Epidemiologic Survey of Legionella Urine Antigen Testing Within a Large Wisconsin-Based Health Care System

Journal of Patient-Centered Research and Reviews

Kayla Heslin¹  Hannah M. William¹  Jessica J. F. Kram²  Caroline P. Toberna²  Dennis J. Baumgardner² 

[1] Center for Urban Population Health, Milwaukee, WI;Aurora Health Care, Milwaukee, WI;

关键词: legionella;    antigens;    bacterial;    pneumonia;    disease outbreaks;   

DOI  :  10.17294/2330-0698.1721

来源: DOAJ

【 摘 要 】

Purpose: Legionella pneumophila pneumonia is a life-threatening, environmentally acquired infection identifiable via Legionella urine antigen tests (LUAT). We aimed to identify cumulative incidence, demographic distribution, and undetected disease outbreaks of Legionella pneumonia via positive LUAT in a single eastern Wisconsin health system, with a focus on urban Milwaukee County. Methods: A multilevel descriptive ecologic study was conducted utilizing electronic medical record data from a large integrated health care system of patients who underwent LUAT from 2013 to 2017. A random sample inclusive of all positive tests was reviewed to investigate geodemographic differences among patients testing positive versus negative. Statistical comparisons used chi-squared or 2-sample t-tests; stepwise regression followed by binary logistic regression was used for multivariable analysis. Positive cases identified by LUAT were mapped to locate hotspots; positive cases versus total tests performed also were mapped by zip code. Results: Of all LUAT performed (n = 21,599), 0.68% were positive. Among those in the random sample (n = 11,652), positive cases by LUAT were more prevalent in the June–November time period (86.2%) and younger patients (59.4 vs 67.7 years) and were disproportionately male (70.3% vs 29.7%) (P < 0.0001 for each). Cumulative incidence was higher among nonwhite race/ethnicity (1.91% vs 1.01%, P < 0.0001) but did not remain significant on multivariable analysis. Overall, 5507 tests were performed in Milwaukee County zip codes, yielding 82 positive cases by LUAT (60.7% of all positive cases in the random sample). A potential small 2016 outbreak was identified. Conclusions: Cumulative incidence of a positive LUAT was less than 1%. LUAT testing, if done in real time by cooperative health systems, may complement public health detection of Legionella pneumonia outbreaks.

【 授权许可】

Unknown