J Patient Cent Res Rev. 2020 Apr 27;7(2):165-175. doi: 10.17294/2330-0698.1721. eCollection 2020.
Epidemiologic Survey of Legionella Urine Antigen Testing Within a Large Wisconsin-Based Health Care System.
Journal of patient-centered research and reviews
Caroline P Toberna, Hannah M William, Jessica J F Kram, Kayla Heslin, Dennis J Baumgardner
Affiliations
Affiliations
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.
- Center for Urban Population Health, Milwaukee, WI.
- Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI.
PMID: 32377550
PMCID: PMC7197889 DOI: 10.17294/2330-0698.1721
Abstract
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.
© 2020 Aurora Health Care, Inc.
Keywords: Legionella; antigens, bacterial; disease outbreaks; pneumonia, bacterial
Conflict of interest statement
Conflicts of Interest None.
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