Nosocomial legionellosis is a growing concern worldwide. In Hungary, about 20% of the reported cases are health-care associated, but in the absence of legal regulation, environmental monitoring of Legionella is not routinely performed in hospitals. In the present study, 23 hospitals were investigated. The hot water distribution system was colonized by Legionella in over 90%; counts generally exceeded the public health limit value. Hot water temperature was critically low in all systems (<45 °C), and large differences (3-38 °C temperature drop) were observed within buildings, indicating insufficient circulation. Most facilities were older than 30 years (77%); however, new systems (n = 3) were also shown to be rapidly colonized at low hot water temperature. Vulnerable source of drinking water, complex distribution system, and large volume hot water storage increased the risk of Legionella prevalence (OR = 28.0, 27.3, 27.7, respectively). Risk management interventions (including thermal or chemical disinfection) were only efficient if the system operation was optimized. Though the risk factors were similar, in those hospitals where nosocomial legionellosis was reported, Legionella counts and the proportion of L. pneumophila sg 1 isolates were significantly higher. The results of environmental prevalence of legionellae in hospitals suggest that the incidence of nosocomial legionellosis is likely to be underreported. The observed colonization rates call for the introduction of a mandatory environmental monitoring scheme.

中文翻译：

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匈牙利医院的军团菌感染率和军团菌病风险。

医院内的军团菌病在世界范围内日益引起关注。在匈牙利，约有20％的报告病例与医疗保健有关，但是由于缺乏法律法规，军团菌的环境监测不在医院常规进行。在本研究中，对23家医院进行了调查。军团菌在热水分配系统中占据了90％以上的殖民地；计数通常超过公共卫生极限值。在所有系统中，热水温度都非常低（<45°C），并且在建筑物内观察到较大的差异（温度下降3-38°C），这表明循环不足。大多数设施的年龄都在30年以上（77％）；然而，新系统（n = 3）也显示出在较低的热水温度下可以快速定殖。饮用水的脆弱来源，复杂的分配系统，大量的热水存储会增加军团菌的患病风险（OR分别为28.0、27.3、27.7）。只有优化系统操作，风险管理干预措施（包括热或化学消毒）才有效。尽管危险因素相似，但在那些报告医院内发生军团菌病的医院中，军团菌计数和肺炎链球菌sg 1分离株的比例明显更高。医院中军团菌的环境流行情况的结果表明，医院军团菌病的发病率可能被低报。观察到的殖民化率要求引入强制性的环境监测计划。仅在优化系统操作的情况下，风险管理干预措施（包括热或化学消毒）才有效。尽管危险因素相似，但在那些报告医院内发生军团菌病的医院中，军团菌计数和肺炎链球菌sg 1分离株的比例明显更高。医院中军团菌的环境流行情况的结果表明，医院军团菌病的发病率可能被低报。观察到的殖民化率要求引入强制性的环境监测计划。只有优化系统操作，风险管理干预措施（包括热或化学消毒）才有效。尽管危险因素相似，但在那些报告医院内发生军团菌病的医院中，军团菌计数和肺炎链球菌sg 1分离株的比例明显更高。医院中军团菌的环境流行情况的结果表明，医院军团菌病的发病率可能被低报。观察到的殖民化率要求引入强制性的环境监测计划。肺炎球菌sg 1分离株明显更高。医院中军团菌的环境流行情况的结果表明，医院军团菌病的发病率可能被低估。观察到的殖民化率要求引入强制性的环境监测计划。肺炎球菌sg 1分离株明显更高。医院中军团菌的环境流行情况的结果表明，医院军团菌病的发病率可能被低报。观察到的殖民化率要求引入强制性的环境监测计划。