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Potable water and nosocomial Legionnaires' disease – check water from all rooms in which patient has stayed

Published online by Cambridge University Press:  15 May 2009

T. J. Marrie ,
W. Johnson ,
S. Tyler ,
G. Bezanson ,
D. Haldane ,
S. Burbridge  and
J. Joly
T. J. Marrie*
Affiliation:
Departments of MedicineDalhousie University and Victoria General Hospital, Halifax, Nova Scotia Microbiology, Dalhousie University and Victoria General Hospital, Halifax, Nova Scotia
W. Johnson
Affiliation:
Laboratory Center for Disease Control, Tunney's Pasture, Ottawa, Ontario
S. Tyler
Affiliation:
Laboratory Center for Disease Control, Tunney's Pasture, Ottawa, Ontario
G. Bezanson
Affiliation:
Microbiology, Dalhousie University and Victoria General Hospital, Halifax, Nova Scotia
D. Haldane
Affiliation:
Microbiology, Dalhousie University and Victoria General Hospital, Halifax, Nova Scotia
S. Burbridge
Affiliation:
Departments of MedicineDalhousie University and Victoria General Hospital, Halifax, Nova Scotia
J. Joly
Affiliation:
Université Laval, Québec City, Québec
*
* Correspondence to: Dr T.J.Marie, Room 5014 ACC, Victoria General Hospital, 1278 Tower Road. Halifax, N.S., B3H 2Y9.
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We studied 7 patients with nosocomial Legionnaires' disease to determine the relationship between isolates of Legionella pneumophila recovered from potable water and those recovered from patients. Potable water was cultured from all rooms in which patients had stayed prior to the diagnosis of Legionnaires' disease. The 38 isolates of L. pneumophila (31 environmental, 7 patient) were resolved into 9 distinct patterns by pulse-field gel electrophoresis (PFGE), 3 by plasmid content and 2 each with monoclonal antibodies and conventional agarose gel electrophoresis of small fragments of DNA.

Using PFGE it was determined that 4 of the 7 patients were infected with L. pneumophila identical to an isolate recovered from the potable water supply in one of the rooms each had occupied prior to the diagnosis of Legionnaires' disease. Patients had resided in a mean of 3·57 rooms before a diagnosis of nosocomial Legionnaires' disease. We conclude that in the setting of contaminated potable water and nosocomial Legionnaires' disease water from all the rooms which the patient has occupied prior to this diagnosis should be cultured. PFGE of large DNA fragments discriminated best among the isolates of L. pneumophila.

Type
Research Article
Information
Epidemiology & Infection , Volume 114 , Issue 2 , April 1995 , pp. 267 - 276
Copyright
Copyright © Cambridge University Press 1995

References

REFERENCES

1.Fang, G-D, Fine, M, Orloff, J et al. , New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine 1990; 69: 307–16.CrossRefGoogle ScholarPubMed
2.Marrie, TJ, Haldane, D, McDonald, S et al. , Control of endemic nosocomial Legionnaires' disease by using sterile potable water for high risk patients. Epidemiol Infect 1991; 107: 591–605.CrossRefGoogle ScholarPubMed
3.Stout, JE, Yu, VL, Vickers, RM et al. , Ubiquitousness of Legionella pneumophila in the water supply of a hospital with epidemic Legionnaires' disease. N Engl J Med 1982: 206: 466–8.CrossRefGoogle Scholar
4.Helms, CM.Massanari, RM.Wentzel, RP, Pfaller, MA, Moyer, NP, Hall, N. and the Legionella monitoring committee. Legionnaires' disease associated with a hospital water system. A five year progress progress report on continuous hyperchlorination. JAMA 1988: 259: 2423–7.CrossRefGoogle ScholarPubMed
5.Bezanson, GS.Burbridge, S.Haldane, D, Yoell, C.Marrie, TJ. Diverse populations of Legionella pneumphila present in the water of geographically clustered institutions served by the same water reservoir. J Clin Microbiol 1992: 30: 570–6.CrossRefGoogle Scholar
6.Viekers, RM.Stout, JE.Yu, VL.Riks, JD. Manual of culture methodology for Legionella. Semin Respir Infect 1987: 2: 274–9.Google Scholar
7.Cherry, WB.Pittman, B.Harris, PP.Herbert, GA.Thomason, BM.Weaver, RE. Detection of Legionnaires' disease bacteria by direct immunofluorescent staining. J Clin Microbiol 1981: 14: 298–303.Google Scholar
8.Marrie, TJ.Haldane, D, Bezanson, G.Peppard, R. Each water isolate is a unique ecological niche for Legionella pneumophila. Epidemiol Infect 1992; 108: 261–70.CrossRefGoogle ScholarPubMed
9.Joly, JR.Chen, Y-Y.Ramsay, D. Serogrouping and subtyping of Legionella pneumophila with monoclonal antibodies. J Clin Microbiol 1983: 18: 1040–6.CrossRefGoogle ScholarPubMed
10.Rousell, AL.Chabbert, VA. Taxonomy and epidemiology of gram-negative bacterial plasmids studied by DNA-DNA hybridization in formamide. J. Gen Microbiol 1978: 104: 269–76.CrossRefGoogle Scholar
11.Johnson, WM.Bernard, K.Marrie, TJ.Tyler, SD. Discriminating genomic fingerprinting of Legionella pneumophila by pulsed-field electrophoresis. J Clin Microbiol. In press.Google Scholar
12.Schoonmaker, D.Heimberger, T.Birkhead, G. Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophila isolates obtained during a nosocomial outbreak. J Clin Microbiol 1992: 30: 1491–8.CrossRefGoogle ScholarPubMed
13.Stout, JE.Yu, VL.Muraca, P.Joly, J.Troup, N.Tompkins, LA. Potable water as a cause of sporadic cases of community-acquired Legionnaires' disease. New Engl J Med 1992: 326: 151–5.CrossRefGoogle ScholarPubMed
14.Lowry, PW.Blankenship, RJ.Gridly, W, Troup, NJ.Tompkins, LS. A cluster of Legionella sternal wound infections due to post-operative topical exposure to contaminated water. New Engl J Med 1991: 324: 109–13.CrossRefGoogle Scholar
15.Doebbeling, BN.Wenzel, RP. The epidemiology of Legionella pneumophila infections. Semin Respir Infect 1987; 2: 206–21.Google ScholarPubMed
16.Kirby, BD.Snyder, KM.Meyer, RD.Finegold, SM. Legionnaires' disease: Report of sixty-five nosocomially acquired cases and review of the literature. Medicine 1980: 59: 188–205.CrossRefGoogle ScholarPubMed
17.Marrie, TJ.Bezanson, G.Haldane, DJM.Burbridge, S. Colonisaton of the respiratory tract with Legionella pneumophila for 63 days before the onset of pneumonia. J Infect 1992: 24: 81–6.CrossRefGoogle ScholarPubMed
18.Bridge, JA.Edelstein, PH. Oropharyngeal colonization with Legionella pneumophila. J Clin Microbiol 1983: 18: 1108–12.CrossRefGoogle ScholarPubMed
19.Blatt, SP.Parkinson, MD.Pace, E et al. . Nosocomial Legionnaires' disease: aspiration as a primary mode of disease acquisition. Am J med 1993: 95: 16–22.CrossRefGoogle ScholarPubMed
20.Harrison, TG.Saunders, NA.Haththotuwa, A.Hallas, G.Birtles, RJ.Taylor, AG. Phenotypic variation amongst genotypically homogenous Legionella serogroup 1 isolates: implications for the investigation of outbreaks of Legionnaires' disease. Epidemiol Infect 1990: 104: 171–80.CrossRefGoogle ScholarPubMed
21.Tompkins, LS.Troup, NJ.Woods, T.Bibb, W.McKinney, RM. Molecular epidemiology of Legionella species by restriction endonuclease and alloenzyme analysis. J Clin Microbiol 1987; 25: 1875–80.CrossRefGoogle ScholarPubMed
22.Ott, M.Bender, L.Marre, R.Hacker, J. Pulsed field electrophoresis of genomic restriction fragments for the detection of nosocomial Legionella pneumophila in hospital water supplies. J Clin Microbiol 1991: 29: 813–15.CrossRefGoogle ScholarPubMed
23.Gomez-Lus, P.Fields, BS.Benson, RF, Marter, WT.O'Connor, SP.Black, CM. Comparison of arbitrarily primed polvmerase chain reaction, ribotyping. and monoclonal antibody analysis for subtyping Legionella pneumophila serogroup 1. J Clin Microbiol 1993: 31: 1940–2.CrossRefGoogle ScholarPubMed
24.Bialkowska-Hobrzanska, H.Jaskot, D.Hammerberg, O. A method of DNA restriction endonuclease fingerprinting of coagulase-negative staphylococci. J Microbiol Meth 1990: 12: 41–9.CrossRefGoogle Scholar