Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg, Virginia 24061, United States.
Environ Sci Technol. 2013 Sep 17;47(18):10117-28. doi: 10.1021/es402455r. Epub 2013 Sep 4.
Opportunistic pathogens occurring in premise (i.e., building) plumbing systems, including strains of Legionella, Mycobacterium, Acanthamoeba, and Pseudomonas, are now frequently cited agents of waterborne disease outbreaks. Unlike traditional fecal pathogens, opportunistic pathogens are part of the drinking water microbial ecology and therefore require new paradigms for their control. With the onset of the "microbiome era", notions of eradicating all microbes in drinking water have proven unrealistic, making a probiotic concept worthy of consideration. Research is needed to better understand how engineering controls may individually, or in combination, select for a desirable microbiome, and how the microbiome itself may mediate proliferation of opportunistic pathogens. Ecological interactions such as competition, antagonism, and obligate parasite-host relationships offer potential targets for probiotic control of opportunistic pathogens. A probiotic approach may be defined as intentional inoculation of beneficial microbes or choosing conditions that select for a desirable microbiome. This critical review synthesizes the state of the knowledge of the factors governing opportunistic pathogen control in premise plumbing and potential opportunities for and barriers to implementation of a probiotic approach. Future effort is recommended to demonstrate the feasibility of the probiotic concept; to develop effective, practical, and safe protocols; and to engage relevant stakeholders in evaluating options and assessing corresponding risks.
在建筑物管道系统中出现的机会性病原体，包括军团菌、分枝杆菌、棘阿米巴和假单胞菌等菌株，现在经常被认为是水传播疾病爆发的病原体。与传统的粪便病原体不同，机会性病原体是饮用水微生物生态系统的一部分，因此需要新的控制模式。随着“微生物组时代”的到来，消除饮用水中所有微生物的想法已被证明不切实际，因此益生菌概念值得考虑。需要研究更好地了解工程控制措施如何单独或组合选择理想的微生物组，以及微生物组本身如何介导机会性病原体的增殖。生态相互作用，如竞争、拮抗和专性寄生虫-宿主关系，为益生菌控制机会性病原体提供了潜在的目标。益生菌方法可以定义为有意接种有益微生物或选择有利于理想微生物组的条件。本综述综合了控制建筑物管道中机会性病原体的因素的知识现状，以及实施益生菌方法的潜在机会和障碍。建议未来开展工作，以证明益生菌概念的可行性；制定有效、实用和安全的方案；并让相关利益攸关方参与评估各种选择和评估相应的风险。
