Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
QJM. 2013 Dec;106(12):1087-94. doi: 10.1093/qjmed/hct167. Epub 2013 Aug 22.
The largest outbreak of Legionnaires Disease (LD) in the UK for a decade occurred in Edinburgh in June 2012. We describe the clinical and public health management of the outbreak.
Three acute hospitals covering an urban area of ~480,000.
Data were collected on confirmed and suspected cases and minutes of the Incident Management Team meetings were reviewed to identify key actions.
Over 1600 urine samples and over 600 sputum samples were tested during the outbreak. 61 patients with pneumonia tested positive for Legionella pneumophila serogroup 1 by urinary antigen detection, culture, respiratory PCR or serology. A further 23 patients with pneumonia were treated as suspected cases on clinical and epidemiological grounds but had no microbiological diagnosis. 36% of confirmed and probable cases required critical care admission. Mean ICU length of stay was 11.3 (±7.6) days and mean hospital length of stay for those who were admitted to ICU was 23.0 (±17.2) days. For all hospitalized patients the mean length of stay was 15.7 (±14) days. In total there were four deaths associated with this outbreak giving an overall case fatality of 6.5%. Hospital and critical care mortality was 6.1% and 9.1%, respectively.
A significant proportion of patients required prolonged multiple organ support or complex ventilation. Case fatality compared favourably to other recent outbreaks in Europe. Access to rapid diagnostic tests and prompt antibiotic therapy may have mitigated the impact of pre-existing poor health among those affected.
2012 年 6 月，英国爱丁堡爆发了十年来最大规模的军团病疫情。我们描述了此次疫情的临床和公共卫生管理情况。
三家覆盖约 48 万人口的城市地区的急性医院。
对确诊和疑似病例进行数据收集，并对事件管理团队会议记录进行回顾，以确定关键行动。
在疫情期间，共检测了 1600 多份尿液样本和 600 多份痰液样本。通过尿抗原检测、培养、呼吸道 PCR 或血清学检测，61 例肺炎患者血清群 1 型嗜肺军团菌检测呈阳性。另有 23 例肺炎患者因临床和流行病学原因被视为疑似病例，但无微生物学诊断。36%的确诊和可能病例需要重症监护入院。重症监护病房的平均住院时间为 11.3（±7.6）天，入住 ICU 的患者平均住院时间为 23.0（±17.2）天。所有住院患者的平均住院时间为 15.7（±14）天。此次疫情共导致 4 人死亡，总病死率为 6.5%。医院和重症监护病房的死亡率分别为 6.1%和 9.1%。
相当一部分患者需要长时间的多器官支持或复杂的通气。病死率与欧洲最近的其他几次疫情相比较为有利。快速诊断测试和及时的抗生素治疗的应用可能减轻了受影响人群中原有健康状况不佳的影响。
