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環境採檢的意義

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許多醫學研究顯示,環境中的嗜肺性退伍軍人菌與臨床感染有密切關係,以下相關研究都顯示,原本這些醫院中,沒有退伍軍人症的發生,但是當醫院進行飲用水環境採檢,發現水中退伍軍人菌的移生後,醫院進一步進行臨床肺炎主動偵測後,都陸續發現院內感染退伍軍人症。結果顯示,如果這些醫院未曾進行飲用水的退伍軍人菌採檢,可能都不會有警覺,院中一直有院內感染退伍軍人症的發生

 

Stout JE, Muder RR, Mietzner S, et al. Role of environmental surveillance in determining the risk of hospital-acquired legionellosis: a national surveillance study with clinical correlations. Infect Control Hosp Epidemiol 2007;28:818-24.[Pubmed Info]


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Yu VL, Beam TR, Jr., Lumish RM et al. Routine culturing for Legionella in the hospital environment may be a good idea: a three-hospital prospective study. Am J Med Sci 1987;294:97-9.[Pubmed Info]


Johnson JT, Yu VL, Best MG et al. Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet 1985;2:298-300.[Pubmed Info]


Sabria M, Modol JM, Garcia-Nunez M et al. Environmental cultures and hospital-acquired Legionnaires' disease: a 5-year prospective study in 20 hospitals in Catalonia, Spain. Infect Control Hosp Epidemiol 2004;25:1072-6.[Pubmed Info]


Goetz AM, Stout JE, Jacobs SL et al. Nosocomial legionnaires' disease discovered in community hospitals following cultures of the water system: seek and ye shall find. Am J Infect Control 1998;26:8-11.[Pubmed Info]


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飲用水中退伍軍人菌與臨床退伍軍人症的關連

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過去20年來,有越多的醫學研究證據顯示,經由DNA的比對,退伍軍人症是經由被退伍軍人菌汙染的飲用水(Drinking Water)所引起的,不是冷卻水塔。詳細情形可參考美國www.legionella.org網站。

 

台灣地區之相關報導,整理如下:

 

院內感染退伍軍人症:

Chien ST, Hsueh JC, Lin HH, Shih HY, Lee TM, Ben RJ, Chou ST, Fong CM, Lin YE*, Tseng LR, Chiang CS. Epidemiological Investigation of a Case of Nosocomial Legionnaires’ Disease in Taiwan – Implications for Routine Environmental Surveillance. Clin Microbiol Infection. 2010;16: 761–763. (SCI) [Medline Abstract]

 

Chen YS, Liu YC, Lee SS, Tsai HC, Wann SR, Kao CH, Chang CL, Huang WK, Huang TS, Chao HL, Li CH, Ke CM, Lin YE*. Abbreviated duration of superheat-and-flush and disinfection of taps for Legionella disinfection: lessons learned from failure. Am J Infect Control 2005;33(10):606-10.(SCI) [Medline Abstract]

 

社區感染退伍軍人症:

Chen YS, Lin WR, Liu YC et al. Residential water supply as a likely cause of community-acquired Legionnaires' disease in an immunocompromised host. Eur J Clin Microbiol Infect Dis. 2002 Oct;21(10):706-9.[Pubmed Info]

 

Su HP, Tseng LR, Tzeng SC, Chou CY, Chung TC. A legionellosis case due to contaminated spa water and confirmed by genomic identification in Taiwan. Microbiol Immunol. 2006;50(5):371-7.[Pubmed Info]

 

張瑞炘、鄭麗容、曾士展、陳英彥、黃中興、慕蓉蓉、江春雪、吳和生. 南投縣某公立游泳池退伍軍人菌感染事件之實驗室診斷分析. 疫情報導第23 卷第7 期, 396-404.