{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:59:53Z","timestamp":1792403993732,"version":"4.4.0"},"reference-count":36,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":2742,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2007,7]]},"abstract":"<jats:sec id=\"S0195941700046798_abs1\">\n                    <jats:title>Objective.<\/jats:title>\n                    <jats:p>\n                      Hospital-acquired\n                      <jats:italic>Legionella<\/jats:italic>\n                      pneumonia has a fatality rate of 28%, and the source is the water distribution system. Two prevention strategies have been advocated. One approach to prevention is clinical surveillance for disease without routine environmental monitoring. Another approach recommends environmental monitoring even in the absence of known cases of\n                      <jats:italic>Legionella<\/jats:italic>\n                      pneumonia. We determined the\n                      <jats:italic>Legionella<\/jats:italic>\n                      colonization status of water systems in hospitals to establish whether the results of environmental surveillance correlated with discovery of disease. None of these hospitals had previously experienced endemic hospital-acquired\n                      <jats:italic>Legionella<\/jats:italic>\n                      pneumonia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0195941700046798_abs2\">\n                    <jats:title>Design.<\/jats:title>\n                    <jats:p>Cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0195941700046798_abs3\">\n                    <jats:title>Setting.<\/jats:title>\n                    <jats:p>Twenty US hospitals in 13 states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0195941700046798_abs4\">\n                    <jats:title>Interventions.<\/jats:title>\n                    <jats:p>\n                      Hospitals performed clinical and environmental surveillance for\n                      <jats:italic>Legionella<\/jats:italic>\n                      from 2000 through 2002. All specimens were shipped to the Special Pathogens Laboratory at the Veterans Affairs Pittsburgh Medical Center.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0195941700046798_abs5\">\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Legionella pneumophila<\/jats:italic>\n                      and\n                      <jats:italic>Legionella anisa<\/jats:italic>\n                      were isolated from 14 (70%) of 20 hospital water systems. Of 676 environmental samples, 198 (29%) were positive for\n                      <jats:italic>Legionella<\/jats:italic>\n                      species. High-level colonization of the water system (30% or more of the distal outlets were positive for\n                      <jats:italic>L. pneumophila<\/jats:italic>\n                      ) was demonstrated for 6 (43%) of the 14 hospitals with positive findings.\n                      <jats:italic>L. pneumophila<\/jats:italic>\n                      serogroup 1 was detected in 5 of these 6 hospitals, whereas 1 hospital was colonized with\n                      <jats:italic>L. pneumophila<\/jats:italic>\n                      serogroup 5. A total of 633 patients were evaluated for\n                      <jats:italic>Legionella<\/jats:italic>\n                      pneumonia from 12 (60%) of the 20 hospitals: 377 by urinary antigen testing and 577 by sputum culture. Hospital-acquired\n                      <jats:italic>Legionella<\/jats:italic>\n                      pneumonia was identified in 4 hospitals, all of which were hospitals with\n                      <jats:italic>L. pneumophila<\/jats:italic>\n                      serogroup 1 found in 30% or more of the distal outlets. No cases of disease due to other serogroups or species (\n                      <jats:italic>L. anisa<\/jats:italic>\n                      ) were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0195941700046798_abs6\">\n                    <jats:title>Conclusion.<\/jats:title>\n                    <jats:p>\n                      Environmental monitoring followed by clinical surveillance was successful in uncovering previously unrecognized cases of hospital-acquired\n                      <jats:italic>Legionella<\/jats:italic>\n                      pneumonia.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1086\/518754","type":"journal-article","created":{"date-parts":[[2007,6,11]],"date-time":"2007-06-11T11:19:34Z","timestamp":1181560774000},"page":"818-824","source":"Crossref","is-referenced-by-count":108,"title":["Role of Environmental Surveillance in Determining the Risk of Hospital-Acquired Legionellosis: A National Surveillance Study With Clinical Correlations"],"prefix":"10.1017","volume":"28","author":[{"given":"Janet E.","family":"Stout","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert R.","family":"Muder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Mietzner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn M.","family":"Wagener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary 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