Prevalence of Legionella Species in Water Resources of Iran: A Systematic Review and Meta-Analysis

Background: Legionella species are ubiquitous and naturally found in lakes, rivers, streams and hot springs, and other water resources. The present study aimed to investigate the prevalence of Legionella species in water resources of Iran by a systematic review and meta-analysis. Methods: In search of papers relevant to the prevalence of Legionella in water resources of Iran, the scientific information database in both English and Persian languages was used. The search was limited to studies between the year 2000 and end of July 2016. Each cohort and cross-sectional study that reported the contamination of water with Legionella was included in the present study. For data analysis, comprehensive meta-analysis software with Cochran’s Q and I2 tests were used. P values less than 0.05 were considered statistically significant. Results: The prevalence of Legionella species in water resources of Iran was 27.3% (95% CI: 25.3-29.3). The prevalence of Legionella spp. in hospital water, dental settings water, and other water resources were 28.8% (95% CI: 26.4-31.2), 23.6% (95% CI: 16.1-33.2), and 29.6% (95% CI: 25.6-33.8), respectively. The most common Legionella species was L. pneumophila with a prevalence of 60.5% (95% CI: 53.3-67.2) and the prevalence of all other species was 52.5% (95% CI: 44.7-60.2). The highest prevalence was reported in Isfahan with 55.7% (95% CI: 48.0-63.0). Conclusion: Based on the results, the prevalence rate of Legionella species in water resources of Iran was high and the