Legionella has been reported as the single most commonly reported pathogen associated with disease outbreaks from drinking water.
1Two strategies have been proposed for risk assessment. The first is the strategy advocated by the Centers for Disease Control and Prevention (CDC) to search assiduously for Legionnaires' disease in all cases of hospital-acquired pneumonia. However, the diagnosis is commonly missed, even if the Infectious Diseases Society of America and American Thoracic Society guidelines are followed.
- Craun G.F.
- Brunkard J.M.
- Yoder J.S.
- Roberts V.A.
- Carpenter J.
- Wade T.
- et al.
Causes of outbreaks associated with drinking water in the United States from 1971 to 2006.
Clin Microbiol Rev. 2010; 23: 507-528
2Given that the clinical manifestations of Legionnaires' disease are nonspecific, laboratory tests are required for diagnosis. The most accurate test is culture on selective media, which is not widely available.
- Hollenback B.
- Dupont I.
- Mermel L.A.
How often is a work-up for Legionella pursued in patients with pneumonia? A retrospective study.
BMC Infect Dis. 2011; 11: 237
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to American Journal of Infection Control
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Causes of outbreaks associated with drinking water in the United States from 1971 to 2006.Clin Microbiol Rev. 2010; 23: 507-528
- How often is a work-up for Legionella pursued in patients with pneumonia? A retrospective study.BMC Infect Dis. 2011; 11: 237
- Legionellacae in the hospital water supply–epidemiological link with disease and evaluation of a method of control of nosocomial Legionnaires' disease and Pittsburgh pneumonia.Lancet. 1983; 2: 307-310
- Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission.Lancet. 1985; 2: 298-300
- Hospital characteristics associated with colonization of water systems by Legionella and risk of nosocomial Legionnaires' disease: a cohort study of 15 hospitals.Infect Control Hosp Epidemiol. 1999; 20: 798-805
- Environmental cultures and hospital-acquired Legionnaires' disease: a 5-year prospective study in 20 hospitals in Catalonia, Spain.Infect Control Hosp Epidemiol. 2004; 25: 1072-1076
- Prospective three year surveillance for nosocomial and environmental Legionella: implications for infection control.Infect Control Hosp Epidemiol. 2006; 27: 459-465
- Assessing risk of health care-acquired Legionnaires' disease from environmental sampling: the limits of using a strict percent positivity approach.Am J Infect Control. 2012; 40: 917-921
- Approaches to prevention and control of Legionella infection in Allegheny County health care facilities.1997
- Resolving the controversy on environmental cultures for Legionella.Infect Control Hosp Epidemiol. 1998; 19: 63-66
- Cooling towers and legionellosis: a conundrum with proposed solutions.Int J Hyg Environ Health. 2008; 211: 229-234
- Role of environmental surveillance in determining the risk of hospital-acquired legionellosis: a national surveillance study with clinical correlations.Infect Control Hosp Epidemiol. 2007; 28: 818-824
- Efficacy of point-of-entry copper-silver ionization system in eradicating Legionelle pneumophila in a tropical tertiary care hospital: implications for hospitals contaminated with Legionella in both hot and cold water.J Hosp Infect. 2008; 68: 152-158
- Experiences of the first 16 hospitals using copper-silver ionization for Legionella control: implications for the evaluation and other disinfection modalities.Infect Control Hosp Epidemiol. 2003; 24: 563-568
- Safety and efficacy of chlorine dioxide for Legionella control in a hospital water system.Infect Control Hosp Epidemiol. 2007; 28: 1009-1012
- Relationship between colonization of hospital building with Legionella pneumophila and hot water temperatures.Appl Environ Microbiol. 1983; 46: 769-770
- Potable water as a source of Legionnaires' disease.JAMA. 1985; 253: 1412-1416
- Nosocomial legionellosis traced to a contaminated ice machine.Infect Control Hosp Epidemiol. 1998; 18: 637-640
- Legionnaires' disease associated with a hospital water system. A five-year progress report on continuous hyperchlorination.JAMA. 1988; 259: 2423-2427
- A cluster of Legionella sternal wound infections due to postoperative exposure of contaminated tap water.New Engl J Med. 1991; 324: 109-112
- Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods.Infect Control Hosp Epidemiol. 2011; 32: 166-173
- Association of Legionnaires' disease with construction: contamination of potable water?.Infect Control Hosp Epidemiol. 1995; 16: 76-81
- A cluster of nosocomial Legionnaires' disease linked to a contaminated hospital decorative water fountain.Infect Control Hosp Epidemiol. 2009; 30: 764-768
- Control of nosocomial Legionnaires' disease by keeping the circulating hot water temperature above 55 degrees C: experience from a 10-year surveillance program in a district general hospital.J Hosp Infect. 2002; 50: 213-219
- Nosocomial Legionnaires' disease: aspiration as a primary mode of transmission.Am J Med. 1993; 95: 16-22
- Active surveillance of Legionnaires' disease during a prospective observational study of community- and hospital-acquired pneumonia.Infect Control Hosp Epidemiol. 2007; 28: 1085-1088
- Variable bacterial load of Legionella spp. in a hospital water system.Sci Total Environ. 2009; 408: 242-244
- A proactive approach to prevention of healthcare-acquired Legionnaires' disease: the Allegheny County (Pittsburgh) experience.Am J Infect Control. 2005; 33: 360-367
Conflict of interest: None to report.
© 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Response to commentary on “Assessing risk of health care–acquired Legionnaires' disease from environmental sampling: The limits of using a strict percent positivity approach”American Journal of Infection ControlVol. 42Issue 11
- PreviewWe appreciate the commentary from Pierre et al1 regarding our article published in the American Journal of Infection Control in 2012.2 One of our goals was to start a discourse on the utilization of 30% prevalence of Legionella in a hospital water system as a reliable decision point for determining the risk of Legionnaires' disease and subsequent interventions, and we welcome the opportunity to discuss this important issue further. As shown in our article, and will be further demonstrated in this response, this 30% cut-off has been adopted and referenced by various government agencies and peer-reviewed journal articles without critical evaluation since its emergence in 1983.