Healthcare-Associated Legionnaires’ Disease, Europe, 2008−2017

Beauté, Julien; Plachouras, Diamantis; Sandin, Sven; Giesecke, Johan; Sparén, Pär

doi:10.3201/eid2610.181889

Cited by 23 publications

(23 citation statements)

References 23 publications

(33 reference statements)

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“…This work adds to the limited published surveillance data on HCA LD. Rates of HCA LD and of the specific HCA LD case classifications in this cohort were comparable to previous reports [ 8 , 14 , 16 , 21 ], especially for definite HCA LD (2.9% of all LD cases), which arguably is the classification most likely to be determined at facilities based on the longer contact of the person with a healthcare setting and the more obvious need for a case investigation. Comparison of case rates for possible HCA LD in this work (about 30%) with other reports (typically about 15–20%) is more difficult because of a variability in focus on the identification of such cases, particularly those with only outpatient contact.…”

Section: Discussionsupporting

confidence: 87%

Healthcare-Associated Legionella Disease: A Multi-Year Assessment of Exposure Settings in a National Healthcare System in the United States

et al. 2021

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Healthcare facilities are high-risk environments for Legionella disease (LD), including Legionnaires’ disease, but transmission in these settings is often overlooked. We used the LD database at the U.S. Department of Veterans Affairs (VA) national healthcare system to assess the type of healthcare exposure for LD cases. Cases were extracted from the database for 1 September 2012 through 31 July 2019, focusing on cases with an overnight stay at a VA facility during the 10-day exposure window prior to symptom onset. Patient medical charts were reviewed for demographics and types of healthcare setting exposure(s). There were 99 LD cases in the cohort: 31.3% were classified as having definite VA exposure, 37.4% were classified as possible VA with inpatient exposure, and 31.3% were classified as possible VA with both inpatient and outpatient exposure. For definite VA LD cases, 67.7% had some type of exposure in the long-term care setting. While 63% of the 99 cases had exposure in the acute care setting only, both the long-term care and acute care settings contributed substantially to the total number of exposure days. A review of patient movement during the exposure period showed the variable and sometimes extensive use of the VA system, and it provides insights useful for epidemiologic investigations and potential preventive actions.

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Section: Discussionsupporting

confidence: 87%

Healthcare-Associated Legionella Disease: A Multi-Year Assessment of Exposure Settings in a National Healthcare System in the United States

et al. 2021

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“…Legionnaires' disease (LD) is a major cause of both community-acquired (CA) and hospital-acquired (HA) pneumonia [1][2][3]. Recent data from the European Surveillance System 2008-2017 showed a significant difference in seasonal incidence between HA and CA LD cases.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of Legionnaires’ disease at three Belgian university hospitals, a retrospective study

Moretti

Allard

Dauby

et al. 2021

Acta Clinica Belgica

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Introduction: Legionnaires' disease (LD) is a recognised cause of community-acquired pneumonia. However, Legionella is an overlooked pathogen in hospital-acquired pneumonia. The European Surveillance System 2008-2017 found 23% of the Belgian LD reported cases being healthcare-related, with a higher death-rate than in community-acquired patients. This study aims to describe patients admitted for community-acquired LD or affected by hospitalacquired LD and investigate discriminants associated with lethality. Methods: Medical records were retrospectively reviewed at three Belgian University Hospitals, between 1 January 2016 up to 31 January 2019. Hospital-acquired LD was defined as symptom onset at 10 days or more after admission, according to the Centres for Disease Control and prevention. Community-acquired LD was defined as diagnosis at admission or within 10 days after admission. Results: Fifty patients were included in the study, among them 26% were diagnosed with hospital-acquired LD. The case-fatality rate was 22%, with eight of the eleven deceased patients (73%) being in the hospital-acquired LD group. Medical history of asthma or chronic obstructive pulmonary disease and higher sequential organ failure assessment (SOFA) score at diagnosis were more frequently observed in the hospital-acquired LD group. Furthermore, significantly lower SOFA score at diagnosis of LD and higher rates of treatment with levofloxacin or moxifloxacin were observed in survivors. Conclusion:In the current cohort, LD death-rate was mainly driven by hospital-acquired LD patients. Hospital-acquired LD might especially affect patients with chronic respiratory disease. Respiratory fluoroquinolones treatment and lower SOFA score at diagnosis may be associated with favourable outcomes.

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“…Most of these data are derived from cohort studies or case reports of patients who required admission to hospital. These reports demonstrate striking differences in the number of cases identified in Australia and New Zealand compared with Europe and North America [ 6 , 55 , 56 , 57 , 58 ]. Most cases are sporadic, although clusters of Legionnaires’ disease caused by L. longbeachae have been recognised in Scotland, where six cases of Legionnaires’ disease caused by L. longbeachae were identified over a four-week period in 2013 [ 59 ], and in Sweden, where 30 cases were identified during spring/summer 2018 [ 60 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…The environmental sources of community acquired Legionnaires’ disease has been extensively reviewed [ 97 ]. Nosocomial Legionnaires’ disease with L. micdadei, L. bosemani, L. feelii , and L. anisa has been attributed to infected water distribution systems, including those in hospitals [ 58 , 98 , 99 , 100 ]. L. micdadei has also been identified in ultrasonic nebulisers [ 101 ].…”

Section: Epidemiologymentioning

confidence: 99%

Legionellosis Caused by Non-Legionella pneumophila Species, with a Focus on Legionella longbeachae

et al. 2021

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Although known as causes of community-acquired pneumonia and Pontiac fever, the global burden of infection caused by Legionella species other than Legionella pneumophila is under-recognised. Non-L. pneumophila legionellae have a worldwide distribution, although common testing strategies for legionellosis favour detection of L. pneumophila over other Legionella species, leading to an inherent diagnostic bias and under-detection of cases. When systematically tested for in Australia and New Zealand, L. longbeachae was shown to be a leading cause of community-acquired pneumonia. Exposure to potting soils and compost is a particular risk for infection from L. longbeachae, and L. longbeachae may be better adapted to soil and composting plant material than other Legionella species. It is possible that the high rate of L. longbeachae reported in Australia and New Zealand is related to the composition of commercial potting soils which, unlike European products, contain pine bark and sawdust. Genetic studies have demonstrated that the Legionella genomes are highly plastic, with areas of the chromosome showing high levels of recombination as well as horizontal gene transfer both within and between species via plasmids. This, combined with various secretion systems and extensive effector repertoires that enable the bacterium to hijack host cell functions and resources, is instrumental in shaping its pathogenesis, survival and growth. Prevention of legionellosis is hampered by surveillance systems that are compromised by ascertainment bias, which limits commitment to an effective public health response. Current prevention strategies in Australia and New Zealand are directed at individual gardeners who use potting soils and compost. This consists of advice to avoid aerosols generated by the use of potting soils and use masks and gloves, but there is little evidence that this is effective. There is a need to better understand the epidemiology of L. longbeachae and other Legionella species in order to develop effective treatment and preventative strategies globally.

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Healthcare-Associated Legionnaires’ Disease, Europe, 2008−2017

Cited by 23 publications

References 23 publications

Healthcare-Associated Legionella Disease: A Multi-Year Assessment of Exposure Settings in a National Healthcare System in the United States

Healthcare-Associated Legionella Disease: A Multi-Year Assessment of Exposure Settings in a National Healthcare System in the United States

Clinical features of Legionnaires’ disease at three Belgian university hospitals, a retrospective study

Legionellosis Caused by Non-Legionella pneumophila Species, with a Focus on Legionella longbeachae

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