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Legionella prosthetic-valve endocarditis.

L S Tompkins¹, B J Roessler, S C Redd

¹Department of Medicine, Stanford University, Calif.

The New England Journal of Medicine

|March 3, 1988

Summary

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Legionella bacteria caused prosthetic-valve endocarditis in seven patients, likely acquired during surgery. This highlights Legionella as a cause of culture-negative endocarditis.

Area of Science:

Infectious Diseases
Cardiology
Hospital Epidemiology

Background:

Prosthetic-valve endocarditis (PVE) is a serious complication following cardiac surgery.
Legionella species are known causes of pneumonia but rarely implicated in PVE.

Purpose of the Study:

To investigate clinical features and risk factors of PVE caused by Legionella species.
To determine the source and transmission of Legionella in PVE cases.

Main Methods:

Case series of seven patients with Legionella PVE.
Case-control study to identify risk factors.
Molecular techniques (genotyping) to compare patient isolates with environmental isolates.

Main Results:

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All patients presented with chronic symptoms (fever, weight loss, anemia) 3-19 months post-surgery.

Post-cardiomyotomy syndrome was a significant risk factor (P < 0.013).

Molecular analysis confirmed nosocomial acquisition from hospital drinking water (L. pneumophila) and a unique hospital strain (L. dumoffii).

Conclusions:

Legionella PVE is a nosocomially acquired infection, often occurring perioperatively.
Legionella should be considered in culture-negative endocarditis, expanding the known spectrum of Legionella-associated diseases.
Infection control measures targeting hospital water systems are crucial.