A Cluster of Legionella Sternal-Wound Infections Due to Postoperative Topical Exposure to Contaminated Tap Water

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Abstract
LEGIONELLA is generally regarded as a pulmonary pathogen and has been responsible for numerous outbreaks of pneumonia in both community and hospital settings.1 2 3 4 5 6 7 Although isolated cases of extrapulmonary legionella infection have been reported,8 9 10 11 12 13 14 15 16 17 nosocomial clusters are very rare. We have previously described seven cases of legionella endocarditis occurring at Stanford University Medical Center,18 but the route of transmission was never established. We now describe three cases of sternal-wound infection with legionella, together with evidence that the infections may have arisen after direct inoculation of legionella into fresh sternal wounds during bathing of patients or dressing changes.