Mermel L A, Josephson S L, Giorgio C H, Dempsey J, Parenteau S
Department of Medicine, Rhode Island Hospital, Providence 02903, USA.
Infect Control Hosp Epidemiol. 1995 Feb;16(2):76-81. doi: 10.1086/647060.
To describe two cases of nosocomial legionellosis and discuss the epidemiology of this infection.
Potable water was collected from multiple sites. Patient and environmental isolates were characterized by the Legionella slide agglutination test and monoclonal antibody subtyping. Concordance among isolates was confirmed by pulsed-field gel electrophoresis (PFGE).
A 713-bed university-affiliated hospital.
There was widespread contamination of potable water with Legionella pneumophila during a period of major construction; cooling towers were without growth of Legionella. One patient's isolate was the same by PFGE as the environmental isolate collected from the water faucet in his room. Control measures included superheating water used in all patient care areas to 75 degrees C for 72 hours and flushing superheated water through faucets and showers; cleaning shower heads with a sonicator washer; and raising the hot water storage tank temperature from 43 degrees C to 52 degrees C. After these interventions, repeat environmental cultures over the next 6 months were without growth of Legionella, and no further cases of nosocomial legionnaires' disease were documented. An association between legionnaires' disease and construction is postulated. Heightened surveillance and preventive measures may be warranted during periods of excavation on hospital grounds or when potable water supplies are otherwise shut down and later repressurized.
描述两例医院获得性军团菌病病例，并讨论这种感染的流行病学情况。
从多个地点采集饮用水。通过军团菌玻片凝集试验和单克隆抗体分型对患者和环境分离株进行特征分析。通过脉冲场凝胶电泳（PFGE）确认分离株之间的一致性。
一家拥有713张床位的大学附属医院。
在大规模建设期间，饮用水中广泛存在嗜肺军团菌污染；冷却塔未检测到军团菌生长。一名患者的分离株通过PFGE与从其房间水龙头采集的环境分离株相同。控制措施包括将所有患者护理区域使用的水加热至75摄氏度并保持72小时，然后通过水龙头和淋浴喷头冲洗过热的水；用超声清洗机清洁淋浴喷头；将热水储存箱温度从43摄氏度提高到52摄氏度。经过这些干预措施后，在接下来的6个月里重复进行环境培养，未检测到军团菌生长，也未记录到更多医院获得性军团菌病病例。推测军团菌病与建设之间存在关联。在医院场地进行挖掘期间或饮用水供应中断并随后重新加压时，可能需要加强监测和采取预防措施。
