Clinical features of Legionnaires’ disease at three Belgian university hospitals, a retrospective study

Abstract

Introduction: Legionnaires' disease (LD) is a recognised cause of community-acquired pneumonia. However, Legionella is an overlooked pathogen in hospital-acquired pneumonia. The European Surveillance System 2008-2017 found 23% of the Belgian LD reported cases being healthcare-related, with a higher death-rate than in community-acquired patients. This study aims to describe patients admitted for community-acquired LD or affected by hospitalacquired LD and investigate discriminants associated with lethality. Methods: Medical records were retrospectively reviewed at three Belgian University Hospitals, between 1 January 2016 up to 31 January 2019. Hospital-acquired LD was defined as symptom onset at 10 days or more after admission, according to the Centres for Disease Control and prevention. Community-acquired LD was defined as diagnosis at admission or within 10 days after admission. Results: Fifty patients were included in the study, among them 26% were diagnosed with hospital-acquired LD. The case-fatality rate was 22%, with eight of the eleven deceased patients (73%) being in the hospital-acquired LD group. Medical history of asthma or chronic obstructive pulmonary disease and higher sequential organ failure assessment (SOFA) score at diagnosis were more frequently observed in the hospital-acquired LD group. Furthermore, significantly lower SOFA score at diagnosis of LD and higher rates of treatment with levofloxacin or moxifloxacin were observed in survivors. Conclusion:In the current cohort, LD death-rate was mainly driven by hospital-acquired LD patients. Hospital-acquired LD might especially affect patients with chronic respiratory disease. Respiratory fluoroquinolones treatment and lower SOFA score at diagnosis may be associated with favourable outcomes.

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“…In this cohort, a higher rate of stage IV cancer patients was found within the group of deceased patients, but this difference was not statistically significant. Furthermore, previous studies on hospital-acquired pneumonia and Legionnaire's disease report similar results [18,19].…”

Legionellosis-Associated Hospitalization in Spain from 2002 to 2021

“…Since 1977, the genus Legionella has been recognized as a frequent cause of CAP and a rare cause of HAP. Over time, the prevalence of LD has risen, which might indicate a greater awareness and reporting of the disease [ 17 ], but Legionella is an overlooked pathogen in HAP [ 18 ]. Even prior to the pandemic, legionellosis was a global health concern with an estimated seroprevalence of 13.7% [ 19 ].…”

Legionella pneumophila: The Journey from the Environment to the Blood

“…With the appropriate management, the death rate, even in the above cases, can be reduced to 5–30% [ 109 ]. It is important to mention that healthcare-associated Legionnaires’ disease (HCA LD) can cause nosocomial outbreaks with high death rates [ 110 ].…”