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- Title
Improving the Diagnosis of Legionella Pneumonia within a Healthcare System through a Systematic Consultation and Testing Program.
- Authors
Decker, Brooke K.; Harris, Patricia L.; Muder, Robert R.; Hong, Jae H.; Singh, Nina; Sonel, Ali F.; Clancy, Cornelius J.
- Abstract
<bold>Rationale: </bold>Legionella testing is not recommended for all patients with pneumonia, but rather for particular patient subgroups. As a result, the overall incidence of Legionella pneumonia may be underestimated.<bold>Objectives: </bold>To determine the incidence of Legionella pneumonia in a veteran population in an endemic area after introduction of a systematic infectious diseases consultation and testing program.<bold>Methods: </bold>In response to a 2011-2012 outbreak, the VA Pittsburgh Healthcare System mandated infectious diseases consultations and testing for Legionella by urine antigen and sputum culture in all patients with pneumonia.<bold>Measurements and Main Results: </bold>Between January 2013 and December 2015, 1,579 cases of pneumonia were identified. The incidence of pneumonia was 788/100,000 veterans per year, including 352/100,000 veterans per year and 436/100,000 veterans per year with community-associated pneumonia (CAP) and health care-associated pneumonia, respectively. Ninety-eight percent of patients with suspected pneumonia were tested for Legionella by at least one method. Legionella accounted for 1% of pneumonia cases (n = 16), including 1.7% (12/706) and 0.6% (4/873) of CAP and health care-associated pneumonia, respectively. The yearly incidences of Legionella pneumonia and Legionella CAP were 7.99 and 5.99/100,000 veterans, respectively. The sensitivities of urine antigen and sputum culture were 81% and 60%, respectively; the specificity of urine antigen was >99.97%. Urine antigen testing and Legionella cultures increased by 65% and 330%, respectively, after introduction of our program.<bold>Conclusions: </bold>Systematic testing of veterans in an endemic area revealed a higher incidence of Legionella pneumonia and CAP than previously reported. Widespread urine antigen testing was not limited by false positivity.
- Subjects
PENNSYLVANIA; SPUTUM microbiology; URINE microbiology; LEGIONNAIRES' disease diagnosis; CROSS infection; EPIDEMICS; LEGIONELLA; LEGIONNAIRES' disease; VETERANS; MEDICAL referrals; PNEUMONIA
- Publication
Annals of the American Thoracic Society, 2016, Vol 13, Issue 8, p1289
- ISSN
2329-6933
- Publication type
journal article
- DOI
10.1513/AnnalsATS.201510-715BC