BACKGROUND: Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit. METHODS: We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella species from those sources. We used an air sampler to in an attempt to detect aerosolized Legionella and pulsed-field gel electrophoresis to compare clinical and environmental isolates. RESULTS: The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered. CONCLUSIONS: This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.
BACKGROUND: Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit. METHODS: We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella species from those sources. We used an air sampler to in an attempt to detect aerosolized Legionella and pulsed-field gel electrophoresis to compare clinical and environmental isolates. RESULTS: The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered. CONCLUSIONS: This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.
Authors: H C Boshuizen; S E Neppelenbroek; H van Vliet; J F Schellekens; J W den Boer; M F Peeters; M A Conyn-van Spaendonck Journal: J Infect Dis Date: 2001-07-16 Impact factor: 5.226
Authors: L G Cordes; A M Wiesenthal; G W Gorman; J P Phair; H M Sommers; A Brown; V L Yu; M H Magnussen; R D Meyer; J S Wolf; K N Shands; D W Fraser Journal: Ann Intern Med Date: 1981-02 Impact factor: 25.391
Authors: Timothy F Jones; Robert F Benson; Ellen W Brown; Jerry R Rowland; Steven C Crosier; William Schaffner Journal: Clin Infect Dis Date: 2003-10-13 Impact factor: 9.079
Authors: Jeroen W Den Boer; Ed P F Yzerman; Joop Schellekens; Kamilla D Lettinga; Hendriek C Boshuizen; Jim E Van Steenbergen; Arnold Bosman; Susan Van den Hof; Hans A Van Vliet; Marcel F Peeters; Ruud J Van Ketel; Peter Speelman; Jacob L Kool; Marina A E Conyn-Van Spaendonck Journal: Emerg Infect Dis Date: 2002-01 Impact factor: 6.883
Authors: Rosalyn E O'Loughlin; Lon Kightlinger; Matthew C Werpy; Ellen Brown; Valerie Stevens; Clark Hepper; Tim Keane; Robert F Benson; Barry S Fields; Matthew R Moore Journal: BMC Infect Dis Date: 2007-08-09 Impact factor: 3.090
Authors: Marcie Tomblyn; Tom Chiller; Hermann Einsele; Ronald Gress; Kent Sepkowitz; Jan Storek; John R Wingard; Jo-Anne H Young; Michael J Boeckh; Michael A Boeckh Journal: Biol Blood Marrow Transplant Date: 2009-10 Impact factor: 5.742
Authors: M Scaturro; S Fontana; S Crippa; M G Caporali; T Seyler; E Veschetti; G Villa; M C Rota; M L Ricci Journal: Epidemiol Infect Date: 2014-11-27 Impact factor: 4.434
Authors: Simon F Thomas; Paul Rooks; Fabian Rudin; Sov Atkinson; Paul Goddard; Rachel M Bransgrove; Paul T Mason; Michael J Allen Journal: PLoS One Date: 2014-12-26 Impact factor: 3.240
Authors: Sally Bloomfield; Martin Exner; Hans-Curt Flemming; Peter Goroncy-Bermes; Philippe Hartemann; Peter Heeg; Carola Ilschner; Irene Krämer; Wolfgang Merkens; Peter Oltmanns; Manfred Rotter; William A Rutala; Hans-Günther Sonntag; Matthias Trautmann Journal: GMS Hyg Infect Control Date: 2015-02-04