The contamination of hospital water supply systems by Legionella pneumophila

The risk of severe infectious complications associated with provision of medical care continues to be a pressing issue in modern surgery. Legionella pneumophila, characterized by its wide distribution in water supply systems and is highly active in film formation, represents a dangerous/important cause of hospital-acquired pneumonia. Patients requiring immunosuppression, including organ transplant recipients, are in the special risk group. Prevention of hospital-acquired legionellosis in patients at risk is essential due to severe clinical manifestations and high mortality. Objective: to summarize the practical experience in detecting contamination of water supply systems by Legionella pneumophila strains in multidisciplinary hospitals in Moscow. Materials and methods. Isolation of Legionella pneumophila strains from water and biofilms of water supply systems in multidisciplinary hospitals in Moscow and serotyping of this pathogen using bacteriological, molecular genetic and enzyme immunoassay methods. Results. Legionella pneumophila content in water reached high levels. The peculiarities of Legionella pneumophila contamination of hot water supply systems included formation of stable biofilms, in which other hospital-acquired pathogens were also identified. The share of Legionella pneumophila «SG 1», which causes up to 80% legionellosis cases in the world, was 13% in the water of the hospitals surveyed. The most effective measures for prevention of legionellosis are actions aimed at ensuring water biosecurity. Conclusion. There are potential risks of disease in the surgical wards of hospitals providing medical care, including in immunocompromised patients. Due to potential risks, prevention of hospital-acquired legionellosis is a necessary component of ensuring the safety of treatment for immunosuppressed patients.

1. Torres A, Blasi F, Peetermans WE, Viegi G. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014; 33: 1065-1079.

2. Campese C, Decludt B. Notified cases of Legionnaires disease in France. Eurosurveillance. 2004; 7: 121-128.

3. Luderowski E, Harris CM, Khaliq W, Kotwal S. Severe Atypical Pneumonia Causing Acute Respiratory Failure. Am J Med. 2020; 133 (6): e230-e232. doi: 10.1016/j.am-jmed.2019.10.034.

4. Olson M, Ceri H, Morck DW et al. Biofilm bacteria: Formation and Comparative Susceptibility to antibiotics. Can J Vet Res. 2002; 66: 86-92.

5. McCormick D, Thorn S, Milne D et al. Public Health response to an outbreak of Legionnaires Disease in Edinburgh. United Kingdom. Eurosurveillance. 2012; 17 (28): 200-216.

6. Legionella and prevention of Legionellosis / Ed. by J. Bartram. WHO. 2007.

7. Colbourne JS, Ashworth J. Rubbers, waters and Legionella. Lancet. 1986; 2 (8506): 583.

8. Dronina YuE, Tartakovskij IS, Lyuk K, Hel'big Yu, Sadretdinova OV, Karpova TI i dr. Monoklonal'nye antitela k liposaharidu legionell i ih znachenie dlya tipirovaniya vozbuditelya. ZHizn' bez opasnostej. Zdorov'e. Profilaktika. Dolgoletie. 2010; 4: 122-125.

9. Legionellosis-USA (New Jersey) Nosocomial, fatal. ProMED-mail, Newsday. 2008, Oct. 3.

10. Den Boern JW, Euser SM, Brandsema P et al. Results from the National Legionella Outbreak Detection Program, the Netherlands, 2002-2012. Emerging Infectious Diseases. 2015; 7: 1167-1173.

11. Chuchalin AG, Sinopal'nikov AI, Tartakovskij IS i dr. Prakticheskie rekomendacii po diagnostike i lecheniyu legionelleznoj infekcii, vyzyvaemoj Legionella pneumophila serogruppy 1. Posobie dlya vrachej. Rossijskoe respiratornoe obshchestvo. M.: MAK-MAH, 2009.

12. Borellia P, Montagna M, Romano-Spica V et al. Legionella infection risk from domestic hot water. Emerg Infect Dis. 2004; 10: 457-464.

13. Ryder MA. Catheter-related infections: it's all about biofilms. Topics in advanced practice nursingе Journal. 2005; 5 (3): 1-6.

14. Venezia RA, Agresta MD, Hanley EM et al. Nosocomial legionellosis associated with aspiration of nasogastric feedings diluted in tap water. Infect Control Hosp Epidemiol. 1994; 15: 529-533.

15. Jacobson KL, Miceli MH, Tarrand JJ, Kontoyiannis DP. Legionella pneumonia in cancer patients. Medicine (Baltimore). 2008; 87 (3): 152-159.

16. Tartakovskij IS, Gincburg AL, Lazikova GF i dr. Standarty laboratornoj diagnostiki legionelleza i ih primenenie vo vremya epidemicheskoj vspyshki pnevmonij v g. Verhnyaya Pyshma. ZHurnal mikrobiologii, epidemiologii i immunobiologii. 2008; 2: 16-20.

17. Galstyan GM, Kostina IE, Katrysh SA i dr. Klinicheskie proyavleniya legionelleznoj pnevmonii u gematologicheskih bol'nyh. Terapevticheskij arhiv. 2014; 86 (3): 45-52.

18. Tartakovskij IS, Gruzdeva OA, Galstyan GM, Karpova TI. Profilaktika, diagnostika i lechenie legionelleza. M.: Studiya MDV, 2013. 344 p.

19. Thomas V, Bouchez T, Nicolas V et al. Amoebae in domestic water systems: resistance to disinfection treatments and implication in Legionella persistence. J Appl Microbiol. 2004; 97 (5): 950-963.

20. Guidelines for preventing health-care associated pneumonia 2003: recommendation of CDC and the Health care Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004; 26, 53 (RR-3): 1-36.