Pseudomonas aeruginosa dose response and bathing water infection

D. J. Roser, B. Van Den Akker, S. Boase, C. N. Haas, N. J. Ashbolt, S. A. Rice

Research output: Contribution to journalReview articlepeer-review

27 Citations (Scopus)


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/m 2), 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.

Original languageEnglish
Pages (from-to)449-462
Number of pages14
JournalEpidemiology and Infection
Issue number3
Publication statusPublished - 1 Jan 2014
Externally publishedYes


  • Acute otitis externa
  • Dermatitis
  • Folliculitis


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