Peer-Reviewed Research Study

Hospitalizations Due to Selected Infections Caused by Opportunistic Premise Plumbing Pathogens and Reported Drug Resistance in the United States Older Adult Population

Elena N. Naumova, Alexander Liss, Jyotsna S. Jagai, Irmgard Behlau, Jeffrey K. Griffiths
Palgrave Macmillan, Journal of public health policy, September 2016

The study explores the health implications of opportunistic premise plumbing pathogens (OPPP) in US drinking water, particularly focusing on vulnerable populations like the elderly. These pathogens have gained attention due to the Flint Water Crisis, which exposed unresolved social, environmental, and public health issues related to changes in water source and treatment procedures. The study aims to understand the impact of OPPP, such as Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa, and highlights the need for improved monitoring and prevention.

Analyzing 108,202 hospitalization records from 1991 to 2006, the study reveals significant findings about OPPP-related hospitalizations among the elderly. Legionella pneumophila resulted in 7,933 cases of Legionnaires’ disease. Pseudomonas aeruginosa and gram-negative anaerobes contributed to 544,643 hospitalizations. Among non-tuberculous mycobacteria (NTM), pulmonary infection caused by Mycobacterium avium-intracellulare totaled 71% of the 48,854 cases. Reported drug resistance was observed in 1.68% of Pseudomonas infections, 1.05% of NTM infections, and 0.6% of Legionnaires’ disease cases. Drug resistance led to a 32.8% increase in Medicare charges. The estimated cost of Pseudomonas infections was $8.8 billion USD over 15 years, with a per-case differential payment of $14,510 for resistant cases.

The study highlights a substantial economic burden of OPPP-related hospitalizations in the elderly, with antibiotic resistance significantly impacting costs. There is an urgent need for enhanced identification, reporting, and prevention strategies for these pathogens in premise plumbing systems. The authors emphasize the importance of interdisciplinary collaboration and increased efforts in monitoring and regulatory measures to address the growing issue of OPPP infections. The study underscores the need for comprehensive research to mitigate the health risks posed by these pathogens in drinking water.

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