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[Nosocomial Legionella pneumophila infection in a nephrology department]
B Gahrn-Hansen1, S A Uldum, J Schmidt
1Odense Universitetshospital, klinisk mikrobiologisk afdeling.
Abstract:
During the autumn and winter of 1993-94 four cases of legionellosis were diagnosed in a Department of Nephrology. Three of the patients were kidney transplanted patients. Two of the patients died. The diagnosis was based on positive culture in two patients and by positive urinary antigen test in the other two patients. Serology was negative for all four patients. Legionella pneumophila was initially found in the cold and hot shower water, in ice-water from the ice machine, from the hot water tank and in the cold water inlet to the building. The isolate from patient no. one and isolates of serogroup 5 from the ice machine and the shower water had identical REA profiles, different from the profiles of the isolate from patient no. four. We concluded that at least one of the four patients was likely to have been infected from the water in the department, either by inhalation of contaminated aerosols from the shower or by aspiration of contaminated ice-water. Precautions were taken to reduce the number of Legionella in the shower- and ice-water. In addition, restrictions in the use of showers and ice-water from the ice machine were introduced.
Insights
Four cases of legionellosis, including kidney transplant patients, occurred in a hospital. Legionella pneumophila was identified in the water systems, suggesting a potential link to patient infections and fatalities.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Environmental Health
Background:
- Legionellosis outbreaks pose significant risks, particularly in healthcare settings.
- Kidney transplant patients are immunocompromised and highly susceptible to infections.
Observation:
- Four cases of legionellosis were diagnosed in a hospital's Nephrology Department during 1993-94.
- Two patients, both kidney transplant recipients, died from the infection.
- Legionella pneumophila was detected in various water sources within the department, including showers and an ice machine.
Findings:
- Diagnostic methods included positive cultures and urinary antigen tests; serology was negative.
- Identical REA profiles were found between isolates from one patient and the water sources (ice machine, shower).
- A different REA profile was observed for the isolate from another patient.
Implications:
- The hospital water system, specifically showers and ice machines, was identified as a likely source of Legionella transmission.
- Infection may have occurred through inhalation of contaminated aerosols or aspiration of contaminated ice-water.
- Implemented control measures included reducing Legionella in water systems and restricting the use of showers and ice-water.