{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:45:25Z","timestamp":1782924325515,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Legionella pneumophila<\/jats:italic>\n                      is a recognized cause of hospital-acquired pneumonia particularly in immunocompromised patients. Significant resources are dedicated to the monitoring and control of Legionella contamination in hospital water systems. However, the actual risk of nosocomial Legionella infections in German university hospitals, which represent large tertiary care institutions, remains poorly defined. The aim of this study was to quantify the incidence of nosocomial legionellosis in German university hospitals. In addition, the extent of routine testing of hospital drinking water systems and preventive measures implemented on legal grounds was investigated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of nosocomial Legionella cases over a five-year period (2020\u20142024) at the University Medical Center Freiburg (UMCFR), including in-depth genomic typing. We distributed a survey to all 36 German university hospitals to collect data on the incidence of nosocomial infections and prevention strategies. We collected comprehensive data on preventive measures on a regional level among university hospitals in Baden-W\u00fcrttemberg.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a five-year period at UMCFR, three patients met the criteria for nosocomial Legionnaires\u2019 disease (LD). In two of these cases, we were able to confirm transmission through the hospital\u2019s drinking water system by genome analysis. Nationwide, 26 of 36 University hospitals reported a total of sixteen cases. All hospitals documented abnormal parametric values (\u2265\u2009100\u00a0CFU\/ml) in their drinking water systems at least once per year. Preventive measures varied widely: the number of sampling points ranged from 30 to 2355, and the number of point-of-use water filters from 30 to 2,200 per hospital. Despite this, incidence of LD remained very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nosocomial Legionella infections are rare in German tertiary care hospitals. However, the impact of intensive prevention measures on the incidence rates of nosocomial Legionella infections remains unclear. Therefore, current practices should be re-evaluated to optimize the use of resources without compromising patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02782-2","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:08:42Z","timestamp":1775038122000},"page":"1455-1463","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The burden of hospital-acquired legionellosis in German teaching hospitals"],"prefix":"10.1007","volume":"54","author":[{"given":"Stefanie","family":"Kramme","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried","family":"Ebner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"L\u00f6sslein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Liese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Heininger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"von Baum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjibbe","family":"Donker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Reuter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Henneke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Baden-W\u00fcrttemberg Hospital Infection Prevention Group (BW-HIP)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"12","key":"2782_CR1","doi-asserted-by":"publisher","DOI":"10.1128\/jb.00324-24","volume":"206","author":"KA Romanov","year":"2024","unstructured":"Romanov KA, O\u2019Connor TJ. Legionellapneumophila, a Rosetta stone to understanding bacterial pathogenesis. J Bacteriol. 2024;206(12):e0032424.","journal-title":"J Bacteriol"},{"issue":"4","key":"2782_CR2","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1097\/QCO.0b013e3283630adf","volume":"26","author":"BK Decker","year":"2013","unstructured":"Decker BK, Palmore TN. The role of water in healthcare-associated infections. Curr Opin Infect Dis. 2013;26(4):345\u201351.","journal-title":"Curr Opin Infect Dis"},{"issue":"22","key":"2782_CR3","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1056\/NEJM197712012972202","volume":"297","author":"JE McDade","year":"1977","unstructured":"McDade JE, et al. Legionnaires\u2019 disease: isolation of a bacterium and demonstration of its role in other respiratory disease. N Engl J Med. 1977;297(22):1197\u2013203.","journal-title":"N Engl J Med"},{"issue":"2","key":"2782_CR4","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.ijheh.2017.10.011","volume":"221","author":"T Dilger","year":"2018","unstructured":"Dilger T, Melzl H, Gessner A. Legionella contamination in warm water systems: a species-level survey. Int J Hyg Environ Health. 2018;221(2):199\u2013210.","journal-title":"Int J Hyg Environ Health"},{"issue":"4","key":"2782_CR5","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.ajic.2015.10.025","volume":"44","author":"EB Kruse","year":"2016","unstructured":"Kruse EB, Wehner A, Wisplinghoff H. Prevalence and distribution of Legionella spp in potable water systems in Germany, risk factors associated with contamination, and effectiveness of thermal disinfection. Am J Infect Control. 2016;44(4):470\u20134.","journal-title":"Am J Infect Control"},{"issue":"Suppl A","key":"2782_CR6","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/0195-6701(91)90060-L","volume":"18","author":"CA Hart","year":"1991","unstructured":"Hart CA, Makin T. Legionella in hospitals: a review. J Hosp Infect. 1991;18(Suppl A):481\u20139.","journal-title":"J Hosp Infect"},{"issue":"8","key":"2782_CR7","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1016\/j.ajic.2021.02.013","volume":"49","author":"MA Kessler","year":"2021","unstructured":"Kessler MA, et al. Hospital-acquired Legionella pneumonia outbreak at an academic medical center: lessons learned. Am J Infect Control. 2021;49(8):1014\u201320.","journal-title":"Am J Infect Control"},{"issue":"10","key":"2782_CR8","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1056\/NEJM199709043371006","volume":"337","author":"JE Stout","year":"1997","unstructured":"Stout JE, Yu VL. Legionellosis. N Engl J Med. 1997;337(10):682\u20137.","journal-title":"N Engl J Med"},{"issue":"2","key":"2782_CR9","doi-asserted-by":"publisher","first-page":"195","DOI":"10.7326\/0003-4819-94-2-195","volume":"94","author":"LG Cordes","year":"1981","unstructured":"Cordes LG, et al. Isolation of Legionella pneumophila from hospital shower heads. Ann Intern Med. 1981;94(2):195\u20137.","journal-title":"Ann Intern Med"},{"issue":"7","key":"2782_CR10","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1128\/JCM.37.7.2189-2196.1999","volume":"37","author":"P Visca","year":"1999","unstructured":"Visca P, et al. Multiple types of Legionellapneumophila serogroup 6 in a hospital heated-water system associated with sporadic infections. J Clin Microbiol. 1999;37(7):2189\u201396.","journal-title":"J Clin Microbiol"},{"issue":"8","key":"2782_CR11","doi-asserted-by":"publisher","first-page":"e0082724","DOI":"10.1128\/mbio.00827-24","volume":"15","author":"CTD Price","year":"2024","unstructured":"Price CTD, et al. Amoebae as training grounds for microbial pathogens. MBio. 2024;15(8):e0082724.","journal-title":"MBio"},{"issue":"9","key":"2782_CR12","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1086\/586741","volume":"46","author":"H von Baum","year":"2008","unstructured":"von Baum H, et al. Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia. Clin Infect Dis. 2008;46(9):1356\u201364.","journal-title":"Clin Infect Dis"},{"issue":"10","key":"2782_CR13","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.3201\/eid2610.181889","volume":"26","author":"J Beaute","year":"2020","unstructured":"Beaute J, et al. Healthcare-associated Legionnaires\u2019 Disease, Europe, 2008\u20132017. Emerg Infect Dis. 2020;26(10):2309\u201318.","journal-title":"Emerg Infect Dis"},{"key":"2782_CR14","first-page":"81","volume":"42","author":"B Jong","year":"2021","unstructured":"Jong B, Hallstrom LP. European surveillance of Legionnaires\u2019 Disease. Curr Issues Mol Biol. 2021;42:81\u201396.","journal-title":"Curr Issues Mol Biol"},{"key":"2782_CR15","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.1017\/S0950268823001206","volume":"151","author":"MA Moffa","year":"2023","unstructured":"Moffa MA, et al. Legionellosis on the rise: a scoping review of sporadic, community-acquired incidence in the United States. Epidemiol Infect. 2023;151:e133.","journal-title":"Epidemiol Infect"},{"issue":"6","key":"2782_CR16","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1007\/s00103-011-1287-0","volume":"54","author":"H von Baum","year":"2011","unstructured":"von Baum H, Luck C. [Community-acquired Legionella pneumonia: data from the CAPNETZ study]. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2011;54(6):688\u201392.","journal-title":"Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz"},{"issue":"11","key":"2782_CR17","doi-asserted-by":"publisher","first-page":"2200114","DOI":"10.2807\/1560-7917.ES.2023.28.11.2200114","volume":"28","author":"J Samuelsson","year":"2023","unstructured":"Samuelsson J, et al. Legionnaires\u2019 disease in the EU\/EEA*: increasing trend from 2017 to 2019. Euro Surveill. 2023;28(11):2200114.","journal-title":"Euro Surveill"},{"key":"2782_CR18","unstructured":"Pongstigl, H. SMALT aligns DNA sequencing reads with a reference genome. 2015; Available from: https:\/\/www.sanger.ac.uk\/tool\/smalt\/."},{"key":"2782_CR19","doi-asserted-by":"publisher","DOI":"10.1093\/gigascience\/giab008","author":"P Danecek","year":"2021","unstructured":"Danecek P, et al. Twelve years of SAMtools and BCFtools. Gigascience. 2021. https:\/\/doi.org\/10.1093\/gigascience\/giab008.","journal-title":"Gigascience"},{"issue":"9","key":"2782_CR20","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1101\/gr.107524.110","volume":"20","author":"A McKenna","year":"2010","unstructured":"McKenna A, et al. The Genome Analysis Toolkit: a MapReduce framework for analyzing next-generation DNA sequencing data. Genome Res. 2010;20(9):1297\u2013303.","journal-title":"Genome Res"},{"issue":"5","key":"2782_CR21","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1089\/cmb.2012.0021","volume":"19","author":"A Bankevich","year":"2012","unstructured":"Bankevich A, et al. SPAdes: a new genome assembly algorithm and its applications to single-cell sequencing. J Comput Biol. 2012;19(5):455\u201377.","journal-title":"J Comput Biol"},{"issue":"3","key":"2782_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/gb-2014-15-3-r46","volume":"15","author":"DE Wood","year":"2014","unstructured":"Wood DE, Salzberg SL. Kraken: ultrafast metagenomic sequence classification using exact alignments. Genome Biol. 2014;15(3):R46.","journal-title":"Genome Biol"},{"issue":"3","key":"2782_CR23","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gku1196","volume":"43","author":"NJ Croucher","year":"2015","unstructured":"Croucher NJ, et al. Rapid phylogenetic analysis of large samples of recombinant bacterial whole genome sequences using Gubbins. Nucleic Acids Res. 2015;43(3):e15.","journal-title":"Nucleic Acids Res"},{"issue":"4","key":"2782_CR24","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1093\/bioinformatics\/btr703","volume":"28","author":"T Carver","year":"2012","unstructured":"Carver T, et al. Artemis: an integrated platform for visualization and analysis of high-throughput sequence-based experimental data. Bioinformatics. 2012;28(4):464\u20139.","journal-title":"Bioinformatics"},{"issue":"9","key":"2782_CR25","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1093\/cid\/cix153","volume":"64","author":"S David","year":"2017","unstructured":"David S, et al. Seeding and establishment of Legionella pneumophila in hospitals: implications for genomic investigations of nosocomial Legionnaires\u2019 Disease. Clin Infect Dis. 2017;64(9):1251\u20139.","journal-title":"Clin Infect Dis"},{"key":"2782_CR26","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268824000013","volume":"152","author":"CKM McMullen","year":"2024","unstructured":"McMullen CKM, et al. Estimating the burden of illness caused by domestic waterborne Legionnaires\u2019 disease in Canada: 2015-2019. Epidemiol Infect. 2024;152:e18.","journal-title":"Epidemiol Infect"},{"key":"2782_CR27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-002175","author":"S Reuter","year":"2013","unstructured":"Reuter S, et al. A pilot study of rapid whole-genome sequencing for the investigation of a Legionella outbreak. BMJ Open. 2013. https:\/\/doi.org\/10.1136\/bmjopen-2012-002175.","journal-title":"BMJ Open"},{"issue":"2","key":"2782_CR28","first-page":"E166","volume":"65","author":"L Massolo","year":"2024","unstructured":"Massolo L, et al. Environmental Surveillance of Legionella spp. in an Italian University Hospital: results of 7 years of analysis. J Prev Med Hyg. 2024;65(2):E166\u201371.","journal-title":"J Prev Med Hyg"},{"key":"2782_CR29","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.00429-18","author":"Y Sharaby","year":"2018","unstructured":"Sharaby Y, et al. Virulence Traits of Environmental and Clinical Legionella pneumophila Multilocus Variable-Number Tandem-Repeat Analysis (MLVA) Genotypes. Appl Environ Microbiol. 2018. https:\/\/doi.org\/10.1128\/AEM.00429-18.","journal-title":"Appl Environ Microbiol"},{"issue":"4","key":"2782_CR30","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1097\/QCO.0000000000000842","volume":"35","author":"C Hayward","year":"2022","unstructured":"Hayward C, Brown MH, Whiley H. Hospital water as the source of healthcare-associated infection and antimicrobial-resistant organisms. Curr Opin Infect Dis. 2022;35(4):339\u201345.","journal-title":"Curr Opin Infect Dis"},{"issue":"11","key":"2782_CR31","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1038\/ng.3114","volume":"46","author":"L Sanchez-Buso","year":"2014","unstructured":"Sanchez-Buso L, et al. Recombination drives genome evolution in outbreak-related Legionella pneumophila isolates. Nat Genet. 2014;46(11):1205\u201311.","journal-title":"Nat Genet"},{"issue":"11","key":"2782_CR32","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1038\/s41564-019-0492-8","volume":"4","author":"S David","year":"2019","unstructured":"David S, et al. Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread. Nat Microbiol. 2019;4(11):1919\u201329.","journal-title":"Nat Microbiol"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02782-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-026-02782-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02782-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:50:58Z","timestamp":1782921058000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-026-02782-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":32,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["2782"],"URL":"https:\/\/doi.org\/10.1007\/s15010-026-02782-2","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"assertion":[{"value":"18 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was carried out following definitions of Good Clinical Practise, according to the declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}