Two Nursing Home Outbreaks of Respiratory Infection with Legionella sainthelensi
Identifieur interne : 001D19 ( Main/Exploration ); précédent : 001D18; suivant : 001D20Two Nursing Home Outbreaks of Respiratory Infection with Legionella sainthelensi
Auteurs : Mark Loeb [Canada] ; Simor [Canada] ; Lionel Mandell [Canada] ; Paul Krueger [Canada] ; Margaret Mcarthur [Canada] ; Marilyn James [Canada] ; Stephen Walter [Canada] ; Elizabeth Richardson [Canada] ; Michael Lingley [Canada] ; Janet Stout [États-Unis] ; David Stronach [Canada] ; Allison Mcgeer [Canada]Source :
- Journal of the American Geriatrics Society [ 0002-8614 ] ; 1999-05.
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Abstract
OBJECTIVE: To describe outbreaks of infection caused by Legionella sainthelensi occurring in older residents of two nursing homes and to determine risk factors for the development of infection. DESIGN: Descriptive epidemiology and a case‐control study. SETTING: Two nursing homes (140 beds and 254 beds in nursing homes A and B, respectively) located in southern Ontario, Canada, experiencing outbreaks of respiratory tract infection in July and August 1994. SUBJECTS: Case‐residents of the two nursing homes who met clinical and laboratory criteria for Legionella infection. Control‐residents were defined as those who were in the homes during the outbreaks and were asymptomatic. MEASUREMENTS: Active surveillance was conducted in both nursing homes to identify symptomatic residents. Residents with fever or respiratory tract symptoms had nasopharyngeal swabs taken for viral antigen detection and culture, urine for Legionella antigen detection, and acute and convalescent serology for viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella. Chest X‐rays were performed, and an attempt was made to obtain blood and sputum cultures. Water samples from shower heads, faucets, and air conditioning units were collected for Legionella culture and polymerase chain reaction (PCR) assay. A case‐control study was done to assess possible risk factors for legionellosis. RESULTS: Twenty‐nine cases — 17 in nursing home A; 12 in nursing home B — were identified. Four (14%) case‐residents had documented pneumonia and four case‐residents died. Univariate analysis revealed that a history of stroke (odds ratio (OR) 2.3 (95% CI, 1.0–5.3)), eating pureed food (OR 4.6 (95% CI, 1.6–12.7)), and having fluids administered with medication (OR 2.5 (95% CI, 1.0–5.9)) were significant risk factors. Cases were less likely to wear dentures (OR .4 (95% CI, .2‐.9)) or to eat solid food (OR .3, (95% CI, .1‐.6)). Only eating pureed food remained significant in a multivariable analysis (OR 4.6 (95% CI, 1.6–13.0, P = .01)). CONCLUSION: This report describes outbreaks of legionellosis in two nursing homes, representing the first reported outbreaks of infection caused by Legionella sainthelensi. The association with illness of dietary characteristics indicative of swallowing disorders suggests that aspiration was the most likely mode of infection. The diagnosis of legionellosis should be considered during outbreaks of respiratory infection in nursing homes. J Am Geriatr Soc 47:547–552, 1999.
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DOI: 10.1111/j.1532-5415.1999.tb02568.x
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sortKey="Walter, Stephen" sort="Walter, Stephen" uniqKey="Walter S" first="Stephen" last="Walter">Stephen Walter</name></author><author><name sortKey="Richardson, Elizabeth" sort="Richardson, Elizabeth" uniqKey="Richardson E" first="Elizabeth" last="Richardson">Elizabeth Richardson</name></author><author><name sortKey="Lingley, Michael" sort="Lingley, Michael" uniqKey="Lingley M" first="Michael" last="Lingley">Michael Lingley</name></author><author><name sortKey="Stout, Janet" sort="Stout, Janet" uniqKey="Stout J" first="Janet" last="Stout">Janet Stout</name></author><author><name sortKey="Stronach, David" sort="Stronach, David" uniqKey="Stronach D" first="David" last="Stronach">David Stronach</name></author><author><name sortKey="Mcgeer, Allison" sort="Mcgeer, Allison" uniqKey="Mcgeer A" first="Allison" last="Mcgeer">Allison Mcgeer</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno 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sortKey="Simor" sort="Simor" uniqKey="Simor" last="Simor">Simor</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Department of Microbiology, Sunny‐brook Health Science Centre, North York, Ontario, and the University of Toronto, Toronto</wicri:cityArea></affiliation><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Department of Medicine, Baycrest Centre for Geriatric Care, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Mandell, Lionel" sort="Mandell, Lionel" uniqKey="Mandell L" first="Lionel" last="Mandell">Lionel Mandell</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Division of Infectious Diseases, Hamilton Civic Hospitals and McMaster University, Hamilton</wicri:cityArea></affiliation></author><author><name sortKey="Krueger, Paul" sort="Krueger, Paul" uniqKey="Krueger P" first="Paul" last="Krueger">Paul Krueger</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Hamilton‐Wenfworth Department of Public‐Health Services, Hamilton</wicri:cityArea></affiliation></author><author><name sortKey="Mcarthur, Margaret" sort="Mcarthur, Margaret" uniqKey="Mcarthur M" first="Margaret" last="Mcarthur">Margaret Mcarthur</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Department of Infection Control, Mount Sinai and Princess Margaret Hospitals, the University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="James, Marilyn" sort="James, Marilyn" uniqKey="James M" first="Marilyn" last="James">Marilyn James</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Hamilton‐Wenfworth Department of Public‐Health Services, Hamilton</wicri:cityArea></affiliation></author><author><name sortKey="Walter, Stephen" sort="Walter, Stephen" uniqKey="Walter S" first="Stephen" last="Walter">Stephen Walter</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</wicri:cityArea></affiliation></author><author><name sortKey="Richardson, Elizabeth" sort="Richardson, Elizabeth" uniqKey="Richardson E" first="Elizabeth" last="Richardson">Elizabeth Richardson</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Halton Regional Health Department, Oakville</wicri:cityArea></affiliation></author><author><name sortKey="Lingley, Michael" sort="Lingley, Michael" uniqKey="Lingley M" first="Michael" last="Lingley">Michael Lingley</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Department of Medicine, Hamilton Civic Hospitals and McMaster University, Hamilton</wicri:cityArea></affiliation></author><author><name sortKey="Stout, Janet" sort="Stout, Janet" uniqKey="Stout J" first="Janet" last="Stout">Janet Stout</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Veteran's Administration Medical Center and University of Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Stronach, David" sort="Stronach, David" uniqKey="Stronach D" first="David" last="Stronach">David Stronach</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Halton Regional Health Department, Oakville</wicri:cityArea></affiliation></author><author><name sortKey="Mcgeer, Allison" sort="Mcgeer, Allison" uniqKey="Mcgeer A" first="Allison" last="Mcgeer">Allison Mcgeer</name><affiliation wicri:level="2"><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Department of Infection Control, Mount Sinai and Princess Margaret Hospitals, the University of Toronto, Toronto</wicri:cityArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the American Geriatrics Society</title><idno type="ISSN">0002-8614</idno><idno type="eISSN">1532-5415</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="1999-05">1999-05</date><biblScope unit="volume">47</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="547">547</biblScope><biblScope unit="page" to="552">552</biblScope></imprint><idno type="ISSN">0002-8614</idno></series><idno type="istex">57FEBC03225BB8A4C3BAA84CCF43447FB0B681C3</idno><idno type="DOI">10.1111/j.1532-5415.1999.tb02568.x</idno><idno type="ArticleID">JGS2568</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-8614</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>legionellosis</term><term>nursing home infections</term><term>pneumonia</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE: To describe outbreaks of infection caused by Legionella sainthelensi occurring in older residents of two nursing homes and to determine risk factors for the development of infection. DESIGN: Descriptive epidemiology and a case‐control study. SETTING: Two nursing homes (140 beds and 254 beds in nursing homes A and B, respectively) located in southern Ontario, Canada, experiencing outbreaks of respiratory tract infection in July and August 1994. SUBJECTS: Case‐residents of the two nursing homes who met clinical and laboratory criteria for Legionella infection. Control‐residents were defined as those who were in the homes during the outbreaks and were asymptomatic. MEASUREMENTS: Active surveillance was conducted in both nursing homes to identify symptomatic residents. Residents with fever or respiratory tract symptoms had nasopharyngeal swabs taken for viral antigen detection and culture, urine for Legionella antigen detection, and acute and convalescent serology for viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella. Chest X‐rays were performed, and an attempt was made to obtain blood and sputum cultures. Water samples from shower heads, faucets, and air conditioning units were collected for Legionella culture and polymerase chain reaction (PCR) assay. A case‐control study was done to assess possible risk factors for legionellosis. RESULTS: Twenty‐nine cases — 17 in nursing home A; 12 in nursing home B — were identified. Four (14%) case‐residents had documented pneumonia and four case‐residents died. Univariate analysis revealed that a history of stroke (odds ratio (OR) 2.3 (95% CI, 1.0–5.3)), eating pureed food (OR 4.6 (95% CI, 1.6–12.7)), and having fluids administered with medication (OR 2.5 (95% CI, 1.0–5.9)) were significant risk factors. Cases were less likely to wear dentures (OR .4 (95% CI, .2‐.9)) or to eat solid food (OR .3, (95% CI, .1‐.6)). Only eating pureed food remained significant in a multivariable analysis (OR 4.6 (95% CI, 1.6–13.0, P = .01)). CONCLUSION: This report describes outbreaks of legionellosis in two nursing homes, representing the first reported outbreaks of infection caused by Legionella sainthelensi. The association with illness of dietary characteristics indicative of swallowing disorders suggests that aspiration was the most likely mode of infection. The diagnosis of legionellosis should be considered during outbreaks of respiratory infection in nursing homes. J Am Geriatr Soc 47:547–552, 1999.</div></front></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Ontario</li><li>Pennsylvanie</li></region></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name></region><name sortKey="James, Marilyn" sort="James, Marilyn" uniqKey="James M" first="Marilyn" last="James">Marilyn James</name><name sortKey="Krueger, Paul" sort="Krueger, Paul" uniqKey="Krueger P" first="Paul" last="Krueger">Paul Krueger</name><name sortKey="Lingley, Michael" sort="Lingley, Michael" uniqKey="Lingley M" first="Michael" last="Lingley">Michael Lingley</name><name sortKey="Mandell, Lionel" sort="Mandell, Lionel" uniqKey="Mandell L" first="Lionel" last="Mandell">Lionel Mandell</name><name sortKey="Mcarthur, Margaret" sort="Mcarthur, Margaret" uniqKey="Mcarthur M" first="Margaret" last="Mcarthur">Margaret Mcarthur</name><name sortKey="Mcgeer, Allison" sort="Mcgeer, Allison" uniqKey="Mcgeer A" first="Allison" last="Mcgeer">Allison Mcgeer</name><name sortKey="Richardson, Elizabeth" sort="Richardson, Elizabeth" uniqKey="Richardson E" first="Elizabeth" last="Richardson">Elizabeth Richardson</name><name sortKey="Simor" sort="Simor" uniqKey="Simor" last="Simor">Simor</name><name sortKey="Simor" sort="Simor" uniqKey="Simor" last="Simor">Simor</name><name sortKey="Stronach, David" sort="Stronach, David" uniqKey="Stronach D" first="David" last="Stronach">David Stronach</name><name sortKey="Walter, Stephen" sort="Walter, Stephen" uniqKey="Walter S" first="Stephen" last="Walter">Stephen Walter</name></country><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Stout, Janet" sort="Stout, Janet" uniqKey="Stout J" first="Janet" last="Stout">Janet Stout</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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