caa a22 4500 388032758 CHVBK 20180307124956.0 cr unu---uuuuu 161130e199812 xx s 000 0 eng 10.1086/647761 doi S0195941700092092 pii (NATIONALLICENCE)cambridge-10.1086/647761 A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System [Elektronische Daten] Abstract Background: In 1994, a hospital reported an increase in nosocomial legionnaires' disease after implementing use of a rapid urinary antigen test for Legionella pneumophila serogroup 1 (Lp-1). This hospital was the site of a previous nosocomial legionnaires' disease outbreak during 1980 to 1982. Methods: Infection control records were reviewed to compare rates of nosocomial pneumonia and the proportion of cases attributable to legionnaires' disease during the 1994 outbreak period with those during the same period in 1993. Water samples were collected for Legionella culture from the hospital's potable water system and cooling towers, and isolates were subtyped by monoclonal antibody (MAb) testing and arbitrarily primed polymerase chain reaction (AP-PCR). Results: Nosocomial pneumonia rates were similar from April through October 1993 and April through October 1994: 5.9 and 6.6 per 1,000 admissions, respectively (rate ratio [RR], 1.1; P=.56); however, 3.2% of nosocomial pneumonias were diagnosed as legionnaires' disease in 1993, compared with 23.9% in 1994 (RR, 9.4; P<.001). In 1994, most legionnaires' disease cases were detected by the urinary antigen testing alone. MAb testing and AP-PCR demonstrated identical patterns among Lp-1 isolates recovered from a patient's respiratory secretions, the hospital potable water system, and stored potable water isolates from the 1980 to 1982 outbreak. Conclusions: There may have been persistent transmission of nosocomial legionnaires' disease at this hospital that went undiscovered for many years because there was no active surveillance for legionnaires' disease. Introduction of a rapid urinary antigen test improved case ascertainment. Legionella species can be established in colonized plumbing systems and may pose a risk for infection over prolonged periods. Copyright © The Society for Healthcare Epidemiology of America 1998 Lepine Lisa A. Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Jernigan Daniel B. Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Butler Jay C. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Pruckler Janet M. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Benson Robert F. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Kim Grace St Vincent's Medical Center, Bridgeport, Connecticut Hadler James L. Connecticut Department of Public Health, Hartford, Connecticut Cartter Matthew L. Connecticut Department of Public Health, Hartford, Connecticut Fields Barry S. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Infection Control & Hospital Epidemiology Cambridge University Press 19/12(1998-12), 905-910 0899-823X 19:12<905 1998 19 ICE https://doi.org/10.1086/647761 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1086/647761 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lepine Lisa A. Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia NATIONALLICENCE 700 1- Jernigan Daniel B. Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia NATIONALLICENCE 700 1- Butler Jay C. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia NATIONALLICENCE 700 1- Pruckler Janet M. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia NATIONALLICENCE 700 1- Benson Robert F. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia NATIONALLICENCE 700 1- Kim Grace St Vincent's Medical Center, Bridgeport, Connecticut NATIONALLICENCE 700 1- Hadler James L. Connecticut Department of Public Health, Hartford, Connecticut NATIONALLICENCE 700 1- Cartter Matthew L. Connecticut Department of Public Health, Hartford, Connecticut NATIONALLICENCE 700 1- Fields Barry S. Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia NATIONALLICENCE 773 0- Infection Control & Hospital Epidemiology Cambridge University Press 19/12(1998-12), 905-910 0899-823X 19:12<905 1998 19 ICE CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-cambridge