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Persistence of Legionella Pneumophila in a Hospital's Water System: A 13-Year Survey

Published online by Cambridge University Press:  02 January 2015

M. Sigfrido Rangel-Frausto ,
Paul Rhomberg ,
Richard J. Hollis ,
Michael A. Pfaller ,
Richard P. Wenzel ,
Charles M. Helms  and
Loreen A. Herwaldt
M. Sigfrido Rangel-Frausto
Affiliation:
Division of General Internal Medicine, the Department of Internal Medicine, Iowa City, Iowa
Paul Rhomberg
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Richard J. Hollis
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Michael A. Pfaller
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Richard P. Wenzel
Affiliation:
Division of General Internal Medicine, the Department of Internal Medicine, Iowa City, Iowa
Charles M. Helms
Affiliation:
Division of General Internal Medicine, the Department of Internal Medicine, Iowa City, Iowa
Loreen A. Herwaldt*
Affiliation:
Division of General Internal Medicine, the Department of Internal Medicine, Iowa City, Iowa Iowa City Veterans' Administration Medical Center, Iowa City, Iowa University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
Department of Internal Medicine, University of Iowa College of Medicine, C-41 GH, 200 Hawkins Dr. Iowa City. IA 52242-1081
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Abstract

Objective:

To describe the molecular epidemiology of Legionella pneumophila infections in the University of Iowa Hospitals and Clinics (UIHC).

Design:

Molecular epidemiological study using pulsed-field gel electrophoresis (PFGE).

Setting:

A large university teaching hospital.

Isolates:

All surviving isolates obtained from culture-proven nosocomial L pneumophila infections and all surviving isolates obtained from the University of Iowa Hospital and Clinics' water supply between 1981 and 1993.

Results:

Thirty-three isolates from culture-proven nosocomial cases of L pneumophila pneumonia were available for typing. PFGE of genomic DNA from the clinical isolates identified six different strains. However, only strain C (16 cases) and strain D (13 cases) caused more than 1 case. Strain C caused clusters of nosocomial infection in 1981, 1986, and 1993 and also caused 4 sporadic cases. Strain D caused a cluster in 1987 and 1988 plus 4 sporadic cases. Of the six strains causing clinical infections, only strains C and D were identified in water samples. PFGE identified three strains in the water supply, of which strains C and D caused clinical disease and also persisted in the water supply during most of the study period.

Conclusion:

Specific strains of L pneumophila can colonize hospital water supplies and cause nosocomial infections over long periods of time.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 12 , December 1999 , pp. 793 - 797
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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References

1. Fay, D, Baird, IM, Aguirre, A, Haegren, V, Werling, K, Bell, TW. Unrecognized legionnaires' disease as a cause of fatal illness. JAMA 1980;243:2311–2313.Google Scholar
2. Johnson, JT, Yu, VL, Best, MG, Vickers, RM, Goetz, A, Wagner, R, et al. Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet 1985;2:298–300.CrossRefGoogle ScholarPubMed
3. Yu, VL. Legionella pneumophila, legionnaires' disease. In: Mandell, G, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases, 4th ed. New York, NY: Churchill Livingstone; 1995:2087–2097.Google Scholar
4. Kirby, BD, Snyder, KM, Meyer, RD, Finegold, SM. Legionnaires' disease: report of sixty-five nosocomially acquired cases of review of literature. Medicine 1980;59:188–205.CrossRefGoogle Scholar
5. Korvick, JA, Yu, VL. Legionnaires' disease: an emerging surgical problem. Ann Thorac Surg 1987;43:341–347.CrossRefGoogle ScholarPubMed
6. Beaty, HN, Miller, AA, Broome, CV, Goings, S, Phillips, CA. Legionnaires' disease in Vermont, May to October 1977. JAMA 1978;240:127–131.Google Scholar
7. Dondero, TJ Jr, Clegg, HW 2d, Tsai, TF, Weeks, RM, Duncan, E, Strickler, J, et al. Legionnaires' disease in Kingsport, Tennessee. Ann Intern Med 1979;90:569–573.Google Scholar
8. Yu, VL, Kroboth, FJ, Shonnard, J, Brown, A, McDearman, S, Magnussen, M. Legionnaires' disease: new clinical perspective from a prospective pneumonia study. J Med 1982;73:357–361.Google Scholar
9. Haley, CE, Cohen, ML, Halter, J, Meyer, RD. Nosocomial legionnaires' disease: a continuing common source epidemic at Wadsworth Medical Center. Ann Intern Med 1979;90:583–586.Google Scholar
10. Shands, KN, Ho, JL, Meyer, RD, Gorman, GW, Edelstein, PH, Mallison, GF, et al. Potable water as a source of legionnaires' disease. JAMA 1985;253:1412–1416.Google Scholar
11. Helms, CM, Massanari, RM, Zeitler, R, Streed, S, Gilchrist, MJ, Hall, N, et al. Legionnaires' disease associated with a hospital water system: a cluster of 24 nosocomial cases. Ann Intern Med 1983;99:172–178.Google Scholar
12. Dondero, TJ Jr, Rendtorff, RC, Mallison, GF, Weeks, RM, Levy, JS, Wong, EW, et al. An outbreak of legionnaires' disease associated with a contaminated air-conditioning cooling tower. N Engl J Med 1980;302-365–370.CrossRefGoogle ScholarPubMed
13. Kaufmann, AF, McDade, JE, Patton, CM, Bennett, JV, Skaliy, P, Feeley, JC, et al. Pontiac fever: isolation of the enologie agent (Legionella pneumophila) and demonstration of its mode of transmission. Am J Epidemiol 1981;114:337–347.Google Scholar
14. Blatt, SPParkinson, MD, Pace, E, Hoffman, P, Dolan, D, Lauderdale, P, et al. Nosocomial legionnaires' disease: aspiration as a primary node of disease acquisition. Am J Med 1993;95:16–22.Google Scholar
15. Venezia, RA, Agresta, MD, Hanley, EM, Urquhart, K, Schoonmaker, D. Nosocomial legionellosis associated with aspiration of nasogastric feedings diluted in tap water. Infect Control Hosp Epidemiol 1994;15:529–533.Google Scholar
16. Stout, J, YU, VL, Vickers, RM, Zuravleff, J, Best, M, Brown, A, et al. Ubiquitousness of Legionella pneumophila in the water supply of a hospital with endemic legionnaires' disease. N Engl J Med 1982;306:466–468.Google Scholar
17. Brenner, DJ. Classification of the legionellae. Semin Respir Infect 1987;2:190–205.Google Scholar
18. Bezanson, G, Burbridge, S, Haidane, D, Yoell, C, Marrie, T. Diverse populations of Legionella pneumophila present in water of geographically clustered institutions served by the same water reservoir. J Clin Microbiol 1992;30:570–576.Google Scholar
19. Doebbeling, BN, Ishak, MA, Wade, BH, Pasquale, MA, Gerszten, RE, Groschel, DH, et al. Nosocomial Legionella mkdadei pneumonia: 10 years experience and a case-control study. J Hosp Infect 1989;13:289–298.CrossRefGoogle ScholarPubMed
20. Nicolle, LE, Bialkowska-Hobrzanska, H, Dyck, B, Seria, L, Parker, S. Molecular epidemiology of Legionella pneumophila at a Canadian tertiary care institution. Canadian Journal of Infectious Diseases 1994;5:157–162.CrossRefGoogle Scholar
21. Stout, JE, Joly, J, Para, M, Plouffe, J, Ciesielski, C, Blaser, MJ, et al. Comparison of molecular methods for subtyping patients and epidemio-logically linked environmental isolates of Legionella pneumophila. J Infect Dis 1988;157:486–495.CrossRefGoogle ScholarPubMed
22. Mamolen, M, Breiman, RF, Barbaree, JM, Gunn, RA, Stone, KM, Spika, JS, et al. Use of multiple molecular subtyping techniques to investigate a legionnaires' disease outbreak due to identical strains at two tourist lodges. J Clin Microbiol 1993;31:2584–2588.Google Scholar
23. Doebbeling, BN, Hollis, RJIsenberg, HD, Wenzel, RP, Pfaller, MA. Restriction fragment analysis of a Candida tropicalis outbreak of sternal wound infections. J Clin Microbiol 1991;29:1268–1270.CrossRefGoogle ScholarPubMed
24. Chetchotisakd, P, Phelps, CL, Hartsten, AI. Assessment of bacterial cross-transmission as a cause of infections in patients in intensive care units. Clin Infect Dis 1994;18:929–937.Google Scholar
25. van Belkum, A, Bax, R, Prevost, G. Comparison of four genotyping assays for epidemiological study of methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1994;13:420–424.Google Scholar
26. Luck, PC, Dinger, E, Helbig, JH, Thurm, V, Keuchel, H, Presch, C, et al. Analysis of Legionella pneumophila strains associated with nosocomial pneumonia in a neonatal intensive care unit. Eur J Clin Microbiol Infect Dis 1994;13:565–571.Google Scholar
27. Luck, PC, Helbig, JH, Gunter, U, Assmann, M, Blau, R, Koch, H, et al. Epidemiologic investigation by macrorestriction analysis and by using monoclonal antibodies of nosocomial pneumonia caused by Legionella pneumophila serogroup 10. J Clin Microbiol 1994;32:2692–2697.Google Scholar
28. Broderick, A, Mori, M, Nettleman, MD, Streed, SA, Wenzel, RP. Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk. Am J Epidemiol 1990;131:734–742.Google Scholar
29. Rodgers, FG, Pasculle, W. Legionella. In: Balows, A, Hausler, WJ Jr, Herrmann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991:442–453.Google Scholar
30. Helms, CM, Massanari, RM, Wenzel, RP, Pfaller, MA, Moyer, NP, Hall, N. Legionnaires' disease associated with a hospital water system. A five-year progress report on continuous hyperchlorination. JAMA 1988;259:2423–2427.Google Scholar
31. Rowbotham, TJ. Isolation of Legionella pneumophila from clinical specimens via amoebae, and the interaction of those and other isolates with amoebae. J Clin Pathol 1983;36:978–986.CrossRefGoogle ScholarPubMed
32. Stout, JE, YU, VL, Best, MG. Ecology of Legionella pneumophila within water distribution systems. Appl Environ Microbiol 1985;49:221–228.CrossRefGoogle ScholarPubMed
33. Marrie, TJ, Haldane, D, Bezanson, G, Peppard, R. Each water outlet is a unique ecological niche for Legionella pneumophila. Epidemiol Infect 1992;108:261–270.CrossRefGoogle ScholarPubMed
34. Dournon, E, Rajagolapan, P. Correlation between monoclonal antibody pattern, serum sensitivity and intracellular growth of Legionella. Presented at the Annual Meeting of the American Society for Microbiology. Atlanta, GA; March 1-6,1987:71. Abstract B-279.Google Scholar
35. Edelstein, PH, Edelstein, MA. Intracellular growth of Legionella pneumophila serogroup 1 monoclonal antibody type 2 positive and negative bacteria. Epidemiol Infect 1993;111:499–502.Google Scholar
36. Fields, BS, Barbaree, JM, Sanden, GN, Morrill, WE. Virulence of a Legionella anisa strain associated with Pontiac fever: an evaluation using protozoan, cell culture, and guinea pig models. Infect Immun 1990;58:3139–3142.CrossRefGoogle ScholarPubMed