Hanifi, N.; Köster, M.; Schierling, M.B.; Höller, C. Occurrence of Antibiotic-Resistant Bacteria in Therapy Pools and Surrounding Surfaces. Int. J. Environ. Res. Public Health 2018, 15, 2666.

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