Authors:
Masoud KhajezadehCellular and Molecular Gerash Research Center, Gerash University of Medical Sciences, Gerash, Iran

Search for other papers by Masoud Khajezadeh in
Current site
Google Scholar
PubMed
Close
,
Fatemeh MohseniDepartment of Anesthesiology, Nursing School, Gerash University of Medical Sciences, Gerash, Iran
Department of Medical Education, Medical School, Tehran University of Medical Sciences, Tehran, Iran

Search for other papers by Fatemeh Mohseni in
Current site
Google Scholar
PubMed
Close
,
Azad KhalediInfectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

Search for other papers by Azad Khaledi in
Current site
Google Scholar
PubMed
Close
, and
Arezoo FiroozehDepartment of Microbiology, Mashhad University of Medical Sciences, Mashhad, Iran

Search for other papers by Arezoo Firoozeh in
Current site
Google Scholar
PubMed
Close
Open access

Abstract

This review aimed to evaluate the contamination rate of dental unit waterlines (DUWL) with Pseudomonas aeruginosa and Legionella pneumophila in several countries in the Middle East.

Literature search was conducted in databases such as PubMed, Scopus, Web of Science, and Google Scholar to gather studies published from the beginning of 2000 to 30th April 2020. Medical Subject Headings (MeSH) terms were; “Legionellosis”; “Legionnaire”, “Legionellosis”, “L. pneumophila”, “dent”, “dental”, “dentistry”, “Dental Unit Waterlines”, “dental water”, “DUWL”, “Middle East”, “P. aeruginosa”, “Iran”, “Turkey”, “Iraq”, and “Jordan”. The search was independently conducted by two of the authors. Data was analyzed using Comprehensive Meta-Analysis software.

Almost all studies included in this review reported a high rate of bacterial contamination of DUWL, which exceeded the current standard bacterial contamination level of <200 (CFU) mL−1 recommended by the American Dental Association (ADA). The combined prevalence of L. pneumophila from four countries (Iran, Jordan, Turkey, and Iraq) was 23.5% (95% Cl: 6.5–57.7), and the combined prevalence of P. aeruginosa was reported 21.7% (95% Cl: 7.1–50.1%).

This study showed a high bacterial contamination rate of DUWL with opportunistic pathogens. So, it is recommended to prevent biofilm formation in DUWL, some measures should be extended by practical approaches allowing for water quality control and improvement on-site in the dental practices such as mobile filtration units, chlorination and disinfection chemicals.

Abstract

This review aimed to evaluate the contamination rate of dental unit waterlines (DUWL) with Pseudomonas aeruginosa and Legionella pneumophila in several countries in the Middle East.

Literature search was conducted in databases such as PubMed, Scopus, Web of Science, and Google Scholar to gather studies published from the beginning of 2000 to 30th April 2020. Medical Subject Headings (MeSH) terms were; “Legionellosis”; “Legionnaire”, “Legionellosis”, “L. pneumophila”, “dent”, “dental”, “dentistry”, “Dental Unit Waterlines”, “dental water”, “DUWL”, “Middle East”, “P. aeruginosa”, “Iran”, “Turkey”, “Iraq”, and “Jordan”. The search was independently conducted by two of the authors. Data was analyzed using Comprehensive Meta-Analysis software.

Almost all studies included in this review reported a high rate of bacterial contamination of DUWL, which exceeded the current standard bacterial contamination level of <200 (CFU) mL−1 recommended by the American Dental Association (ADA). The combined prevalence of L. pneumophila from four countries (Iran, Jordan, Turkey, and Iraq) was 23.5% (95% Cl: 6.5–57.7), and the combined prevalence of P. aeruginosa was reported 21.7% (95% Cl: 7.1–50.1%).

This study showed a high bacterial contamination rate of DUWL with opportunistic pathogens. So, it is recommended to prevent biofilm formation in DUWL, some measures should be extended by practical approaches allowing for water quality control and improvement on-site in the dental practices such as mobile filtration units, chlorination and disinfection chemicals.

Introduction

The microbial quality of water in dental unit water systems (DUWL) is highly important to prevent the exposure of dentists, dental staff, and patients to contaminated water aerosols produced by these units [1]. Dental unit water systems consist of several long nylon or polyvinyl chloride pipes with a small diameter. When water flow becomes stagnant in these pipes for a long time, biofilm formation on the inner surface of water lines is facilitated [2], leading to bacterial contamination and infections [3]. According to the guidelines of the American Dental Association (ADA), DUWL should contain no more than 200 colony-forming units (CFU) mL−1 [4].

Pseudomonas aeruginosa and Legionella pneumophila are commonly found in dental unit waterlines [5]. According to reports, dentists, dental staff, and the patients referring to dental clinics are exposed to a higher risk of bacterial and viral infections and consequently higher rates of respiratory disorders compared to the general public [6]. It is believed that a significant ratio of respiratory infections in dentists is due to the large production of aerosols during the scaling process [6, 7].

It appears that the hospital water system contaminated with endemic Legionella is the main source of nosocomial legionellosis resulting from the inhalation of contaminated water aerosols from water sources [8, 9]. Legionella spp. are responsible for about 3–8% of all community-acquired pneumonias (CAP), and particularly, 85% of these pneumonias are attributed to L. pneumophila [10].

Generally, Pseudomonas spp. are not causative agents for oral infections; however, patients with cystic fibrosis and immunodeficiency have a higher susceptibility to pulmonary infections caused by P. aeruginosa, which an important route of its transmission is via the aerosols produced during dentistry procedures [11, 12]. Hence, water quality monitoring in dental clinics is vital for the early identification of Legionella and other microorganisms and preventing the infections raised by these microorganisms.

Objective

There is no comprehensive review on the contamination rate of DUWL with microbial agents in the Middle East. Considering the critical importance of this issue, we decided to explore the contamination rate of DUWL with P. aeruginosa and L. pneumophila in a number of Middle East countries through systematic review and meta-analysis.

Methods

Data sources and search strategy

Literature search was conducted in the databases of PubMed, Scopus, Web of Science, and Google Scholar to gather the studies published from the beginning of 2000 to 30th April 2020. Medical Subject Heading (MeSH) terms and text words were; “Legionellosis”, “Legionnaire”, “Legionnaires disease”, “Legionellosis”, “Legionella”, “L. pneumophila”, “dent, dental”, “dentist”, “dentistry”, “Dental Unit Waterlines”, “dental water”, “DUWL”, “Middle East”, “P. aeruginosa”, “P. aeruginosa”, “Iran”, “Turkey”, “Iraq”, and “Jordan”. The search was independently conducted by two of the authors.

Study eligibility criteria

We focused on the studies reporting the contamination rate of DUWL with L. pneumophila and P. aeruginosa, published from the beginning of 2000 to 30th April 2020. Only the studies that used standard diagnostic methods for the microorganisms were included. The studies conducted before 2000 and those employing substandard methods were excluded. Case reports, case series, conference papers, and abstracts were also excluded.

Quality assessment

For quality assessment of the studies, in addition to eligibility criteria, was used the Critical Appraisal Skills Programme (CASP) checklist for cross-sectional studies (www.casp-uk.net) [13].

Data extraction

Two authors extracted the data, including the following items: the family name of the first author, publication year, time of study conduction, setting (s), sample size, the prevalence of Legionella spp., L. pneumophila, Pseudomonas spp., and P. aeruginosa, and diagnostic techniques.

Statistical analysis

Statistical analysis was performed using Comprehensive Meta-Analysis software (Version 3.3.070). The random effect method was used to estimate the overall prevalence of Pseudomonas and Legionella. Statistical heterogeneity among the selected studies was explored using the Q2 test and the I2 statistic. The I2 value of >50% or a P-value of <0.05 were considered as a sign of significant heterogeneity among the studies. As well, the Egger regression test and funnel plot were used for assessing publication bias.

Results

Characteristics of the studies included

In total, 1738 studies were obtained through literature searching. After removing duplicates, 245 additional studies were excluded upon reading the abstracts, titles, and full-texts. Finally, 10 studies were selected for systematic review and meta-analysis. Four out of the 10 studies were from Turkey, three from Iraq, two from Iran, and one from Jordan. No studies from other Middle Eastern countries met our inclusion criteria. The studies included in the present review used phenotypic methods, such as buffered charcoal yeast extract (BCYE), cetrimide agar, the oxidase test, molecular testing such as polymerase chain reaction (PCR), and also, direct fluorescent antibody assay and the ELISA technique to identify microorganisms (Table 1).

Table 1.

Characteristics extracted from included studies

First author (s)Study timePublicationLocationSample sizeLegionella spp.Legionella pneumophilaPseudomonas spp.Pseudomonas aeruginosaTechnique
P. Ghalyani [6]2015Iran5054PCR, Culture in Cetrimide agar, and oxidase test
B. Ajami [14]20092012Iran5219ELISA test
A.A. Taher [7]2015–162017Iraq9434BCYE, PCR, Culture in Cetrimide agar, and oxidase test
Z. S. Alsehlawi [33]20162016Iraq949BCYE, PCR, Culture in Cetrimide agar, and oxidase test
S. R. Oleiwi [15]2017Iraqi5211Culture
SY. Ma'ayeh [16]2008Jordan3026BCYE, Culture in Cetrimide agar, and oxidase test
A. Uzel [1]20072008Turkey2007622BCYE
D. Goksay [3]2008Turkey59014BCYE, Culture in Cetrimide agar, and oxidase test
D. Gungor [18]2014Turkey1000133BCYE, latex agglutination

Kit, Culture in Cetrimide agar, and oxidase test
E. Bodrumlu [17]2007Turkey710BCYE, Direct fluorescent antibody assay

Abbreviations: PCR; polymerase chain reaction, BCYE; buffered charcoal yeast extract

Total viable count (TVC)

Legionella was present at the concentration of 312 CFU/100 mL or greater [B Ajami et al. [14]], and bacteria were present at a concentration between 50 and 90 CFU/100 mL [RS Oleiwi et al. [15]]. The count of L. pneumophila in the samples obtained from DUWL ranged between 0 and 8.3 × 103 (CFU) mL−1 [SY Ma'ayeh et al. [16]]. Also, samples from DUWL were contaminated with bacteria beyond 200 CFU mL−1 [E Bodrumlu et al. [17], Dogruöz Güngör et al. [18], Duygu Göksay et al. [3], and A Uzel et al. [1]]. The detailed microbial contamination data of DUWL have been summarized in Table 2.

Table 2.

Total viable count (TVC) used in the studies included in the present review

First authorExplanations
P. Ghalyani [6]
B. Ajami [14]
  • Legionella was present at concentrations of 312 CFU/100 mL or greater

A.A. Taher [7]
Z. S. Alsehlawi [33]
S. R. Oleiwi [15]
  • 50–90 CFU/100 mL

SY. Ma'ayeh [16]
  • The counts of Legionella pneumophila obtained from the DUWL samples ranged between 0 and 8.3 × 103 (CFU) mL−1

A. Uzel [1]
  • All three types of water samples obtained from 20 units were found to have higher TVC values than EU guidelines

D. Göksay [3]
  • All of high-speed drill (range 370–52,240 (CFU) mL−1) and 90% of oral rinsing cup (range 183–119,117 (CFU) mL−1) exceed American Dental Association (ADA) standard for dental unit water

D. Güngör [18]
  • It was found that 37 out of 50 output waters (range 2–58,533 (CFU) mL−1) and 18 out of 50 input waters (range 1–28,111 (CFU) mL−1) exceeded the ADA's limit of 200 (CFU) mL−1 in DUWL

E. Bodrumlu [17]
  • 27% of the dental unit water samples were contaminated with bacteria above 200 (CFU) mL−1

Abbreviations: CFU; colony forming unit, ADA; american dental association, TVC; total viable count

Overall effects

Combined prevalence of L. pneumophila

The prevalence of L. pneumophila reported by the studies reviewed varied between 0 and 86.7%. The combined prevalence of L. pneumophila in four countries (Iran, Jordan, Turkey, and Iraq) was obtained at 23.5% (95% Cl: 6.5–57.7, Z = 1.5, P = 0.001, Q = 53.6, I2 = 92.5, t = 0.13, P = 0.89) (Fig. 1, Table 3). The visual assessment of the relevant funnel plot showed the presence of publication bias among the studies (Fig. 2), but the Egger regression test revealed no publication bias (P = 0.89).

Fig. 1.
Fig. 1.

Forest plot of meta-analysis on the Legionella pneumophila (top image), and Pseudomonas aeruginosa (below image) isolated from dental unit waterlines

Citation: European Journal of Microbiology and Immunology 12, 4; 10.1556/1886.2022.00023

Table 3.

Overall effects of resulted from included studies

Overall effectsNumber of studiesHeterogeneity testEgger's testRandom model
Prevalence (95% CI) (%)ZPQPI2TP
Legionella pneumophila523.5% (6.5–57.7)1.50.0053.60.0092.50.130.89
Pseudomonas aeruginosa510.3 (4.7–20.9)50.0028.50.0085.90.020.98
Fig. 2.
Fig. 2.

Funnel plot of meta-analysis on the Legionella pneumophila (top image), and Pseudomonas aeruginosa (below image) isolated from dental unit waterlines

Citation: European Journal of Microbiology and Immunology 12, 4; 10.1556/1886.2022.00023

Combined prevalence of P. aeruginosa

The prevalence of P. aeruginosa in the selected studies varied between 3% and 23.7%. The combined prevalence of P. aeruginosa in four countries (Iran, Jordan, Turkey, and Iraq) was obtained at 21.7% (95% Cl: 7.1–50.1%), Z = 1.95, P = 0.051, Q = 42,105, I2 = 90.5, t = 0.16, P = 0.87) (Fig. 1, Table 3). The results of funnel plot analysis suggested the presence of publication bias among the studies (Fig. 2); however, this was not confirmed by the Egger regression test (P = 0.87).

Discussion

The ADA has recommended an allowable standard for the contamination of DUWL with aerobic mesophilic bacteria as no more than 200 (CFU) mL−1 [4]. In the present study, Legionella was detected at the concentration of 312 CFU/100 mL or greater [14], and the concentration of 50–90 CFU/100 mL in one of studies included in the present review [15]. In another study, the count of L. pneumophila in DUWL samples ranged between 0 and 8.3 × 103 (CFU) mL−1 [16]. As well, all of the three studies conducted in Turkey showed that DUWL samples were contaminated with bacteria at concentrations >200 (CFU) mL−1[1, 3, 17]. These results were in line with the findings of a study conducted in seven European countries evaluating the microbiological profile of DUWL in general dentistry offices reporting that the microbial content of the water supplied by 51% of DUWL exceeded the current ADA-recommended bacterial contamination threshold (i.e. <200 (CFU) mL−1) [19]. Compared with our findings, different studies have reported high microbial contamination rates above the ADA's standard who reported the contamination rates of 96%, and 63.1%, respectively [20, 21].

Our systematic review and meta-analysis on the studies included showed that the prevalence of L. pneumophila in DUWL varied from 0 to 86.7%. The combined prevalence of L. pneumophila in DUWL samples from four countries (Iran, Jordan, Turkey, and Iraq) was obtained at 23.5%. The prevalence of P. aeruginosa in DUWL samples varied between 3% and 23.7%, and its combined prevalence from the studies conducted in four countries (Iran, Jordan, Turkey, and Iraq) was obtained at 21.7%. This broad variation in the prevalence of Legionella and Pseudomonas in the present review can be possibly attributed to variabilities in geographical locations, water sources [16], diagnostic methods, the type and quality of water supplying systems [19], chlorine concentration in water lines [17], the materials used in the manufacturing of tubes [16], the duration of the use of tubes, infection control measures in dental offices, and the age of the waterline system [6].

As mentioned, the diagnostic method is an important parameter in detecting bacterial contamination. Some Legionella spp. cannot be easily identified by routine culture methods and need molecular-based techniques [3]. Also, the DFA technique has a relatively low sensitivity and specificity for detecting Legionella, which may even interfere with the detection of other bacteria [17]. Two studies reported that the loads of microorganisms were significantly higher in the output water of dental units compared to input water, showing biofilm formation in DUWL [318]. These results were inconsistent with the findings of two studies conducted in another region of the world [2223]. Due to their complex nature, established biofilms are difficult to be removed [24] even by hydrogen peroxide and iodine [25]. The presence of sludge, sediment, and some materials associated with biofilm formation may play a significant role in the persistence of L. spp. [26]. The input water of DUWL is typically free of pathogenic bacteria, but the detachment of microorganisms from biofilms causes the bacterial contamination of the output water [27]. In accordance with our study, other studies have reported the presence of Legionella in DUWL [22]. A study conducted in seven European countries showed a low level of contamination of DUWL with Legionella spp. (i.e. 9% in Danish and Spanish samples and zero in samples from the UK (United Kingdom), the Netherlands, Greece, Germany, and Ireland), which was lower compared to the value obtained in this review[19]. Regarding P. aeruginosa contamination, the results of the recent study were comparable with our findings, where P. aeruginosa was isolated from 6, 5, 7, and 10% of samples from Greece, the Netherlands, Germany, and Spain, respectively [19]. Similar to our results, several studies have reported the high prevalence of L. pneumophila in dental units with the frequencies of 58, 33.3 [28], and 30% [29].

It is known that P. aeruginosa is an opportunistic pathogen that more frequently causes infections in immunocompromised patients [4]. Consistent with our observation in this review, Others found that P. aeruginosa was the most prevalent bacteria in the samples collected from DUWL [3031]. Accordingly, another one in 2002, declared that dentists' offices due to contaminated aerosols were a high-risk place for the transmission of P. aeruginosa to dentists, dental staff, and patients [32]. Overall, the high contamination rate reported by almost all the studies included in the current review seems alarming in terms of infection control measures in Middle Eastern countries.

Therefore, in the light of available guidelines, the quality of water in DUWL should be regularly checked to prevent biofilm formation and the excessive growth of pathogenic microorganisms in these tubes and lines. Moreover, DUWL must be constantly chlorinated, and dental units' reservoirs and tanks should be fed with sterile and high-quality water. Also, water used for dental units should have a total colony count of <200 CFU mL−1 and fulfil standards of drinking water certain bacteria. Sterile water or saline should be provided from a separate, and reasonably single use source for surgical procedures. Anti-retraction valves should be fixed on all handpieces and must be frequently checked and kept.

Conclusions

The present review and meta-analysis showed a high contamination rate of DUWL with L. pneumophila and P. aeruginosa in some Middle Eastern countries. Therefore, it is recommended to use high-quality water, implant filters in water reservoirs, and regularly monitor water resources, as the best measures that can be taken, to prevent bacterial colonization and biofilm formation in DUWL and avoid many infections caused by opportunistic pathogens.

Declaration of competing of interest

All authors – none to declare.

Authors' contributions

All authors listed have made a substantial, direct and intellectual contribution to the work and approved it for publication.

Funding

None to declare.

Ethics statement

Not applicable.

Acknowledgments

The authors thank their colleagues for their help in this study.

References

  • 1.

    Uzel A, Cogulu D, Oncag O. Microbiological evaluation and antibiotic susceptibility of dental unit water systems in general dental practice. Int J dental Hyg. 2008;6(1):437.

    • Search Google Scholar
    • Export Citation
  • 2.

    Mills SE. The dental unit waterline controversy: defusing the myths, defining the solutions. J Am Dental Assoc. 2000;131(10):142741.

  • 3.

    Göksay D, Çotuk A, Zeybek Z. Microbial contamination of dental unit waterlines in Istanbul, Turkey. Environ Monit Assess. 2008;147(1):2659.

  • 4.

    Association AD. ADA statement on dental unit waterlines. J Am Dent Assoc. 1996;127(185):e6.

  • 5.

    Singh R, Stine OC, Smith DL, Spitznagel JK, Labib ME, Williams HN. Microbial diversity of biofilms in dental unit water systems. Appl Environ Microbiol. 2003;69(6):341220.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ghalyani P, Karami M, Havaei A, Naderi A, Alikhani M. Contamination of dental scaler waterlines with Legionella pneumophila, Pseudomonas aeruginosa and gram positive cocci. J Islamic Dental Assoc Iran. 2015;27(1):537.

    • Search Google Scholar
    • Export Citation
  • 7.

    Aa T, Alsehlawi Z, Al-Yasiri I. Molecular survey of Legionella pneumophila in dental unit waterlines at Najaf dental clinics-Iraq. J Dent Oral Disord. 2017;3(1):1049.

    • Search Google Scholar
    • Export Citation
  • 8.

    Cloud J, Carroll KC, Pixton P, Erali M, Hillyard D. Detection of Legionella species in respiratory specimens using PCR with sequencing confirmation. J Clin Microbiol. 2000;38(5):170912.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Khaledi A, Esmaeili S-A, Vazini H, Karami P, Bahrami A, Sahebkar A. Evaluation of the prevalence of Legionella pneumophila in Iranian clinical samples: a systematic review and meta-analysis. Microb Pathog 2019;129(4):9398.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Khaledi A, Bahrami A, Nabizadeh E, Amini Y, Esmaeili D. Prevalence of Legionella species in water resources of Iran: a systematic review and meta-analysis. Iranian J Med Sci. 2018;43(6):571.

    • Search Google Scholar
    • Export Citation
  • 11.

    Franco F, Spratt D, Leao J, Porter S. Biofilm formation and control in dental unit waterlines. Biofilms. 2005;2(1):917.

  • 12.

    Walker JT, Bradshaw DJ, Bennett AM, Fulford MR, Martin MV, Marsh PD. Microbial biofilm formation and contamination of dental-unit water systems in general dental practice. Appl Environ Microbiol. 2000;66(8):33637.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Pol Manag. 2014;3(3):123.

    • Search Google Scholar
    • Export Citation
  • 14.

    Ajami B, Ghazvini K, Movahhed T, Ariaee N, Shakeri M, Makarem S. Contamination of a dental unit water line system by legionella pneumophila in the mashhad school of dentistry in 2009. Iranian Red Crescent Med J. 2012;14(6):376.

    • Search Google Scholar
    • Export Citation
  • 15.

    Oleiwi R. Bacterial contamination of dental unity water lines (DUWL) in Baghdad city. IOSR J Dent Med Sci. 2017;16:4750.

  • 16.

    Ma’Ayeh S, Al‐Hiyasat A, Hindiyeh M, Khader Y. Legionella pneumophila contamination of a dental unit water line system in a dental teaching centre. Int J Dental Hyg. 2008;6(1):4855.

    • Search Google Scholar
    • Export Citation
  • 17.

    Bodrumlu E, Alaçam T, Bayraktar A. Legionella in the dental office. Int J Dental Hyg. 2007;5(2):11621.

  • 18.

    Güngör ND, Kadaifçiler DG, Peker . Investigation of the bacterial load and antibiotic susceptibility of dental units. Environ Monit Assess. 2014;186(3):184753.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Walker J, Bradshaw D, Finney M, Fulford M, Frandsen E, ØStergaard E, et al. Microbiological evaluation of dental unit water systems in general dental practice in Europe. Eur J Oral Sci. 2004;112(5):4128.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Nikaeen M, Hatamzadeh M, Sabzevari Z, Zareh O. Microbial quality of water in dental unit waterlines. J Res Med Sci Off J Isfahan Univ Med Sci. 2009;14(5):297.

    • Search Google Scholar
    • Export Citation
  • 21.

    Szymanska J. Risk of exposure to Legionella in dental practice. Ann Agric Environ Med. 2004;11(1).

  • 22.

    Szymańska J. Risk of exposure to Legionella in dental practice. Ann Agric Environ Med. 2004;11(1):912.

  • 23.

    Türetgen I, Göksay D, Cotuk A. Comparison of the microbial load of incoming and distal outlet waters from dental unit water systems in Istanbul. Environ Monit Assess. 2009;158(1–4):9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284(5418):131822.

  • 25.

    Walker J, Bradshaw D, Fulford M, Marsh P. Microbiological evaluation of a range of disinfectant products to control mixed-species biofilm contamination in a laboratory model of a dental unit water system. Appl Environ Microbiol. 2003;69(6):332732.

    • Search Google Scholar
    • Export Citation
  • 26.

    Committee SotSA. National guidelines for the control of Legionellosis in Ireland, 2009; 2009.

  • 27.

    Ryan M, Pembroke J, Adley C. Ralstonia pickettii: a persistent gram-negative nosocomial infectious organism. J Hosp Infect. 2006;62(3):27884.

  • 28.

    Montagna M, Tato D, Napoli C, Castiglia P, Guidetti L, Liguori G, et al. Pilot study on the presence of Legionella spp in 6 Italian cities' dental units. Annali di igiene: medicina preventiva e di comunita. 2006;18(4):297.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Singh T, Coogan M. Isolation of pathogenic Legionella species and legionella-laden amoebae in dental unit waterlines. J Hosp Infect. 2005;61(3):25762.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Al‐Hiyasat A, Ma'Ayeh S, Hindiyeh M, Khader Y. The presence of Pseudomonas aeruginosa in the dental unit waterline systems of teaching clinics. Int J dental Hyg. 2007;5(1):3644.

    • Search Google Scholar
    • Export Citation
  • 31.

    Barbeau J, Tanguay R, Faucher E, Avezard C, Trudel L, Côté L, et al. Multiparametric analysis of waterline contamination in dental units. Appl Environ Microbiol. 1996;62(11):39549.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Araujo MW, Andreana S. Risk and prevention of transmission of infectious diseases in dentistry. Quintessence Int. 2002;33(5).

  • 33.

    Alsehlawi ZS, Al-Yasiri IK, Fakhriddeen AJ, Taher AA. Antibiotic susceptibility patterns of Legionella pneumophila isolated from water lines of dental settings. Smile Dental J. 2016;110(4085):12.

    • Search Google Scholar
    • Export Citation
  • 1.

    Uzel A, Cogulu D, Oncag O. Microbiological evaluation and antibiotic susceptibility of dental unit water systems in general dental practice. Int J dental Hyg. 2008;6(1):437.

    • Search Google Scholar
    • Export Citation
  • 2.

    Mills SE. The dental unit waterline controversy: defusing the myths, defining the solutions. J Am Dental Assoc. 2000;131(10):142741.

  • 3.

    Göksay D, Çotuk A, Zeybek Z. Microbial contamination of dental unit waterlines in Istanbul, Turkey. Environ Monit Assess. 2008;147(1):2659.

  • 4.

    Association AD. ADA statement on dental unit waterlines. J Am Dent Assoc. 1996;127(185):e6.

  • 5.

    Singh R, Stine OC, Smith DL, Spitznagel JK, Labib ME, Williams HN. Microbial diversity of biofilms in dental unit water systems. Appl Environ Microbiol. 2003;69(6):341220.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ghalyani P, Karami M, Havaei A, Naderi A, Alikhani M. Contamination of dental scaler waterlines with Legionella pneumophila, Pseudomonas aeruginosa and gram positive cocci. J Islamic Dental Assoc Iran. 2015;27(1):537.

    • Search Google Scholar
    • Export Citation
  • 7.

    Aa T, Alsehlawi Z, Al-Yasiri I. Molecular survey of Legionella pneumophila in dental unit waterlines at Najaf dental clinics-Iraq. J Dent Oral Disord. 2017;3(1):1049.

    • Search Google Scholar
    • Export Citation
  • 8.

    Cloud J, Carroll KC, Pixton P, Erali M, Hillyard D. Detection of Legionella species in respiratory specimens using PCR with sequencing confirmation. J Clin Microbiol. 2000;38(5):170912.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Khaledi A, Esmaeili S-A, Vazini H, Karami P, Bahrami A, Sahebkar A. Evaluation of the prevalence of Legionella pneumophila in Iranian clinical samples: a systematic review and meta-analysis. Microb Pathog 2019;129(4):9398.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Khaledi A, Bahrami A, Nabizadeh E, Amini Y, Esmaeili D. Prevalence of Legionella species in water resources of Iran: a systematic review and meta-analysis. Iranian J Med Sci. 2018;43(6):571.

    • Search Google Scholar
    • Export Citation
  • 11.

    Franco F, Spratt D, Leao J, Porter S. Biofilm formation and control in dental unit waterlines. Biofilms. 2005;2(1):917.

  • 12.

    Walker JT, Bradshaw DJ, Bennett AM, Fulford MR, Martin MV, Marsh PD. Microbial biofilm formation and contamination of dental-unit water systems in general dental practice. Appl Environ Microbiol. 2000;66(8):33637.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Pol Manag. 2014;3(3):123.

    • Search Google Scholar
    • Export Citation
  • 14.

    Ajami B, Ghazvini K, Movahhed T, Ariaee N, Shakeri M, Makarem S. Contamination of a dental unit water line system by legionella pneumophila in the mashhad school of dentistry in 2009. Iranian Red Crescent Med J. 2012;14(6):376.

    • Search Google Scholar
    • Export Citation
  • 15.

    Oleiwi R. Bacterial contamination of dental unity water lines (DUWL) in Baghdad city. IOSR J Dent Med Sci. 2017;16:4750.

  • 16.

    Ma’Ayeh S, Al‐Hiyasat A, Hindiyeh M, Khader Y. Legionella pneumophila contamination of a dental unit water line system in a dental teaching centre. Int J Dental Hyg. 2008;6(1):4855.

    • Search Google Scholar
    • Export Citation
  • 17.

    Bodrumlu E, Alaçam T, Bayraktar A. Legionella in the dental office. Int J Dental Hyg. 2007;5(2):11621.

  • 18.

    Güngör ND, Kadaifçiler DG, Peker . Investigation of the bacterial load and antibiotic susceptibility of dental units. Environ Monit Assess. 2014;186(3):184753.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Walker J, Bradshaw D, Finney M, Fulford M, Frandsen E, ØStergaard E, et al. Microbiological evaluation of dental unit water systems in general dental practice in Europe. Eur J Oral Sci. 2004;112(5):4128.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Nikaeen M, Hatamzadeh M, Sabzevari Z, Zareh O. Microbial quality of water in dental unit waterlines. J Res Med Sci Off J Isfahan Univ Med Sci. 2009;14(5):297.

    • Search Google Scholar
    • Export Citation
  • 21.

    Szymanska J. Risk of exposure to Legionella in dental practice. Ann Agric Environ Med. 2004;11(1).

  • 22.

    Szymańska J. Risk of exposure to Legionella in dental practice. Ann Agric Environ Med. 2004;11(1):912.

  • 23.

    Türetgen I, Göksay D, Cotuk A. Comparison of the microbial load of incoming and distal outlet waters from dental unit water systems in Istanbul. Environ Monit Assess. 2009;158(1–4):9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284(5418):131822.

  • 25.

    Walker J, Bradshaw D, Fulford M, Marsh P. Microbiological evaluation of a range of disinfectant products to control mixed-species biofilm contamination in a laboratory model of a dental unit water system. Appl Environ Microbiol. 2003;69(6):332732.

    • Search Google Scholar
    • Export Citation
  • 26.

    Committee SotSA. National guidelines for the control of Legionellosis in Ireland, 2009; 2009.

  • 27.

    Ryan M, Pembroke J, Adley C. Ralstonia pickettii: a persistent gram-negative nosocomial infectious organism. J Hosp Infect. 2006;62(3):27884.

  • 28.

    Montagna M, Tato D, Napoli C, Castiglia P, Guidetti L, Liguori G, et al. Pilot study on the presence of Legionella spp in 6 Italian cities' dental units. Annali di igiene: medicina preventiva e di comunita. 2006;18(4):297.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Singh T, Coogan M. Isolation of pathogenic Legionella species and legionella-laden amoebae in dental unit waterlines. J Hosp Infect. 2005;61(3):25762.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Al‐Hiyasat A, Ma'Ayeh S, Hindiyeh M, Khader Y. The presence of Pseudomonas aeruginosa in the dental unit waterline systems of teaching clinics. Int J dental Hyg. 2007;5(1):3644.

    • Search Google Scholar
    • Export Citation
  • 31.

    Barbeau J, Tanguay R, Faucher E, Avezard C, Trudel L, Côté L, et al. Multiparametric analysis of waterline contamination in dental units. Appl Environ Microbiol. 1996;62(11):39549.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Araujo MW, Andreana S. Risk and prevention of transmission of infectious diseases in dentistry. Quintessence Int. 2002;33(5).

  • 33.

    Alsehlawi ZS, Al-Yasiri IK, Fakhriddeen AJ, Taher AA. Antibiotic susceptibility patterns of Legionella pneumophila isolated from water lines of dental settings. Smile Dental J. 2016;110(4085):12.

    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand
The author instruction is available in PDF.
Please, download the file from HERE.
 

Senior editors

Editor(s)-in-Chief: Dunay, Ildiko Rita

Editor(s)-in-Chief: Heimesaat, Markus M.

Vice Editor(s)-in-Chief: Fuchs, Anja

Editorial Board

Chair of the Editorial Board:
Jeffrey S. Buguliskis (Thomas Jefferson University, USA)

  • Jörn Albring (University of Münster, Germany)
  • Stefan Bereswill (Charité - University Medicine Berlin, Germany)
  • Dunja Bruder (University of Megdeburg, Germany)
  • Jan Buer (University of Duisburg, Germany)
  • Jeff Buguliskis (Thomas Jefferson University, USA)
  • Edit Buzas (Semmelweis University, Hungary)
  • Charles Collyer (University of Sydney, Australia)
  • Renato Damatta (UENF, Brazil)
  • Ivelina Damjanova (Semmelweis University, Hungary)
  • Maria Deli (Biological Research Center, HAS, Hungary)
  • Olgica Djurković-Djaković (University of Belgrade, Serbia)
  • Jean-Dennis Docquier (University of Siena, Italy)
  • Anna Erdei (Eötvös Loránd University, Hungary)
  • Zsuzsanna Fabry (University of Washington, USA)
  • Beniam Ghebremedhin (Witten/Herdecke University, Germany)
  • Nancy Guillen (Institute Pasteur, France)
  • Georgina L. Hold (University of Aberdeen, United Kingdom)
  • Ralf Ignatius (Charité - University Medicine Berlin, Germany)
  • Zsuzsanna Izsvak (MDC-Berlin, Germany)
  • Achim Kaasch (University of Cologne, Germany)
  • Tamás Laskay (University of Lübeck, Germany)
  • Oliver Liesenfeld (Roche, USA)
  • Shreemanta Parida (Vaccine Grand Challenge Program, India)
  • Matyas Sandor (University of Wisconsin, USA)
  • Ulrich Steinhoff (University of Marburg, Germany)
  • Michal Toborek (University of Miami, USA)
  • Mary Jo Wick (University of Gothenburg, Sweden)
  • Susanne A. Wolf (MDC-Berlin, Germany)

 

Dr. Dunay, Ildiko Rita
Magdeburg, Germany
E-mail: ildikodunay@gmail.com

Indexing and Abstracting Services:

  • PubMed Central
  • Scopus
  • ESCI
  • CABI
  • CABELLS Journalytics

 

2021  
Web of Science  
Total Cites
WoS
790
Journal Impact Factor not applicable
Rank by Impact Factor not applicable
Impact Factor
without
Journal Self Cites
not applicable
5 Year
Impact Factor
not applicable
Journal Citation Indicator 0,64
Rank by Journal Citation Indicator Microbiology 81/157
Scimago  
Scimago
H-index
not indexed
Scimago
Journal Rank
not indexed
Scimago Quartile Score not indexed
Scopus  
Scopus
Cite Score
not indexed
Scopus
CIte Score Rank
  not indexed
Scopus
SNIP
not indexed

2020  
CrossRef Documents 23
WoS Cites 708
Wos H-index 27
Days from submission to acceptance 219
Days from acceptance to publication 176
Acceptance Rate 70%

2019  
WoS
Cites
558
CrossRef
Documents
24
Acceptance
Rate
92%

 

European Journal of Microbiology and Immunology
Publication Model Gold Open Access
Submission Fee none
Article Processing Charge 600 EUR/article
Regional discounts on country of the funding agency World Bank Lower-middle-income economies: 50%
World Bank Low-income economies: 100%
Further Discounts Editorial Board / Advisory Board members: 50%
Corresponding authors, affiliated to an EISZ member institution subscribing to the journal package of Akadémiai Kiadó: 100%
Subscription Information Gold Open Access
Purchase per Title  

European Journal of Microbiology and Immunology
Language English
Size A4
Year of
Foundation
2011
Volumes
per Year
1
Issues
per Year
4
Founder Akadémiai Kiadó
Founder's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 2062-509X (Print)
ISSN 2062-8633 (Online)

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Aug 2022 0 0 0
Sep 2022 0 0 0
Oct 2022 0 0 0
Nov 2022 0 0 0
Dec 2022 0 0 0
Jan 2023 0 201 111
Feb 2023 0 0 0