Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study

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Abstract
Most hospitals have yet to record a case of nosocomial Legionnaires'' disease; the importance of isolation of Legionella pneumophila in the water system of such an institution is unclear. A prospective pneumonia study was taken in tandem at a veterans hospital where Legionnaires'' disease was known to be endemic and a community teaching hospital where Legionnaires'' disease had never been documented. Legionella serological tests were performed on all patients with pneumonia; selective culture media and direct fluorescent antibody testing for Legionella were made readily available. Simultaneous environmental surveys for Legionella were performed. At the community hospital, 64% of sites in the water distribution system yielded L. pneumophila; 14.3% of nosocomial pneumonias were Legionnaires'' disease. The epidemologic implications of these findings are discussed. Options concerning case detection and eradication measures in the face of hospital water contamination with L. pneumophila are presented.