title: Genotypic and phenotypic methods for the investigation of a nosocomial Legionella pneumophila outbreak and efficacy of control measures.
abstract: To determine the source of a nosocomial outbreak of Legionella pneumophila serogroup 1 infection and the efficacy of control measures, clinical and environmental isolates were characterized by molecular subtyping and disease surveillance was conducted. The outbreak involved 32 cases (relative risk, 4.0; P less than .001 vs. previous period). Water colonization with L. pneumophila serogroup 1 and patients' exposure to faucet use incriminated the water system as the environmental source. Monoclonal antibody typing showed that patient isolates belonged mainly to type Pontiac and water isolates mainly to type Bellingham (P less than .001). By four genotypic techniques, outbreak-related isolates from patients and the water system were found to be clonally related and distinct from control strains (P less than .001). Heat and UV light treatment of the water system showed a protective efficacy of 88% (95% confidence interval, 75%-94%). These findings indicate that phenotypic variation may interfere with monoclonal antibody typing of legionellae and that waterborne legionellosis can be controlled by physical disinfection.
authors.affiliation: Hospital Epidemiology and Infection Control Unit, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
authors.forename: M J
authors.initials: MJ
authors.lastname: Struelens
authors.forename: N
authors.initials: N
authors.lastname: Maes
authors.forename: F
authors.initials: F
authors.lastname: Rost
authors.forename: A
authors.initials: A
authors.lastname: Deplano
authors.forename: F
authors.initials: F
authors.lastname: Jacobs
authors.forename: C
authors.initials: C
authors.lastname: Liesnard
authors.forename: N
authors.initials: N
authors.lastname: Bornstein
authors.forename: F
authors.initials: F
authors.lastname: Grimont
authors.forename: S
authors.initials: S
authors.lastname: Lauwers
authors.forename: M P
authors.initials: MP
authors.lastname: McIntyre
mesh_terms: D001530:Belgium / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks; D005838:Genotype; D006801:Humans; D007108:Immune Tolerance; D016952:Legionella pneumophila / Q000145:classification*; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D010641:Phenotype; D015183:Restriction Mapping; D012189:Retrospective Studies; D012703:Serotyping; D014871:Water Microbiology; D014881:Water Supply / Q000592:standards