Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy.
Section of Legal Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
Public Health. 2023 Jan;214:31-37. doi: 10.1016/j.puhe.2022.10.027. Epub 2022 Dec 1.
According to current knowledge about legionella transmission, healthcare workers (HCWs) are at an increased risk of exposure. The aim of this research was to systematically review the literature about HCWs' exposure to legionella and establish whether there is an occupational risk.
This was a systematic review and meta-analysis.
PubMed, Scopus and Web of Science were searched to identify studies regarding the occupational risk of legionellosis for HCWs. Keywords used in the search were 'Legionella pneumophila', 'occupational medicine', 'occupational' and 'risk'. Selected studies were reviewed to assess the quality and meta-analysed. Finally, the nine epidemiological principles of Bradford-Hill criteria were used to assess whether legionellosis could be considered an occupational risk for HCWs.
The search strategy retrieved 124 studies, and 10 studies were included in the present review. The overall study quality was low. The pooled odds ratio estimate was 2.45 (95% confidence interval: 1.52-3.96). The assessment using Bradford-Hill criteria showed that only two criteria (plausibility and coherence) were met, which is insufficient to establish an occupational risk.
This systematic review suggests that there is a higher risk of legionella exposure for HCWs, but there is currently no clinical evidence. Further studies with appropriate study design are needed to determine whether legionella infection is an occupational risk for HCWs.
根据目前有关军团菌传播的知识，医护人员（HCWs）接触的风险增加。本研究旨在系统地回顾有关 HCWs 接触军团菌的文献，并确定是否存在职业风险。
这是一项系统回顾和荟萃分析。
在 PubMed、Scopus 和 Web of Science 上搜索有关 HCWs 患军团病的职业风险的研究。搜索中使用的关键词是“嗜肺军团菌”、“职业医学”、“职业”和“风险”。对选定的研究进行了回顾，以评估其质量并进行荟萃分析。最后，使用 Bradford-Hill 标准的九条流行病学原则来评估军团病是否可以被认为是 HCWs 的职业风险。
搜索策略共检索到 124 项研究，其中 10 项研究纳入本综述。整体研究质量较低。汇总的优势比估计值为 2.45（95%置信区间：1.52-3.96）。使用 Bradford-Hill 标准进行评估显示，仅满足两个标准（合理性和一致性），这不足以确定职业风险。
本系统回顾表明，HCWs 接触军团菌的风险较高，但目前尚无临床证据。需要进一步研究设计合理的研究来确定军团菌感染是否是 HCWs 的职业风险。
