{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:59:42Z","timestamp":1774573182308,"version":"3.50.1"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2016,9,19]],"date-time":"2016-09-19T00:00:00Z","timestamp":1474243200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec id=\"S0899823X16002051_abs1\" sec-type=\"general\"><jats:title>OBJECTIVE<\/jats:title><jats:p>To determine the source of a<jats:italic>Legionella pneumophila<\/jats:italic>serogroup 5 nosocomial outbreak and the role of the heat exchanger installed on the hot water system within the previous year.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16002051_abs2\" sec-type=\"general\"><jats:title>SETTING<\/jats:title><jats:p>A 400-bed tertiary care university hospital in Sherbrooke, Canada.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16002051_abs3\" sec-type=\"methods\"><jats:title>METHODS<\/jats:title><jats:p>Hot water samples were collected and cultured for<jats:italic>L. pneumophila<\/jats:italic>from 25 taps (baths and sinks) within wing A and 9 taps in wing B. Biofilm (5) and 2 L water samples (3) were collected within the heat exchangers for<jats:italic>L. pneumophila<\/jats:italic>culture and detection of protists. Sequence-based typing was performed on strain DNA extracts and pulsed-field gel electrophoresis patterns were analyzed.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16002051_abs4\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>Following 2 cases of hospital-acquired legionellosis, the hot water system investigation revealed a large proportion of<jats:italic>L. pneumophila<\/jats:italic>serogroup 5 positive taps (22\/25 in wing A and 5\/9 in wing B). High positivity was also detected in the heat exchanger of wing A in water samples (3\/3) and swabs from the heat exchanger (4\/5). The outbreak genotyping investigation identified the hot water system as the source of infections. Genotyping results revealed that all isolated environmental strains harbored the same related pulsed-field gel electrophoresis pattern and sequence-based type.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16002051_abs5\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p>Two cases of hospital-acquired legionellosis occurred in the year following the installation of a heat exchanger to preheat hospital hot water. No cases were reported previously, although the same<jats:italic>L. pneumophila<\/jats:italic>strain was isolated from the hot water system in 1995. The heat exchanger promoted<jats:italic>L. pneumophila<\/jats:italic>growth and may have contributed to confirmed clinical cases.<\/jats:p><jats:p><jats:italic>Infect. Control Hosp. Epidemiol.<\/jats:italic>2016;1475\u20131480<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2016.205","type":"journal-article","created":{"date-parts":[[2016,9,19]],"date-time":"2016-09-19T01:42:38Z","timestamp":1474249358000},"page":"1475-1480","source":"Crossref","is-referenced-by-count":24,"title":["Energy Conservation and the Promotion of<i>Legionella pneumophila<\/i>Growth: The Probable Role of Heat Exchangers in a Nosocomial Outbreak"],"prefix":"10.1017","volume":"37","author":[{"given":"Emilie","family":"B\u00e9dard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"L\u00e9vesque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Pinsonneault","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran","family":"Paranjape","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy","family":"Lalancette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles-\u00c9ric","family":"Dolc\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Villion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Valiquette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00e9bastien P.","family":"Faucher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mich\u00e8le","family":"Pr\u00e9vost","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2016,9,19]]},"reference":[{"key":"S0899823X16002051_ref17","unstructured":"Government of South Australia, Health Protection Programs, Public Health Services, Public Health and Clinical Systems, Department for Health and Ageing, on the recommendation of the Chief Public Health Officer. 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Technical guide \u2013 controlling the risk of Legionella in sanitary hot water distribution systems\u2014Ma\u00eetrise du risque de d\u00e9veloppement des l\u00e9gionelles dans les r\u00e9seaux d\u2019eau chaude sanitaire\u2014faults and recommandations [in French]. http:\/\/www.ars.rhonealpes.sante.fr\/fileadmin\/RHONE-ALPES\/RA\/Direc_sante_publique\/Protection_Promotion_Sante\/Environnement_Sante\/Legionelle\/guideCSTB-312.pdf. 2012."},{"key":"S0899823X16002051_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2011.12.022"},{"key":"S0899823X16002051_ref21","unstructured":"Association Fran\u00e7aise de Normalisation (AFNOR). Qualit\u00e9 de l\u2019eau\u2014Recherche et d\u00e9nombrement de Legionella spp et de Legionella pneumophila\u2014M\u00e9thode par ensemencement direct et apr\u00e8s concentration par filtration sur membrane ou centrifugation. La Plaine Saint-Denis, France, 2014:34."},{"key":"S0899823X16002051_ref13","unstructured":"Health and Safety Executive (HSE). Legionnaires\u2019 Disease: Technical Guidance. Part 2: The control of Legionella bacteria in hot and cold water systems. United Kingdom: HSE Books; 2013."},{"key":"S0899823X16002051_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ870"},{"key":"S0899823X16002051_ref18","unstructured":"DVGW German Technical and Scientific Association for Gas and Water. Technical Rule: Code of Practice W 551. 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Circular DGS\/EA4\/2010\/448, December 21st 2010 regarding the implementation of February 1st 2010 Ministerial Order Legionella surveillance in sanitary hot water production, storage and distribution installations [in French]. http:\/\/www.sante.gouv.fr\/fichiers\/bo\/2011\/11-01\/ste_20110001_0100_0130.pdf. Published 2010. 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