Management and Control of Legionella pneumophila Nosocomial Outbreak Risk in a Tertiary Level Pediatric Hospital

Abstract

Abstract Background Legionnaires' disease is a rare cause of pneumonia in the pediatric population. Case reports are described in children with risk factors such as immunocompromised. Outbreaks are commonly associated with buildings or structures that have complex water systems like hospitals. The most likely sources of infection include water used for showering, cooling towers, respiratory therapy equipment, humidifiers and other health care devices. Clinical presentation does not distinguish from other respiratory infections, difficult access to rapid diagnostic methods and empirical antibiotic treatment not effective are all factors that delay diagnosis and subsequent control measures, leading to an increased spread risk. Methods A case of Legionnaires' disease was rapidly detected in an immunocompromised pediatric patient with nosocomial pneumonia using BIOFIRE® FILMARRAY® Pneumonia Plus Panel and urinary antigen. The Infection Control Committee was reported, initiating control and surveillance measures: hospital's water sources were studied and patients with nosocomial pneumonia with no etiological diagnosis were studied in the same way. Results L. pneumophila was isolated in a water tank's sample with the same restriction profile as the clinical sample. A water safety plan was implemented: the water tank's temperature was raised to 65°C and hyperchlorinated to maintain an adequate level of disinfectant. Control cultures were performed, all negative. No new cases were detected. Conclusions It is important to consider Legionella pneumophila as a potential agent of pneumonia in children since it can result in life-threatening health conditions and severe nosocomial outbreak infection. The incorporation of rapid molecular or antigen diagnostic techniques allow prompt diagnosis and treatment, as well as rapid environmental and clinical surveillance measures that can reduce morbidity and mortality. When detecting Legionella infection, it is essential to identify the environmental focus so as to prevent the development of new cases.