{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T07:05:15Z","timestamp":1791011115735,"version":"4.1.0"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":1980,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:sec id=\"S0195941700027946_abs1\"><jats:title>Background.<\/jats:title><jats:p>Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to<jats:italic>Legionella pneumophila<\/jats:italic>serogroup 1 that occurred among patients on our stem cell transplantation unit.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027946_abs2\"><jats:title>Methods.<\/jats:title><jats:p>We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for<jats:italic>Legionella<\/jats:italic>species from those sources. We used an air sampler to in an attempt to detect aerosolized<jats:italic>Legionella<\/jats:italic>and pulsed-field gel electrophoresis to compare clinical and environmental isolates.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027946_abs3\"><jats:title>Results.<\/jats:title><jats:p>The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow<jats:italic>Legionella<\/jats:italic>species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded<jats:italic>L. pneumophila<\/jats:italic>serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700027946_abs4\"><jats:title>Conclusions.<\/jats:title><jats:p>This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.<\/jats:p><\/jats:sec>","DOI":"10.1086\/598855","type":"journal-article","created":{"date-parts":[[2009,7,6]],"date-time":"2009-07-06T16:40:31Z","timestamp":1246898431000},"page":"764-768","source":"Crossref","is-referenced-by-count":83,"title":["A Cluster of Cases of Nosocomial Legionnaires Disease Linked to a Contaminated Hospital Decorative Water Fountain"],"prefix":"10.1017","volume":"30","author":[{"given":"Tara N.","family":"Palmore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida","family":"Stock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MaryAnn","family":"Bordner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Michelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick R.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K.","family":"Henderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700027946_ref017","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1128\/AEM.53.2.447-453.1987","article-title":"Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila within a model plumbing system","volume":"53","author":"Muraca","year":"1987","journal-title":"Appi Environ Microbiol"},{"key":"S0195941700027946_ref019","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2004.10.016"},{"key":"S0195941700027946_ref008","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1542\/peds.92.3.450","article-title":"Nosocomial Legionella pneumonia in the neonate","volume":"92","author":"Holmberg","year":"1993","journal-title":"Pediatrics"},{"key":"S0195941700027946_ref007","doi-asserted-by":"publisher","DOI":"10.3200\/AEOH.60.6.302-306"},{"key":"S0195941700027946_ref014","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)91532-F"},{"key":"S0195941700027946_ref004","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1703628"},{"key":"S0195941700027946_ref020","doi-asserted-by":"publisher","DOI":"10.1086\/322049"},{"key":"S0195941700027946_ref011","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116895"},{"key":"S0195941700027946_ref021","doi-asserted-by":"publisher","DOI":"10.1016\/0196-6553(86)90119-7"},{"key":"S0195941700027946_ref018","doi-asserted-by":"publisher","DOI":"10.1016\/S0043-1354(02)00188-4"},{"key":"S0195941700027946_ref001","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-94-2-195"},{"key":"S0195941700027946_ref002","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/146.4.460"},{"key":"S0195941700027946_ref003","doi-asserted-by":"publisher","DOI":"10.1086\/647689"},{"key":"S0195941700027946_ref015","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2005.047"},{"key":"S0195941700027946_ref016","first-page":"3","article-title":"Laboratory observations of biocide efficiency against Legionella in model cooling tower systems","volume":"105","author":"Thomas","year":"1999","journal-title":"ASHRAE Trans"},{"key":"S0195941700027946_ref005","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/16.3.466"},{"key":"S0195941700027946_ref006","doi-asserted-by":"publisher","DOI":"10.1086\/323023"},{"key":"S0195941700027946_ref013","doi-asserted-by":"publisher","DOI":"10.1086\/379017"},{"key":"S0195941700027946_ref009","doi-asserted-by":"publisher","DOI":"10.3201\/eid0801.010176"},{"key":"S0195941700027946_ref010","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-7-93"},{"key":"S0195941700027946_ref012","doi-asserted-by":"publisher","DOI":"10.2807\/esm.06.07.00228-en"}],"container-title":["Infection Control &amp; 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