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Epidemiol Infect. 2014 Mar;142(3):449-62. doi: 10.1017/S0950268813002690. Epub 2013 Nov 8.

Pseudomonas aeruginosa dose response and bathing water infection.

Author information

  • 1UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia.
  • 2Department of Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, Woodville, SA, Australia.
  • 3Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, USA.
  • 4The School of Biotechnology and Biomolecular Sciences and the Centre for Marine Bio-Innovation, University of New South Wales, Sydney, NSW, Australia.


Pseudomonas aeruginosa is the opportunistic pathogen mostly implicated in folliculitis and acute otitis externa in pools and hot tubs. Nevertheless, infection risks remain poorly quantified. This paper reviews disease aetiologies and bacterial skin colonization science to advance dose-response theory development. Three model forms are identified for predicting disease likelihood from pathogen density. Two are based on Furumoto & Mickey's exponential 'single-hit' model and predict infection likelihood and severity (lesions/m2), respectively. 'Third-generation', mechanistic, dose-response algorithm development is additionally scoped. The proposed formulation integrates dispersion, epidermal interaction, and follicle invasion. The review also details uncertainties needing consideration which pertain to water quality, outbreaks, exposure time, infection sites, biofilms, cerumen, environmental factors (e.g. skin saturation, hydrodynamics), and whether P. aeruginosa is endogenous or exogenous. The review's findings are used to propose a conceptual infection model and identify research priorities including pool dose-response modelling, epidermis ecology and infection likelihood-based hygiene management.

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