Evidence map›Paper›PMID 33237924›Full record

ArticlePloS one2020

Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019.

Udo Buchholz, Heiko Juergen Jahn, Bonita Brodhun, Ann-Sophie Lehfeld, Marina M Lewandowsky, Franziska Reber, Kristin Adler, Jacqueline Bochmann, Christina Förster, Madlen Koch and 49 more

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Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

59 authors.

Udo BuchholzDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.ORCID 0000-0001-6597-3995
Heiko Juergen JahnDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.ORCID 0000-0001-5915-5283
Bonita BrodhunDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.
Ann-Sophie LehfeldDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.
Marina M LewandowskyDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.
Franziska ReberDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.
Kristin AdlerSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Jacqueline BochmannSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Christina FörsterSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Madlen KochSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Yvonne SchreinerSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Fabian StemmlerSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Corinna GagellFaculty of Medicine Carl Gustav Carus, Institute of Medical Microbiology and Hygiene/Institute of Virology, National Consulting Laboratory for Legionella, TU Dresden, Dresden, Germany.
Edith HarbichFaculty of Medicine Carl Gustav Carus, Institute of Medical Microbiology and Hygiene/Institute of Virology, National Consulting Laboratory for Legionella, TU Dresden, Dresden, Germany.
Sina BärwolffHealth Department, DHA Tempelhof-Schöneberg, Berlin, Germany.
Andreas BeyerHealth Department, DHA Steglitz-Zehlendorf, Berlin, Germany.
Ute Geuß-FosuHealth Department, DHA Lichtenberg, Berlin, Germany.
Martina HänelHealth Department, DHA Marzahn-Hellersdorf, Berlin, Germany.
Patrick LarscheidHealth Department, DHA Reinickendorf, Berlin, Germany.
Lukas MurajdaHealth Department, DHA Mitte, Berlin, Germany.
Klaus MorawskiHealth Department, DHA Neukölln, Berlin, Germany.
Uwe PetersHealth Department, DHA Pankow, Berlin, Germany.
Raimund PitzingHealth Department, DHA Friedrichshain-Kreuzberg, Berlin, Germany.
Andreas von WelczeckHealth Department, DHA Treptow-Köpenick, Berlin, Germany.
Gudrun WiddersHealth Department, DHA Spandau, Berlin, Germany.
Nicoletta WischnewskiHealth Department, DHA Charlottenburg-Wilmersdorf, Berlin, Germany.
Inas AbdelgawadHealth Department, DHA Spandau, Berlin, Germany.
Anke HinzmannHealth Department, DHA Pankow, Berlin, Germany.
Denis HedelerHealth Department, DHA Treptow-Köpenick, Berlin, Germany.
Birte SchillingHealth Department, DHA Tempelhof-Schöneberg, Berlin, Germany.
Silvia SchmidtHealth Department, DHA Steglitz-Zehlendorf, Berlin, Germany.
Jakob SchumacherHealth Department, DHA Reinickendorf, Berlin, Germany.ORCID 0000-0002-9894-6085
Irina ZuschneidHealth Department, DHA Charlottenburg-Wilmersdorf, Berlin, Germany.
Iskandar AtmowihardjoDRK Hospitals Berlin, Berlin, Germany.
Keikawus ArastéhVivantes Hospitals Berlin, Berlin, Germany.
Steffen BehrensVivantes Hospitals Berlin, Berlin, Germany.
Petra CreutzCharité Hospitals Berlin, Berlin, Germany.
Johannes EliasDRK Hospitals Berlin, Berlin, Germany.ORCID 0000-0002-5878-7040
Martina GregorVivantes Hospitals Berlin, Berlin, Germany.
Stefan KahlDRK Hospitals Berlin, Berlin, Germany.
Henning KahnertVivantes Hospitals Berlin, Berlin, Germany.
Viktor KimmelVivantes Hospitals Berlin, Berlin, Germany.
Josefa LehmkeVivantes Hospitals Berlin, Berlin, Germany.
Pascal MigaudVivantes Hospitals Berlin, Berlin, Germany.
Agata MikolajewskaCharité Hospitals Berlin, Berlin, Germany.
Verena MoosCharité Hospitals Berlin, Berlin, Germany.
Maria-Barbara NaumannVivantes Hospitals Berlin, Berlin, Germany.
Wulf PankowVivantes Hospitals Berlin, Berlin, Germany.
Hans ScherüblVivantes Hospitals Berlin, Berlin, Germany.
Bernd SchmidtDRK Hospitals Berlin, Berlin, Germany.
Thomas SchneiderCharité Hospitals Berlin, Berlin, Germany.
Hartmut StockerVivantes Hospitals Berlin, Berlin, Germany.
Norbert SuttorpCharité Hospitals Berlin, Berlin, Germany.
Dorina ThiemigVivantes Hospitals Berlin, Berlin, Germany.
Carsten GollnischHygiene Inspection for Drinking Water Systems, Berlin, Germany.
Uwe MannschatzHygiene Inspection for Drinking Water Systems, Berlin, Germany.
Walter HaasDepartment of Infectious Disease Epidemiology, Unit 36: Respiratory Infections, Robert Koch Institute, Berlin, Germany.
Benedikt SchaeferSection II 3.5 Microbiology of Drinking Water and Swimming Pool Water, German Environment Agency, Bad Elster, Germany.
Christian LückFaculty of Medicine Carl Gustav Carus, Institute of Medical Microbiology and Hygiene/Institute of Virology, National Consulting Laboratory for Legionella, TU Dresden, Dresden, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionSources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.

objectiveIdentification of sources of infection of CALD.

settingBerlin; December 2016-May 2019.

participantsAdult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.

main outcome measurePercentage of cases of CALD with attributed source of infection.

methodsAnalysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).

resultsInclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.

conclusionUsing the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.

Indexed as

AdultAgedAged, 80 and overAntibodies, MonoclonalBerlinCase-Control StudiesCommunity-Acquired InfectionsDenturesDisinfectantsDrinking WaterFemaleHumansLegionella pneumophilaLegionnaires' DiseaseMaleMiddle AgedAntibodies, MonoclonalDisinfectantsDrinking Water

Identifiers

PMID33237924
PMCPMC7688155

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