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Rasheduzzaman, Md; Singh, Rajveer; Haas, Charles N.; Gurian, Patrick L.
Water research (Oxford), 09/2020, Volume: 182Journal Article
Legionella spp. occurring in hotel hot water systems, in particular Legionella pneumophila, are causing serious pneumonic infections, and water temperature is a key factor to control their occurrence in plumbing systems. We performed a systematic review and meta-analyses of the available evidence on the association between water temperature and Legionella colonization to identify the water temperature in hotel hot water systems required for control of Legionella. Qualitative synthesis and quantitative analysis were performed on 13 studies that met our inclusion criteria to identify the effect of temperature. The Receiver Operating Characteristic (ROC) curve identified 55 °C as a cutoff point for hotel hot water temperature with an Area Under the Curve (AUC) value of 0.914. The odds ratios (OR) for detecting Legionella at temperatures >55 °C compared to lower temperatures from a meta-analysis of three studies was 0.17 95% CI: 0.11, 0.25, which indicates a strong negative association between temperature and Legionella colonization. A logistic regression on results from multiple studies using both molecular and culture methods found a temperature of 59 °C associated with an 8% probability of detectable Legionella. Only two studies reported sufficiently detailed data to allow a model of concentration vs. temperature to be fit, and this model was not statistically significant. Additional research or more detailed reporting of existing datasets is required to assess if Legionella growth can be limited below particular concentration targets at different temperatures. Display omitted •A systematic review of the association between temperature and Legionella in hotels.•The effects of temperature to control Legionella were identified.•55 °C to 59 °C was identified as likely to reduce Legionella to non-detectable levels.•Species of Legionella has a minimal impact, but analytical method affects results.•Identified temperature can be used to calculate the water heater temperature.
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