- Email: [email protected]
Reply Prevention of nosocomial legionellosis: Legionella anisa
J Infect Chemother (2004) 10:134 DOI 10.1007/s10156-003-0297-8
© Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases 2004
LETTER TO THE EDITOR
Natsuo Yamamoto · Michio Koide · Atsushi Saito
Reply Prevention of nosocomial legionellosis: Legionella anisa
Received: December 4, 2003 / Accepted: December 10, 2003
To the Editor, We appreciate the kind consideration of Dr. Yu VL. of our research, and are impressed by his insightful and direct evidence-based suggestion about the method of disinfection against Legionnaire’s disease. We understand that Legionella anisa is a relatively usual habitant compared to Legionella pneumophila, and many investigators regard it as such (personal communication, Vladimir Drasar, Public Health Institute Brno, National Legionella Ref. Laboratory, July 2003).1 On the other hand, evidence has been provided that L. anisa is the causative pathogen of about 2% of adult cases of Legionnaires’ disease.2,3 Also, there is no evidence that newborns are completely safe against infection caused by L. anisa, particularly because a high incidence of nosocomial legionellosis has been reported in this population.4 As infection control measures within the neonatal ward are likely to depend on the policy of the organization, to address these problems, we designed a study to survey the serum antibody titer in newborns exposed to Legionella-contaminated showers. However, we were confronted with the ethical aspect of the study and concerns about pseudonegative outcome due to the premature immunological status of infants, and therefore we could not pursue that study. Instead, it was agreed, at the initial phase in 1996, to examine the contaminated showerheads. After a 7-year research period, we were successful in obtaining approval for the reconstruction of these wards, in October 2003. We agree with Dr. Yu that replacement of showerheads may not be adequate for permanent prevention and could not be applied in every hospital.2 Our demonstration of the
N. Yamamoto (*) · M. Koide · A. Saito Division of Infectious Diseases, Department of Internal Medicine, Graduate School and Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan Tel. ⫹81-98-895-1144; Fax ⫹81-98-895-1414 e-mail: [email protected]
“persistence” of a single clone may also imply re-emergence during long-term observation. Direct swabs from detached showerheads and rubber hoses recovered far fewer cultures than expected. As indicated in a series of studies published by Dr. Yu and coworkers,3,4 complete eradication could be achieved by their technique of using recommended hot water. However, in our hospital, two major obstacles have prevented the use of this technique to date; the risk of scalding and that the cold water system could not be completely flushed with hot water. We hope that an effective hot-water flushing technique is applied at every Legionellaisolated (sick) hospital and that newborn babies and other patients are provided with extra care to prevent Legionnaires’ disease.
References 1. Grove DI, Lawson PJ, Burgess JS, Moran JL, O’Fathartaigh MS, Winslow WE. An outbreak of Legionella longbeachae infection in an intensive care unit? J Hosp Infect 2002;52:250–8. 2. McNally C, Hackman B, Fields BS, Plouffe JF. Potential importance of Legionella species as etiologies in community acquired pneumonia (CAP). Diagn Microbiol Infect Dis 2000;38:79–82. 3. Yu VL, Plouffe JF, Pastoris MC, Stont JE, Schousboe M, Widmer A, et al. Distribution of Legionella species and serologroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis 2002;186:127–8. 4. Yu VL, Mandell GL, Bennett JE, Dolin R. Legionella pneumophila (Legionnaires’ disease). In: Mandell, Douglas, and Bennett’s principles and practice of infectious Disease. 5th Ed. Philadelphia: Churchill Livingstone; 2000. p. 2424–35.
© Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases 2004
LETTER TO THE EDITOR
Natsuo Yamamoto · Michio Koide · Atsushi Saito
Reply Prevention of nosocomial legionellosis: Legionella anisa
Received: December 4, 2003 / Accepted: December 10, 2003
To the Editor, We appreciate the kind consideration of Dr. Yu VL. of our research, and are impressed by his insightful and direct evidence-based suggestion about the method of disinfection against Legionnaire’s disease. We understand that Legionella anisa is a relatively usual habitant compared to Legionella pneumophila, and many investigators regard it as such (personal communication, Vladimir Drasar, Public Health Institute Brno, National Legionella Ref. Laboratory, July 2003).1 On the other hand, evidence has been provided that L. anisa is the causative pathogen of about 2% of adult cases of Legionnaires’ disease.2,3 Also, there is no evidence that newborns are completely safe against infection caused by L. anisa, particularly because a high incidence of nosocomial legionellosis has been reported in this population.4 As infection control measures within the neonatal ward are likely to depend on the policy of the organization, to address these problems, we designed a study to survey the serum antibody titer in newborns exposed to Legionella-contaminated showers. However, we were confronted with the ethical aspect of the study and concerns about pseudonegative outcome due to the premature immunological status of infants, and therefore we could not pursue that study. Instead, it was agreed, at the initial phase in 1996, to examine the contaminated showerheads. After a 7-year research period, we were successful in obtaining approval for the reconstruction of these wards, in October 2003. We agree with Dr. Yu that replacement of showerheads may not be adequate for permanent prevention and could not be applied in every hospital.2 Our demonstration of the
N. Yamamoto (*) · M. Koide · A. Saito Division of Infectious Diseases, Department of Internal Medicine, Graduate School and Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan Tel. ⫹81-98-895-1144; Fax ⫹81-98-895-1414 e-mail: [email protected]
“persistence” of a single clone may also imply re-emergence during long-term observation. Direct swabs from detached showerheads and rubber hoses recovered far fewer cultures than expected. As indicated in a series of studies published by Dr. Yu and coworkers,3,4 complete eradication could be achieved by their technique of using recommended hot water. However, in our hospital, two major obstacles have prevented the use of this technique to date; the risk of scalding and that the cold water system could not be completely flushed with hot water. We hope that an effective hot-water flushing technique is applied at every Legionellaisolated (sick) hospital and that newborn babies and other patients are provided with extra care to prevent Legionnaires’ disease.
References 1. Grove DI, Lawson PJ, Burgess JS, Moran JL, O’Fathartaigh MS, Winslow WE. An outbreak of Legionella longbeachae infection in an intensive care unit? J Hosp Infect 2002;52:250–8. 2. McNally C, Hackman B, Fields BS, Plouffe JF. Potential importance of Legionella species as etiologies in community acquired pneumonia (CAP). Diagn Microbiol Infect Dis 2000;38:79–82. 3. Yu VL, Plouffe JF, Pastoris MC, Stont JE, Schousboe M, Widmer A, et al. Distribution of Legionella species and serologroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis 2002;186:127–8. 4. Yu VL, Mandell GL, Bennett JE, Dolin R. Legionella pneumophila (Legionnaires’ disease). In: Mandell, Douglas, and Bennett’s principles and practice of infectious Disease. 5th Ed. Philadelphia: Churchill Livingstone; 2000. p. 2424–35.