Nosocomial Legionellosis in Surgical Patients With Head-and-Neck Cancer: Implications for Epidemiological Reservoir and Mode of Transmission

Johnson, JonasT; Best, MicheleG; Goetz, Angella; Wicker, Helen; Yu, V L; Vickers, Richard M.; Wagner, Robin L.; Woo, Andrew H.

doi:10.1016/s0140-6736(85)90349-6

Cited by 103 publications

(41 citation statements)

References 10 publications

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“…There is considerable evidence from epidemiological and molecular studies that there is a close correlation between nosocomial infections caused by Legionella (3,10,12,14) and P. aeruginosa (4,17,18,20,25,26) and contaminated tap water in ICUs. The present study focused on whether this link includes other NFGNB as well.…”

Section: Discussionmentioning

confidence: 99%

Association between Contaminated Faucets and Colonization or Infection by Nonfermenting Gram-Negative Bacteria in Intensive Care Units in Taiwan

et al. 2009

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This study was designed to determine the strength of the association between the isolation of nonfermentative gram-negative bacilli (NFGNB) from tap water faucet aerators and the prevalence of colonization or infection of patients in intensive care units (ICUs). Surveillance cultures were obtained during a 4-month period from 162 faucet aerators located in seven different ICUs. The prevalence of colonization or infection of ICU patients with NFGNB was determined by prospective surveillance during the same period. Fifty four (33%) of the faucet aerators contained NFGNB. Among the 66 NFGNB isolated from faucet aerators, the most frequently encountered ones were Sphingomonas paucimobili (26 isolates), Pseudomonas aeruginosa (14 isolates), Chryseobacterium meningosepticum (13 isolates), Achromobacter xylosoxidans (6 isolates), Burkholderia cepacia (4 isolates), and Stenotrophomonas maltophilia (3 isolates). Acinetobacter baumannii was not recovered. The most common NFGNB isolated from ICU patients were P. aeruginosa and A. baumannii. There was a significant correlation between the overall prevalence of NFGNB in faucet aerators and their prevalence in exposed ICU patients (Spearman r ‫؍‬ 0.821, P ‫؍‬ 0.02). There was also a significant correlation between the prevalence of C. meningosepticum in faucet aerators and its prevalence among ICU patients (Spearman r ‫؍‬ 0.847, P ‫؍‬ 0.016). The electrokaryotypes of four clinical isolates of C. meningosepticum were similar to those of faucet isolates. Measures directed at making the water supply safe may prevent infection by C. meningosepticum and other waterborne pathogens.Nosocomial infections caused by nonfermentative gram-negative bacilli (NFGNB) are increasing in intensive care units (ICUs) (19,20,27). Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia account for most endemic infections. Outbreaks by other NFGNB such as Chryseobacterium spp. and Sphingomonas spp. are particularly troublesome (19,20,27).Hospital water has been shown to be a significant source of health care-associated infections caused P. aeruginosa in ICUs (4,15,17,18,25,26). Trautmann et al. (24) reported that P. aeruginosa could be frequently recovered from tap water outlets in ICUs and that the same genotypes were recovered from colonized or infected patients (24). Anaissie et al. estimated that 1,400 deaths occur each year in the United States as a result of waterborne nosocomial pneumonias caused by P. aeruginosa (1). Chlorinated tap water in hospitals often contains low levels of Legionella, P. aeruginosa, other NFGNB, mycobacteria, and Aspergillus (2,7,23,24,29). Assurance of a safe water supply is therefore an essential component of infection control in ICUs.During a recent investigation to determine the source of an outbreak of multidrug-resistant A. baumannii in an ICU, we cultured tap water faucets. P. aeruginosa and numerous other NFGNB, including Chryseobacterium meningosepticum, A. xylosoxidans, and Sphingomonas paucimobilis, were recovered. A. baumannii co...

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Section: Discussionmentioning

confidence: 99%

Association between Contaminated Faucets and Colonization or Infection by Nonfermenting Gram-Negative Bacteria in Intensive Care Units in Taiwan

et al. 2009

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“…Aspiration of oropharyngeal contents has also been suggested as a possibility, because the frequency of nosocomial pneumonia has been low in patients who have had a laryngectomy and therefore no communication between the lower and upper respiratory tracts (143). It is difficult to exclude this possibility.…”

Section: Route Of Infectionmentioning

confidence: 99%

Legionnaires disease: historical perspective

1988

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In the summer of 1976, a mysterious epidemic of fatal respiratory disease in Philadelphia launched an intensive investigation that resulted in the definition of a new family of pathogenic bacteria, the Legionellaceae. In retrospect, members of the family had been isolated from clinical specimens as early as 1943. Unsolved epidemics of acute respiratory disease dating to the 1950s were subsequently attributed to the newly described pathogens. In the intervening years, the Legionellaceae have been firmly established as important causes of sporadic and epidemic respiratory disease. The sources of the infecting bacteria are environmental, and geographic variation in the frequency of infection has been documented. Airborne dissemination of bacteria from cooling towers and evaporative condensers has been responsible for some epidemics, but potable water systems are perhaps more important sources. The mode of transmission from drinking water is unclear. The Legionellaceae are gram-negative, facultative, intracellular pathogens. The resident alveolar macrophage, usually an effective antibacterial defense, is the primary site of growth. Cell-mediated immunity appears to be the most important immunological defense; the role of humoral immunity is less clear. Erythromycin remains the antibiotic of choice for therapy of infected patients, but identification and eradication of environmental sources are also essential for the control of infection.

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“…The true incidence of nosocomial infections is not known; however, some series have demonstrated that Legionella species can account for up to 30% of nosocomial pneumonias. 1,2 Despite increased awareness of and advances in the treatment of these infections, the mortality rate for nosocomial Legionella pneumonia remains in the range of 35% to 40%. 3,4 Furthermore, cases of nosocomial legionnaires' disease can be a source of negative publicity and litigation for hospitals because these infections are generally believed to be preventable.…”

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confidence: 99%

A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply

Srinivasan

Bova

Ross

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To assess the safety and efficacy of a chlorine dioxide water treatment system in controlling Legionella in a hospital water supply.Design:For 17 months following installation of the system, we performed regular water cultures throughout the building, assessed chlorine dioxide and chlorite levels, and monitored metal corrosion.Results:Sites that grew Legionella species decreased from 41% at baseline to 4% (P = .001). L. anisa was the only species recovered and it was found in samples of both hot and cold water. Levels of chlorine dioxide and chlorite were below Environmental Protection Agency (EPA) limits for these chemicals in potable water. Further, enhanced carbon filtration effectively removed the chemicals, even at chlorine dioxide levels of more than twice what was used to treat the water. After 9 months, corrosion of copper test strips exposed to the chlorine dioxide was not higher than that of control strips. During the evaluation period, there were no cases of nosocomial Legionella in the building with the system, whereas there was one case in another building.Conclusions:Our results indicate that operation of a chlorine dioxide system effectively removed Legionella species from a hospital water supply. Furthermore, we found that the system was safe, as levels of chlorine dioxide and chlorite were below EPA limits. The system did not appear to cause increased corrosion of copper pipes. Our results indicate that chlorine dioxide may hold promise as a solution to the problem of Legionella contamination of hospital water supplies.

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Nosocomial Legionellosis in Surgical Patients With Head-and-Neck Cancer: Implications for Epidemiological Reservoir and Mode of Transmission

Cited by 103 publications

References 10 publications

Association between Contaminated Faucets and Colonization or Infection by Nonfermenting Gram-Negative Bacteria in Intensive Care Units in Taiwan

Association between Contaminated Faucets and Colonization or Infection by Nonfermenting Gram-Negative Bacteria in Intensive Care Units in Taiwan

Legionnaires disease: historical perspective

A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply

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