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SUMMARY   Research background   Legionella  are Gram-negative bacteria that are ubiquitous in the natural environment. Contaminated water in man-made water systems is a potential source of transmission of legionnaires’ disease. The aim of this study is to explore the prevalence of  Legionella pneumophila  in the drinking water distribution system (DWDS) of Primorje-Gorski Kotar (PGK) County, Croatia, for the period 2013-2019, coupled with the incidence of legionnaires’ disease. A number of  L. pneumophila- positive samples (>100 CFU/L), serogroup distribution and the degree of contamination of specific facilities (health and aged care, tourism, and sports) were assessed. Based on the obtained results, the reasoning for the implementation of a mandatory  Legionella  environmental surveillance program was assessed.    Experimental approach  Sample testing for  Legionella  was carried out according to the standard method for enumeration of this bacterium. A heterotrophic plate count (HPC) and  Pseudomonas aeruginosa  number were analysed along with the basic physicochemical indicators of drinking water quality. The research period was divided into two parts, namely, the 2013-2018 period (before implementation of the prevention program, after the outbreak of legionnaires’ disease), and the year 2019 (proactive approach, no disease cases recorded).    Results and conclusion  During the 7-year observation period in PGK County, an increase in the number of samples tested for  Legionella  was found. An increase in  Legionella -positive samples (particularly pronounced during the warmer part of the year) was recorded, along with a growing trend in the number of reported legionnaires’ disease cases. In addition to hot water systems, the risk of  Legionella  colonisation also applies to cold water systems. Health and aged care facilities appear to be at highest risk. In addition to the higher proportion of positive samples and a higher degree of microbiological load in these facilities, the highest proportion of  L. pneumophila  SGs 2-14 was identified. Due to the diagnostic limitations of the applied tests, the number of legionnaires’ disease cases is underdiagnosed.    Novelty and scientific contribution  The introduction of a mandatory preventive approach to monitoring  Legionella  in DWDS water samples, along with the definition of national criteria for the interpretation of the results will create the preconditions for diagnosis and adequate treatment of larger numbers of legionnaires’ disease cases.

Is a Proactive Approach to Controlling Legionella in the Environment Justified?