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Nosocomial legionnaires disease in a children's hospital
1Department of Pediatrics and Preventive Medicine, Ohio State University College of Medicine, Columbus.
Insights
Hospital-acquired Legionnaires disease in children was linked to contaminated water sources like showers and aerosol equipment. Preventive measures, including prohibiting immunocompromised children from showering, halted new cases.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Hospital Epidemiology
Background:
- Legionella pneumophila is a cause of hospital-acquired pneumonia (HAP).
- Nosocomial infections pose significant risks, especially in pediatric populations.
- Identifying sources of hospital-acquired infections is crucial for patient safety.
Purpose of the Study:
- To investigate an outbreak of Legionnaires disease in a pediatric hospital.
- To identify the source and transmission routes of Legionella pneumophila.
- To implement control measures to prevent further nosocomial infections.
Main Methods:
- Retrospective case series of seven pediatric patients with hospital-acquired pneumonia.
- Epidemiological investigation including patient demographics, clinical presentation, and risk factors.
- Environmental sampling of potable water, aerosol equipment, and shower facilities.
Main Results:
- Seven pediatric patients developed Legionnaires disease between 1982 and 1985.
- Common risk factors included immunosuppression and chronic lung/kidney disease.
- L. pneumophila was identified in hospital potable water; showers and aerosol equipment were implicated sources.
- Four patients required mechanical ventilation; six improved with erythromycin and/or rifampin therapy.
- One patient died from persistent lung disease.
Conclusions:
- Contaminated potable water in hospital showers and aerosol equipment can lead to nosocomial Legionnaires disease in children.
- Implementing strict water safety protocols, including prohibiting showers for immunocompromised patients and using sterile water for equipment, effectively prevented further cases.
Abstract:
Between August 1982 and December 1985, seven patients at a children's hospital developed hospital-acquired pneumonia caused by Legionella pneumophila. Demographic data included the following: mean age 12.3 years (range 9 months to 20.5 years); male/female ratio 5:2; all patients were white. Some previously identified risk factors present in our patients included high-dose corticosteroid therapy (five patients), other immunosuppressive therapy (four), and chronic lung (five) or kidney (three) disease. Symptoms and signs included rapid onset, fever, cough, pleuritic chest pain, dyspnea, abdominal pain, diarrhea, and headache. Rhinitis, myalgia, and neurologic abnormalities were not noted. Chest roentgenograms revealed single-lobe consolidation in three patients, diffuse bilateral alveolar infiltrates in three, and pleural effusion in three. All patients were treated with erythromycin; three patients also received rifampin. Tracheal intubation and mechanical ventilation were required by four patients. Six patients improved after therapy. One child died of persistent lung disease 1 month after the onset of legionnaires disease. L. pneumophila was isolated from potable water in the hospital. Aerosol equipment cleansed with tap water and the showers were implicated as means of exposure by patients to contaminated potable water. No new nosocomial cases were seen after immunocompromised children were prohibited from taking showers, and sterile water was used to cleanse equipment for administering aerosol medications.