Skip to main content Accessibility help
×
Home

A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System

Published online by Cambridge University Press:  02 January 2015

Lisa A. Lepine
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Daniel B. Jernigan
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jay C. Butler
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Janet M. Pruckler
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert F. Benson
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Grace Kim
Affiliation:
St Vincent's Medical Center, Bridgeport, Connecticut
James L. Hadler
Affiliation:
Connecticut Department of Public Health, Hartford, Connecticut
Matthew L. Cartter
Affiliation:
Connecticut Department of Public Health, Hartford, Connecticut
Barry S. Fields
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Abstract

Background:

In 1994, a hospital reported an increase in nosocomial legionnaires' disease after implementing use of a rapid urinary antigen test for Legionella pneumophila serogroup 1 (Lp-1). This hospital was the site of a previous nosocomial legionnaires' disease outbreak during 1980 to 1982.

Methods:

Infection control records were reviewed to compare rates of nosocomial pneumonia and the proportion of cases attributable to legionnaires' disease during the 1994 outbreak period with those during the same period in 1993. Water samples were collected for Legionella culture from the hospital's potable water system and cooling towers, and isolates were subtyped by monoclonal antibody (MAb) testing and arbitrarily primed polymerase chain reaction (AP-PCR).

Results:

Nosocomial pneumonia rates were similar from April through October 1993 and April through October 1994: 5.9 and 6.6 per 1,000 admissions, respectively (rate ratio [RR], 1.1; P=.56); however, 3.2% of nosocomial pneumonias were diagnosed as legionnaires' disease in 1993, compared with 23.9% in 1994 (RR, 9.4; P<.001). In 1994, most legionnaires' disease cases were detected by the urinary antigen testing alone. MAb testing and AP-PCR demonstrated identical patterns among Lp-1 isolates recovered from a patient's respiratory secretions, the hospital potable water system, and stored potable water isolates from the 1980 to 1982 outbreak.

Conclusions:

There may have been persistent transmission of nosocomial legionnaires' disease at this hospital that went undiscovered for many years because there was no active surveillance for legionnaires' disease. Introduction of a rapid urinary antigen test improved case ascertainment. Legionella species can be established in colonized plumbing systems and may pose a risk for infection over prolonged periods.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below.

References

1.Gross, PA, Neu, HC, Aswapokee, P, Van Antwerpen, C, Aswapokee, N. Deaths from nosocomial infections: experience in a university hospital and a community hospital. Am J Med 1980;68:219223.CrossRefGoogle Scholar
2.Haley, CE, Cohen, ML, Halter, J, Meyer, RD. Nosocomial legionnaires' disease: a continuing common source epidemic at Wadsworth Medical Center. Ann Intern Med 1979;90:583586.CrossRefGoogle ScholarPubMed
3.Yu, VL, Kroboth, FJ, Brown, A, McDearman, S, Magnussen, M. Legionnaires' disease: new clinical perspective from a prospective pneumonia study. Am J Med 1982;73:357361.CrossRefGoogle ScholarPubMed
4.Muder, RR, Yu, VL, McClure, JK, Kroboth, FJ, Kominos, SD, Lumish, RN. Nosocomial legionnaires' disease uncovered in a prospective pneumonia study: implications for underdiagnosis. JAMA 1983;249:31843188.CrossRefGoogle Scholar
5.Brennan, C, Vickers, JP, Yu, VL, Puntereri, A, Yee, YC. Discovery of occult Legionella pneumonia in a long-stay hospital: results of prospective serologic survey. BMJ 1987;295:306307.CrossRefGoogle Scholar
6.Marrie, TJ, MacDonald, S, Clarke, K, Haldane, D. Nosocomial legionnaires' disease: lessons from a four-year prospective study. Am J Infect Control 1991;19:7985.CrossRefGoogle ScholarPubMed
7.Roig, J, Aguilar, X, Ruiz, J, Domingo, C, Mesalles, E, Manterola, J, et al.Comparative study of Legionella pneumophila and other nosocomial-acquired pneumonias. Chest 1991;99(2):344350.CrossRefGoogle ScholarPubMed
8.Marston, BJ, Lipman, HB, Breiman, RF. Surveillance for legionnaires' disease: risk factors for morbidity and mortality. Arch Intern Med 1994;154:24172422.CrossRefGoogle ScholarPubMed
9.Centers for Disease Control and Prevention. Sustained transmission of nosocomial legionnaires' disease—Arizona and Ohio. MMWR 1997;46:416421.Google ScholarPubMed
10.Kohler, RB, Zimmerman, SE, Wilson, E, Allen, SD, Edelstein, PH, Wheat, LJ, et al.Rapid radioimmunoassay diagnosis of legionnaires' disease: detection and partial characterization of urinary antigen. Ann Intern Med 1981;94:601605.CrossRefGoogle ScholarPubMed
11.Ruf, B, Shürmann, D, Horbach, I, Fehrenbach, FJ, Pohle, HD. Prevalence and diagnosis of Legionella pneumonia: a 3-year prospective study with emphasis on application of urinary antigen detection. J Infect Dis 1990;162:13411348.CrossRefGoogle ScholarPubMed
12.Plouffe, JF, File, TM, Breiman, RF, Hackman, BA, Salstrom, SJ, Marston, BJ, et al.Reevaluation of the definition of legionnaires' disease: use of the urinary antigen assay. Clin Infect Dis 1995;20:12861291.CrossRefGoogle ScholarPubMed
13.Hackman, BA, Plouffe, JF, Benson, RF, Fields, BS, Breiman, RF. Comparison of Binax Legionella urinary antigen EIA kit with Binax RIA urinary antigen kit for detection of Legionella pneumophila serogroup 1 antigen. J Clin Microbiol 1996;34:15791580.Google ScholarPubMed
14.Jones, E, Checko, P, Dalton, A, Cope, J, Barbaree, J, Klein, G, et al.Nosocomial legionnaires' disease associated with exposure to respiratory therapy equipment, Connecticut. Thornsberry, C, Feeley, JC, eds. Proceedings of the Second International Symposium on Legionella. Washington, DC: American Society for Microbiology; 1984:225227.Google Scholar
15.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.CrossRefGoogle ScholarPubMed
16.Barbaree, JM, Morill, WE, Fields, BS, Martin, WT, Sanden, GN. Detection and recovery of Legionella in water. Toxicity Assessment 1988;3:479490.CrossRefGoogle Scholar
17.Breiman, R, Cozen, W, Fields, BS, Mastro, TD, Carr, SJ, Spika, JS, et al.Role of air sampling in investigation of an outbreak of legionnaires' disease associated with exposure to aerosols from an evaporative condenser. J Infect Dis 1990;161:12571261.CrossRefGoogle ScholarPubMed
18.Joly, JR, McKinney, RM, Tobin, JO, Bibb, WF, Watkins, ID, Ramsay, D. Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol 1986;23:768771.Google ScholarPubMed
19.Welsh, J, McClelland, M. Fingerprinting genomes using PCR with arbitrary primers. Nucleic Acids Res 1990;18:72137218.CrossRefGoogle ScholarPubMed
20.Gomez-Lus, P, Fields, BS, Benson, RF, Martin, WT, O'Connor, SP, Black, CM. Comparison of arbitrarily primed polymerase chain reaction, ribotyping, and monoclonal antibody analysis for subtyping Legionella pneumophila serogroup 1. J Clin Microbiol 1993;31:19401942.Google ScholarPubMed
21.Pruckler, JM, Mermel, LA, Benson, RF, Giorgio, C, Cassiday, PK, Breiman, RF, et al.Comparison of Legionella pneumophila isolates by arbitrarily primed PCR and pulsed-field gel electrophoresis: analysis for seven epidemic investigations. J Clin Microbiol 1995;33:28722875.Google ScholarPubMed
22.Edelstein, PH. Laboratory diagnosis of legionnaires' disease: an update from 1984. Barbaree, JM, Breiman, RF, Dufor, AP, eds. Legionella: Current Status and Emerging Perspectives. Washington, DC: American Society for Microbiology; 1993:711.Google Scholar
23.Le Saux, NM, Sekla, L, McLeod, J, Parker, S, Rush, D, Jeffery, JR, et al.Epidemic of nosocomial legionnaires' disease in renal transplant recipients: a case-control and environmental study. Can Med Assoc J 1989;140:10471053.Google ScholarPubMed
24.Carratala, J, Gudiol, F, Pallares, R, Dorca, J, Verdaguer, R, Ariza, J, et al.Risk factors for nosocomial Legionella pneumophila pneumonia. Am J Respir Crit Care Med 1994;149:625629.CrossRefGoogle ScholarPubMed
25.Joseph, CA, Watson, JM, Harrison, TG, Bartlett, CLR. Nosocomial legionnaires' disease in England and Wales, 1980-92. Epidemiol Infect 1994;112:329345.CrossRefGoogle ScholarPubMed
26.Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. MMWR 1997;46(RR-1):179.Google ScholarPubMed
27.Kohler, RB, Winn, WC Jr, Wheat, LJ. Onset and duration of urinary antigen excretion in legionnaires' disease. J Clin Microbiol 1984;20:605607.Google Scholar
28.Chang, F-Y, Jacobs, SL, Colodny, SM, Stout, JE, Yu, VL. Nosocomial legionnaires' disease caused by Legionella pneumophila serogroup 5: laboratory and epidemiologic implications. J Infect Dis 1996;174:11161119.CrossRefGoogle ScholarPubMed
29.Tang, PW, Toma, S. Broad-spectrum enzyme-linked immunosorbent assay for detection of Legionella soluble antigens. J Clin Microbiol 1986;24:556558.Google ScholarPubMed
30.Allegheny County Health Department. Approaches to Prevention and Control of Legionella Infection in Allegheny County Health Care Facilities. Pittsburgh, PA: Allegheny County Health Department; 1993:113.Google Scholar
31.Fiore, AE, Nuorti, PJ, Levine, OS, Marx, A, Weltman, AC, Yeager, S, et al.Epidemic legionnaires' disease two decades later: old sources, new diagnostic methods. Clin Infect Dis 1998;26:426433.CrossRefGoogle ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 21 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 27th January 2021. This data will be updated every 24 hours.

Hostname: page-component-898fc554b-gwqw7 Total loading time: 0.328 Render date: 2021-01-27T02:15:51.226Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *