Legionnaires Disease Surveillance in US Department of Veterans Affairs Medical Facilities and Assessment of Health Care Facility Association

Gamage, Shantini D.; Ambrose, Meredith; Kralovic, Stephen M.; Simbartl, Loretta A.; Roselle, Gary A.

doi:10.1001/jamanetworkopen.2018.0230

Cited by 13 publications

(21 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 The incidence of Legionella in the United States is likely under-reported and under-appreciated. 15 Legionella can present with a range of symptoms, from a mild febrile illness to severe septic shock and ARDS, 2 as was demonstrated in these cases. This series is atypical in that all occurred in New England within a six-week span in the late summer to autumn of 2018, but they do not appear to have come from a common source.…”

Section: Discussionmentioning

confidence: 86%

“…This series of four cases illustrates the benefits of initiation of inhaled epoprostenol to facilitate transport of severely hypoxemic patients with ARDS from Legionella pneumonia to tertiary care ECMO centers. Legionnaires' disease, caused by Legionella pneumophila, naturally found in many bodies of water, including both natural and human-made, [14][15][16] causes both community acquired pneumonia and potentially health care acquired pneumonia. 1 The incidence of Legionella in the United States is likely under-reported and under-appreciated.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Inhaled Epoprostenol to Facilitate Safe Transport in Legionnaires’ Disease

Foster¹,

Frakes²,

Puopolo

et al. 2020

Prehosp. Disaster med.

View full text Add to dashboard Cite

Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.

show abstract

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Inhaled Epoprostenol to Facilitate Safe Transport in Legionnaires’ Disease

Foster¹,

Frakes²,

Puopolo

et al. 2020

Prehosp. Disaster med.

View full text Add to dashboard Cite

show abstract

“…The VA has had long-standing policy for preventing LD, including policy initiated in 2008 encouraging routine testing of pneumonia patients for LD [32]. More recent data confirm extensive LD testing in VHA [33], and the policy in effect at the timeframe of this study population likely promoted the diagnosis and therefore availability of a sizable number of LD cases for this analysis. By not being limited to outbreak-associated cases and by using medical records to examine case histories, this study avoided recall bias associated with patient selfreport or recording of health metrics before and after a recognized LD outbreak [34].…”

Section: Plos Onementioning

confidence: 90%

Health after Legionnaires' disease: A description of hospitalizations up to 5 years after Legionella pneumonia

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and objectives Research on Legionnaires’ Disease (LD) suggests there may be long-term health complications, but data are limited. This study investigated whether Intensive Care Unit (ICU) admission during LD hospitalization may be associated with adverse health outcomes and characterized subsequent discharge diagnoses in patients with LD up to 5 years post-LD. Methods We conducted a retrospective case series study with follow up for 5 years among patients hospitalized at a Department of Veterans Affairs (VA) Medical Center between 2005 and 2010 with LD. Data were collected from medical records on health history, LD severity (including ICU admission), and discharge diagnoses for 5 years post-LD or until death. We used ordinal logistic regression to explore associations between ICU admission and hospitalizations post-LD. Frequency counts were used to determine the most prevalent discharge diagnoses in the 5 years post-LD. Results For the 292 patients with laboratory-confirmed LD, those admitted to the ICU during LD hospitalization were more likely to have a greater number of hospitalizations within 5 years compared to non-ICU patients (ORHosp 1.92 CI95% 1.25, 2.95). Fifty-five percent (161/292) had ≥ 1 hospitalization within 5 years post-LD. After accounting for pre-existing diagnosis codes in patients with at least one hospitalization in the 2 years prior to LD (n = 77/161 patients, 47.8%), three of the four most frequent new diagnoses in the 5 years post-LD were non-chronic conditions: acute renal failure (n = 22, 28.6%), acute respiratory failure (n = 17, 22.1%) and unspecified pneumonia (n = 15, 19.5%). Conclusions Our findings indicate that LD requiring ICU admission is associated with more subsequent hospitalizations, a factor that could contribute to poorer future health for people with severe LD. In addition to chronic conditions prevalent in this study population, we found new diagnoses in the 5-year post-LD period including acute renal failure. With LD incidence increasing, more research is needed to understand conditions and factors that influence long term health after LD.

show abstract

“…In 2014, the Veterans Health Administration (VHA) issued an updated directive for the prevention of HCA Legionella infections. 6 Gamage et al 6 report results from their retrospective analysis of the first 3 years of this unique national surveillance program. In many ways, the findings paralleled national trends as reported to the CDC.…”

mentioning

confidence: 99%

“…Most cases (49 805 [94%]) were tested using urine antigen test (335 positive results [0.67%]); the remainder were tested with culture, serology, immunochemistry, or nucleic acid detection.The low and decreasing LD rate among veterans with overnight exposure to VA hospitals and long-term care facilities is a welcome trend and suggests that improved prevention practices may have the desired effect on patient safety. However, confirmation of this speculation will require further investigation, as the study by Gamage et al6 did not collect information regarding facility compliance with the VHA water management policies for prevention and control of Legionella disease.A limitation of this study is the possibility of missed cases of LD. Although administrative reporting at VA facilities appears to have been fairly complete according to the study's validation protocol, the reporting system did not capture cases within the cohort that may have been diagnosed and treated at non-VA facilities.…”

mentioning

confidence: 99%