title: The effect of a large Legionnaires' disease outbreak in Southwest Edinburgh on acute and critical care services.
abstract: OBJECTIVE
  The largest outbreak of Legionnaires Disease (LD) in the UK for a decade occurred in Edinburgh in June 2012. We describe the clinical and public health management of the outbreak.
  
  
  METHODS
  Three acute hospitals covering an urban area of ~480,000.
  
  
  METHODS
  Data were collected on confirmed and suspected cases and minutes of the Incident Management Team meetings were reviewed to identify key actions.
  
  
  RESULTS
  Over 1600 urine samples and over 600 sputum samples were tested during the outbreak. 61 patients with pneumonia tested positive for Legionella pneumophila serogroup 1 by urinary antigen detection, culture, respiratory PCR or serology. A further 23 patients with pneumonia were treated as suspected cases on clinical and epidemiological grounds but had no microbiological diagnosis. 36% of confirmed and probable cases required critical care admission. Mean ICU length of stay was 11.3 (±7.6) days and mean hospital length of stay for those who were admitted to ICU was 23.0 (±17.2) days. For all hospitalized patients the mean length of stay was 15.7 (±14) days. In total there were four deaths associated with this outbreak giving an overall case fatality of 6.5%. Hospital and critical care mortality was 6.1% and 9.1%, respectively.
  
  
  CONCLUSIONS
  A significant proportion of patients required prolonged multiple organ support or complex ventilation. Case fatality compared favourably to other recent outbreaks in Europe. Access to rapid diagnostic tests and prompt antibiotic therapy may have mitigated the impact of pre-existing poor health among those affected.
authors: Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK. michael.gillies@ed.ac.uk.
authors: J F
authors: JF
authors: Irons
authors: M J G
authors: MJ
authors: Dunn
authors: K
authors: K
authors: Kefala
authors: S
authors: S
authors: Thorn
authors: F
authors: F
authors: Lakha
authors: D
authors: D
authors: Caesar
authors: D D
authors: DD
authors: Cameron
authors: D
authors: D
authors: McCormick
authors: A
authors: A
authors: McCallum
authors: K O
authors: KO
authors: Helgason
authors: I F
authors: IF
authors: Laurenson
authors: R L
authors: RL
authors: Paterson
authors: A
authors: A
authors: Greening
authors: M
authors: M
authors: Fried
authors: A T
authors: AT
authors: Hill
authors: M
authors: M
authors: Hanson
authors: M A
authors: MA
authors: Gillies
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001509:Bed Occupancy / Q000706:statistics & numerical data; D003422:Critical Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007877:Legionnaires' Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008828:Microbiological Techniques / Q000379:methods; D008875:Middle Aged; D011635:Public Health Administration / Q000379:methods; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D019037:Urban Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents