Legionella in the hospital water supply: a plea for decision making based on evidence-based medicine.

摘要: Hospital-acquired legionnaires’ disease has become a global public health issue. In this issue of Infection Control and Hospital Epidemiology, Sabria et al present the most comprehensive environmental surveillance to date for Legionella in hospitals.1 The key findings from 20 Barcelona hospitals were as follows: (1) pneumophila was isolated 85% (17/20) hospital potable hot-water systems; (2) L serogroup 1 not common serotype positive hospitals; (3) each had its own unique DNA subtype pneumophila. overall risk acquisition is multifactorial, with host susceptibility (immunosuppressed patients, especially organ transplant recipients elderly patients chronic lung disease, are at highest risk) degree colonization within water supply important factors. Interestingly, assessments based on quantitation (colony-forming units) distal sites (water faucets, showerheads) predictive hospitalacquired infection.2-4 On other hand, percentage that directly correlates incidence disease; greater yielding Legionella, more likely cases will occur. converse also appears true. If there no supply, then Oftentimes when lay media get wind an outbreak hospital-acquired wave negative publicity can occur, financial repercussions unfortunate loss malpractice suits. aware inhabitant man-made distribution systems. Their incorrect assumption unwelcome invader poorly maintained system negligence plays role presence. This becomes ironic, because only few have diagnostic tests available give knowledgeable physician high index suspicion capability diagnosing disease. These their physicians should be congratulated instead maligned. hospitals, legionellosis goes undiagnosed, mortality incorrectly attributed causes. For example, European Georges Pompidou Paris recently experienced 12 over 8-month period. fault placed “low-quality galvanized steel” used pipes, lack heating platforms keep 55°C every level, factors.5 It would been interesting if survey performed Paris. We suspect unfairly singled out blame. Certainly, problems identified news article scientifically validated factors colonization, much $1.35 million spent may little effect colonization. Although surveys Nova Scotia United Kingdom 23% 12%, respectively,6,7 studies show higher rates, Centers Disease Prevention (CDC) study showing 100% San Antonio hospitals.3 “does lead legionellosis?” There persuasive data it does; least six controlled document occurrence after discovering supply.8-12 CDC intimated cultures prompt “a false sense security.”13 Where evidence supports statement? Only inadequately or laboratory isolation samples results unreli-