Legionnaire's disease can be hospital-acquired. It is much harder to recognize sporadic cases than an epidemic.
Sources of hospital-acquired legionellosis:
(1) colonized water supply
(2) cooling tower
Patients at risk:
(1) COPD and/or smoking
(2) transplant patients
(3) corticosteroid therapy
(4) other causes of immunosuppression
(5) general anesthesia or other factors contributing to aspiration
(6) alcohol abuse
Factors contributing to hospital-acquired legionellosis and/or missing the diagnosis:
(1) not monitoring the hospital water supply for Legionella
(2) not responding to or ineffective response to colonization of the water supply
(3) not testing patients for Legionella
The proportion of water-system sites that test positive for Legionella tends to correlate with risk of hospital-acquired legionellosis better than concentration (CFU count).
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