Edelstein P H
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104-4283.
J Hosp Infect. 1988 Feb;11 Suppl A:182-8. doi: 10.1016/0195-6701(88)90185-5.
Nosocomial Legionnaires' disease is a worldwide problem. The lack of prospective surveys using sensitive diagnostic means, such as culture, has resulted in ignorance about the exact magnitude of the problem except at a handful of individual hospitals. Contaminated hospital hot water systems, cooling towers, and non-sterile tap water used for respiratory therapy may all cause disease. Culture diagnosis is the preferred method of case ascertainment, and provides bacterial isolates which can be used to implicate specific environmental sites using molecular epidemiologic techniques. Environmental culture surveys, done in the absence of known disease, are probably not indicated, but there remains concern that wards housing very high risk patients should be legionella-free. Use of monoclonal antibody typing of environmental isolates of L. pneumophila serogroup 1 may be useful in this regard, as it can possibly detect strains most likely to cause disease. Control of nosocomial disease requires centralized management and consultation by expert engineers, epidemiologists, and microbiologists.
医院获得性军团病是一个全球性问题。除了少数几家医院外，由于缺乏使用如培养等敏感诊断手段进行的前瞻性调查，导致对该问题的确切严重程度一无所知。受污染的医院热水系统、冷却塔以及用于呼吸治疗的非无菌自来水都可能引发疾病。培养诊断是病例确诊的首选方法，它能提供细菌分离株，可利用分子流行病学技术来确定特定的环境来源。在未知疾病的情况下进行环境培养调查可能并无必要，但仍有人担心收治高危患者的病房应无嗜肺军团菌。在这方面，对嗜肺军团菌血清1型环境分离株进行单克隆抗体分型可能会有所帮助，因为它有可能检测出最有可能致病的菌株。控制医院获得性疾病需要由专业工程师、流行病学家和微生物学家进行集中管理和咨询。
