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Prospective 3-Year Surveillance for Nosocomial and Environmental Legionella pneumophila: Implications for Infection Control

Published online by Cambridge University Press:  21 June 2016

S. Boccia ,
P. Laurenti ,
P. Borella ,
U. Moscato ,
G. Capalbo ,
A. Cambieri ,
R. Amore ,
G. Quaranta ,
F. Boninti  and
M. Orsini
...Show all authors
S. Boccia*
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
P. Laurenti
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
P. Borella
Affiliation:
Institute of Hygiene, University of Modena and Reggio Emilia, Modena, Italy
U. Moscato
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
G. Capalbo
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
A. Cambieri
Affiliation:
Hospital Head Unit, Catholic University Medical School, Rome, Italy
R. Amore
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
G. Quaranta
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
F. Boninti
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
M. Orsini
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
G. Branca
Affiliation:
Institute of Microbiology, Catholic University Medical School, Rome, Italy
G. Fadda
Affiliation:
Institute of Microbiology, Catholic University Medical School, Rome, Italy
V. Romano Spica
Affiliation:
University of Movement Sciences, Rome, Italy
G. Ricciardi
Affiliation:
Institute of Hygiene, Catholic University Medical School, Rome, Italy
*
Institute of Hygiene, Catholic University Medical School, L. go E Vito, 1-00168 Rome, Italy (sboccia@rm.unicatt.it)
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Abstract

Objectives.

To perform a 3-year, prospective surveillance program for legionnaires disease (LD) in a large university hospital in Rome, and to assess the usefulness of the hospital water monitoring program in predicting the risk of nosocomial LD.

Methods.

Samples from patients with new cases of nosocomial pneumonia were sent for legionella laboratory investigations. Meanwhile, water samples for bacteriological analysis were collected every 6 months from high- and medium-risk hospital wards (10 in total). Legionella pneumophila isolates collected were serotyped and analyzed by pulsed-field gel electrophoresis.

Results.

From June 2001 through May 2004, the pneumonia surveillance identified one case of nosocomial LD among 43 cases of nosocomial pneumonia (2.3%). Environmental investigations detected L. pneumophila in 12 (18.7%) of the 64 water samples, of which 50% belonged to serogroup 1. The L. pneumophila count and the percentage of positive locations never exceeded 102 colony-forming units/L and 20%, respectively, except when the LD nosocomial case occurred (positive water samples, 40%; I. pneumophila count, <102 colony-forming units/L). Genotyping showed 3 prevalent clones of L. pneumophila in the water distribution network, of which one persisted over the 3 years. One clone contained 3 different L. pneumophila serogroups (2, 4, and 6).

Conclusions.

The low incidence of nosocomial cases of LD appears to be associated with a low percentage (<20%) of positive water samples per semester and with a low contamination level (<102 colony-forming units/L). An infection control system for nosocomial LD should, therefore, be based on both environmental and clinical surveillance, together with the appropriate maintenance of the hospital water distribution system.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 5 , May 2006 , pp. 459 - 465
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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