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Environmental Cultures and Hospital-Acquired Legionnaires' Disease: A 5-Year Prospective Study in 20 Hospitals in Catalonia, Spain

Published online by Cambridge University Press:  02 January 2015

Miquel Sabrià ,
Josep M. Mòdol ,
Marian Garcia-Nuñez ,
Esteban Reynaga ,
Maria L. Pedro-Botet ,
Nieves Sopena  and
C. Rey-Joly
Miquel Sabrià*
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Josep M. Mòdol
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Marian Garcia-Nuñez
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Esteban Reynaga
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Maria L. Pedro-Botet
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
Nieves Sopena
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
C. Rey-Joly
Affiliation:
Infectious Diseases Section, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
*
Unitat de Malalties Infeccioses, Hospital Germans Trias i Pujol, Ctra del Canyet s/n, 08916 Badalona, Barcelona, Spain
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Abstract

Objective:

To determine whether environmental cultures for Legionella increase the index of suspicion for legionnaires' disease (LD).

Design:

Five-year prospective study.

Setting:

Twenty hospitals in Catalonia, Spain.

Methods:

From 1994 to 1996, the potable water systems of 20 hospitals in Catalonia were tested for Legionella, Cases of hospital-acquired LD and availability of an “in-house” Legionella test in the previous 4 years were assessed. After the hospitals were informed of the results of their water cultures, a prospective 5-year-study was conducted focusing on the detection of new cases of nosocomial legionellosis and the availability and use of Legionella testing.

Results:

Before environmental cultures were started, only one hospital had conducted active surveillance of hospital-acquired pneumonia and used Legionella tests including Legionella urinary antigen in all pneumonia cases. Only one other hospital had used the latter test at all. In six hospitals, Legionella tests had been completely unavailable. Cases of nosocomial LD had been diagnosed in the previous 4 years in only two hospitals. During prospective surveillance, 12 hospitals (60%) used Legionella urinary antigen testing in house and 11 (55%) found cases of nosocomial legionellosis, representing 64.7% (11 of 17) of those with positive water cultures. Hospitals with negative water cultures did not find nosocomial LD.

Conclusions:

The environmental study increased the index of suspicion for nosocomial LD. The number of cases of nosocomial LD increased significantly during the prospective follow-up period, and most hospitals began using the Legionella urinary antigen test in their laboratories.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 12 , December 2004 , pp. 1072 - 1076
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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