Hospital-Wide Eradication of a Nosocomial Legionella pneumophila Serogroup 1 Outbreak

Bartley, Paul B., Ben Zakour, Nouri L., Stanton-Cook, Mitchell, Muguli, Raghuram, Prado, Luis, Garnys, Vyt, Taylor, Katherine, Barnett, Timothy C., Pinna, Glen, Robson, Jennifer, Paterson, David L., Walker, Mark J., Schembri, Mark A. and Beatson, Scott A. (2015) Hospital-Wide Eradication of a Nosocomial Legionella pneumophila Serogroup 1 Outbreak. Clinical Infectious Diseases, 62 3: 273-279. doi:10.1093/cid/civ870

Author Bartley, Paul B.
Ben Zakour, Nouri L.
Stanton-Cook, Mitchell
Muguli, Raghuram
Prado, Luis
Garnys, Vyt
Taylor, Katherine
Barnett, Timothy C.
Pinna, Glen
Robson, Jennifer
Paterson, David L.
Walker, Mark J.
Schembri, Mark A.
Beatson, Scott A.
Title Hospital-Wide Eradication of a Nosocomial Legionella pneumophila Serogroup 1 Outbreak
Formatted title
Hospital-Wide Eradication of a Nosocomial Legionella pneumophila Serogroup 1 Outbreak
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
Publication date 2015-01-01
Year available 2015
Sub-type Article (original research)
DOI 10.1093/cid/civ870
Open Access Status Not Open Access
Volume 62
Issue 3
Start page 273
End page 279
Total pages 7
Place of publication Cary, NC United States
Publisher Oxford University Press
Language eng
Formatted abstract
Background. Two proven nosocomial cases of Legionella pneumonia occurred at the Wesley Hospital (Brisbane, Australia) in May 2013. To trace the epidemiology of these cases, whole genome sequence analysis was performed on Legionella pneumophila isolates from the infected patients, prospective isolates collected from the hospital water distribution system (WDS), and retrospective patient isolates available from the Wesley Hospital and other local hospitals.

Methods. L. pneumophila serogroup 1 isolates were cultured from patient sputum (n=3), endobronchial washings (n=3), pleural fluid (n=1) and the Wesley Hospital WDS (n=39). Whole genome sequencing and de novo assembly allowed comparison with the L. pneumophila Paris reference strain to infer phylogenetic and epidemiological relationships. A rapid disinfection of the hospital WDS with a chlorinated, alkaline detergent, subsequent superchlorination followed by maintenance of residual free chlorine, combined with removal of redundant plumbing, was instituted.

Results. The 2011 and 2013 L. pneumophila patient isolates were serogroup 1 and closely related to all 2013 hospital water isolates based on single nucleotide polymorphisms and mobile genetic element profiles, suggesting a single L. pneumophila population as the source of nosocomial infection. The L. pneumophila population has evolved to comprise three clonal variants, each associated with different parts of the hospital WDS.

Conclusions. This study provides an exemplar for the use of clinical and genomic epidemiological methods together with a program of rapid, effective remedial biofilm, plumbing and water treatment to characterise and eliminate a L. pneumophila population responsible for nosocomial infections.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

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Created: Fri, 23 Oct 2015, 19:42:17 EST by Mrs Louise Nimwegen on behalf of School of Chemistry & Molecular Biosciences