Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990-2004

Objectives: To describe the characteristics of community outbreaks of legionellosis in Catalonia, Spain from 1990 to 2004, to compare two time periods (1990-1996 and 1997-2004), and to assess the influence of outbreak characteristics on the case fatality rate (CFR). Methods: This is a descriptive analysis of the outbreaks detected by epidemiological surveillance units in Catalonia. Variables potentially related to the CFR were analyzed by logistic regression. Results: Of the 118 outbreaks involving 690 patients (overall CFR 4.5%), the urinary antigen test (UAT) was used for first case diagnosis in 80.5%. The origin of the outbreak was identified as a cooling tower in 35.6%, as a water distribution system in a public building in 14.4%, and a water distribution system at other sites in 7.6%. Statistically significant differences were found in the CFR (12.2% vs. 3.9%; p = 0.018) and detection of the first case by UAT (0.0% vs. 87.2%; p < 0.001) between the two time periods investigated. Logistic regression showed an increase in the CFR according to outbreak size (adjusted odds ratio (aOR) 1.18; 95% confidence interval (CI) 1.05-1.33) that was significantly lower in the second period (aOR 0.09; 95% CI 0.04-0.20). Conclusions: Since the UAT was introduced, early diagnosis and treatment has helped to improve the outcomes and CFR of cases involved in outbreaks of legionellosis. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.