Open access peer-reviewed chapter

Introductory Chapter: Hospital-Acquired Infection and Legionnaires’ Disease

By Salim Surani

Reviewed: January 27th 2020Published: March 18th 2020

DOI: 10.5772/intechopen.91373

Downloaded: 178

1. Introduction

According to the Institute of Medicine, hospital-acquired infection and the adverse event in hospitals are responsible for 44,000–98,000 deaths and account for $17–29 billion in the healthcare cost in the USA alone [1, 2]. The care of the patient in the intensive care unit (ICU) is expensive and poses a significant economic burden on the healthcare [3, 4]. In the early part of the twentieth century, the intensive care units were taking care of patients with respiratory failure related to polio. With the advancement of technology and medicine, patients with multiple comorbidities are now being admitted in the ICU. A study by the World Health Organization (WHO) found that 51% of the patients in the ICU have infections [5]. The risk of infection among patients on a mechanical ventilation is 6- to 21-fold higher. Surprisingly, the risk of ICU-acquired infections among low- and middle-income countries was found to be 2–3 times higher than the ICU-acquired infections among ICU patients in developed countries [5, 6]. With the advent of invasive monitoring and therapeutic devices, the incidence and prevalence of the infection have increased, and we have seen a significant increase in antibiotic use and multidrug-resistant (MDR) infections [7]. Infectious conditions, sepsis, and septic shock continue to be responsible for significant morbidity and mortality [7]. Increased MDR infection has now become a global threat. Two million cases and 23,000 deaths each year are attributable to MDR infection in the USA alone, according to the Centers for Disease Control and Prevention (CDC) [8, 9]. In addition, inappropriate use of the antibiotics not only leads to increase in MDR but costs the healthcare $27–42 billion annually [8, 9, 10]. The central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) have also been associated with significant nosocomial infection [11]. With significant efforts from the regulatory agency as well as the healthcare organization and providers, a significant decrease in CLABSI and CAUTI has been seen [1, 12]. Education and antibiotic stewardship programs have been recommended by the CDC in 2014. In 2017, a survey by the National Healthcare Safety Network found that the number of hospitals with antibiotic stewardship program (ASP) has increased to 76.4%. Still 25% of the hospitals do not have ASP. As of September 2019, the ASP is required by the Centers for Medicare and Medicaid Services (CMS) as part of the patient care reimbursement. With this new regulatory requirement by the CMS, it is expected that the ASP in hospitals will reach close to 100% [13].

In this book, we will also be addressing Legionnaires’ disease in detail. Legionnaires’ disease is a bacterial infection caused by Gram-negative bacteria, usually found in freshwater [14]. It can lead to severe pneumonia which can be fatal (Legionnaires’ disease), but milder and subclinical infection forms (Pontiac fever) do exist [14, 15]. This disease is much more common than we think. Approximately, 10,000 patients are hospitalized every year with Legionnaires’ disease in the USA alone. Legionnaires’ disease also creates a public health concern. It is usually transmitted by inhaling the mist or via the cooling and water system issues. There have been numerous Legionnaires’ disease outbreaks over the decades, and the number seems to be increasing [16]. In the 1970s there were five outbreaks, in the 1980s seven, in the 1990s four, and in the 2000s ten. From 2010 to 2018, there were 23 outbreaks. In the year 2019 alone, there were seven outbreaks (shown in Table 1). These reported outbreaks represent just the tip of the iceberg, as not all of them are reported. Moreover, reports from the developing countries are almost nonexistent. The fatalities from Legionnaires’ disease range from 0 to 75% [16]. The longevity, multiple invasive devices, increase in transplants, immunocompromised status, aging population, and increase in travels all pose a significant risk of increased outbreaks and high fatality rates. Research and education need to be done in this area. In this book, we will try to address the epidemiology, clinical and therapeutic as it pertains to disease as well as clinical scenario and treatment of Legionnaires’ disease among immunocompromised host.

CountryCity/stateSourceCasesMortalityFatality rate
London, England [17]WestminsterVia. water system300
Belgium [18]EvergemCooling towers3226.7%
USA [18]Ohio, New Jersey, MichiganUnknown? Flint Michigan water crisis32618.75%
USA [18]Atlanta, Georgia (in Sheraton Hotel)Water system6611.5%
USA [18]Fletcher, North CarolinaHot tub display14142.83
Canada [18]Moncton, New BrunswickUnknown16N/A
USA [18]Batavia, Illinois13N/A

Table 1.

Selected Legionnaires’ disease outbreak in 2019.

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite and reference

Link to this chapter Copy to clipboard

Cite this chapter Copy to clipboard

Salim Surani (March 18th 2020). Introductory Chapter: Hospital-Acquired Infection and Legionnaires’ Disease, Hospital Acquired Infection and Legionnaires' Disease, Salim Surani, IntechOpen, DOI: 10.5772/intechopen.91373. Available from:

chapter statistics

178total chapter downloads

More statistics for editors and authors

Login to your personal dashboard for more detailed statistics on your publications.

Access personal reporting

Related Content

This Book

Next chapter

A Clinical Overview of Hospital-Acquired Legionella Pneumonia: Prevention Is the Key?

By Yamely Mendez, Gloria Rueda, Ismael Garcia and Johanan Luna

Related Book

First chapter

The Phylogeny and Classification of Anopheles

By Ralph E. Harbach

We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. We share our knowledge and peer-reveiwed research papers with libraries, scientific and engineering societies, and also work with corporate R&D departments and government entities.

More About Us