Abstract / Summary
The opportunistic pathogen Pseudomonas aeruginosa is a flexible Gram-negative bacterium with inherent antibiotic resistance, remarkable ability to create biofilms in environments of limited nutrients and water, and a significant armory of virulence factors that makes it one of the most important opportunistic pathogens in hospitals and pharmaceutical manufacturing facilities. Water for pharmaceutical use is employed as both an ingredient, a process medium, and a cleaning material during the manufacture of drugs; thus, pharmaceutical water presents P. aeruginosa with perfect conditions (warm temperature, low nutrients, high surface-to-volume ratio, and constant circulation). This review discusses peer-reviewed, freely available scientific publications about biology, antibiotic resistance, prevalence, and control of Pseudomonas aeruginosa in pharmaceutical water supplies and in the cosmetics product chain where contamination with waterborne pathogens has been associated with recalls in the European Union and elsewhere. According to the U.S. Pharmacopoeia, P. aeruginosa is required to be absent in purified water and non-sterile water-based products. The rapid alert system of the European Union identifies Pseudomonas aeruginosa as the most frequently isolated microorganism from microbiologically contaminated cosmetics. Hospital-acquired infections have been associated with biofilm contamination of faucet aerators, sink traps, solenoid diaphragms, and electronic-eye faucets in various scenarios, including neonatal ICU outbreaks and adult ICU outbreaks that have yielded carbapenemase-producing lineages. Prevention measures should entail multiple approaches including water pretreatment, periodic hot water (≥65–70 °C) or steam sanitization, ozone or peracetic acid-UV sanitization, hypochlorous acid flushing, 0.2-µm filters, and continuous monitoring with culture (USP <60>, <61>, <62>) and rapid molecular (real-time PCR of gyrB or gyrA) tests. Overall, all the above can bring down water system bioburden from “uncountable” to <0.1 × 10¹ CFU/mL.