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目的了解医院水环境军团菌污染及住院肺炎病例军团菌感染来源。方法采集医院冷却塔水和管网末梢水共24件,进行军团菌分离培养。对90例住院肺炎病例进行问卷调查、深部痰液军团菌培养和荧光定量PCR检测、军团菌尿抗原和血抗体检测,明确军团菌发病情况及类型。对分离环境菌株和病人菌株进行了PFGE和SBT检测,进行病原体溯源。结果医院冷却塔水军团菌阳性率100%(5/5),其中有2份水样军团菌浓度大于103cfu/L;管网末梢水军团菌阳性率21.1%(4/19),其中有3份水样军团菌浓度大于103cfu/L。余氯量平均0.03 mg/L,污染军团菌血清型LP1、LP6。住院肺炎病例中军团菌肺炎阳性率15.6%(14/90),其中痰培养和PCR同时阳性1例、尿抗原阳性13例,社区获得性军团菌肺炎16.4%(11/67)、医院获得性军团菌肺炎20.0%(3/15)。分离环境与病人菌株血清型别和PFGE图谱分析均不一致,未能溯源。结论医院水环境军团菌污染严重且污染浓度高,余氯浓度低于标准,存在发生医院内军团菌肺炎甚至暴发流行的严重隐患。建议定期监测医院水环境军团菌,对医院肺炎病人进行军团菌病相关检测,并研究具有可行性的消毒措施去除军团菌污染。
Objective To understand the origins of Legionella infection in hospital water environment and pneumonia in hospital. Methods A total of 24 hospital cooling tower water and pipe network were collected for Legionella isolation and culture. 90 cases of hospitalized pneumonia were investigated by questionnaires, deep sputum Legionella culture and quantitative PCR, Legionella urinary antigen and blood antibody detection, clear the incidence of Legionella and type. PFGE and SBT detection of isolates of environmental strains and patient strains were carried out to trace the pathogens. Results The positive rate of Legionella pneumophila in the cooling tower of the hospital was 100% (5/5), of which 2 samples were more than 103 cfu / L and the positive rate of Legionella pneumophila was 21.1% (4/19), of which 3 Legionella samples water concentration greater than 103cfu / L. Average residual chlorine 0.03 mg / L, contaminated Legionella serotypes LP1, LP6. The positive rate of Legionella pneumonia in hospitalized pneumonia cases was 15.6% (14/90), of which sputum culture and PCR were positive in 1 case, urinary antigen positive in 13 cases, community-acquired Legionnaires pneumonia in 16.4% (11/67), hospital acquired Legionella pneumonia was 20.0% (3/15). Isolation environment and patient strains serotypes and PFGE pattern analysis are inconsistent, failed to trace. Conclusions The water quality of Legionella in the hospital is seriously polluted and the pollution concentration is high. The residual chlorine concentration is lower than the standard. There is a serious hidden danger of Legionella pneumonia and even outbreak in the hospital. It is recommended to regularly monitor the Legionella bacteria in the hospital’s water environment and detect Legionnaire’s disease in hospital pneumonia patients and to study the feasibility of disinfection measures to remove Legionella contamination.