Health after Legionnaires' disease: A description of hospitalizations up to 5 years after Legionella pneumonia

Abstract

Background and objectives Research on Legionnaires’ Disease (LD) suggests there may be long-term health complications, but data are limited. This study investigated whether Intensive Care Unit (ICU) admission during LD hospitalization may be associated with adverse health outcomes and characterized subsequent discharge diagnoses in patients with LD up to 5 years post-LD. Methods We conducted a retrospective case series study with follow up for 5 years among patients hospitalized at a Department of Veterans Affairs (VA) Medical Center between 2005 and 2010 with LD. Data were collected from medical records on health history, LD severity (including ICU admission), and discharge diagnoses for 5 years post-LD or until death. We used ordinal logistic regression to explore associations between ICU admission and hospitalizations post-LD. Frequency counts were used to determine the most prevalent discharge diagnoses in the 5 years post-LD. Results For the 292 patients with laboratory-confirmed LD, those admitted to the ICU during LD hospitalization were more likely to have a greater number of hospitalizations within 5 years compared to non-ICU patients (ORHosp 1.92 CI95% 1.25, 2.95). Fifty-five percent (161/292) had ≥ 1 hospitalization within 5 years post-LD. After accounting for pre-existing diagnosis codes in patients with at least one hospitalization in the 2 years prior to LD (n = 77/161 patients, 47.8%), three of the four most frequent new diagnoses in the 5 years post-LD were non-chronic conditions: acute renal failure (n = 22, 28.6%), acute respiratory failure (n = 17, 22.1%) and unspecified pneumonia (n = 15, 19.5%). Conclusions Our findings indicate that LD requiring ICU admission is associated with more subsequent hospitalizations, a factor that could contribute to poorer future health for people with severe LD. In addition to chronic conditions prevalent in this study population, we found new diagnoses in the 5-year post-LD period including acute renal failure. With LD incidence increasing, more research is needed to understand conditions and factors that influence long term health after LD.

Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing

“…On the other hand, there are few data on survival after L-CAP and none comparing it with P-CAP. Among the few studies that demonstrate a poorer quality of life after L-CAP, Lettinga et al [27] , analyzing 122 individuals with L-CAP, found that 64% had not attained their pre-illness quality of life 2 years after L-CAP, whereas Gamage et al [28] , in a 5-year follow-up of 292 patients, observed that L-CAP re-quiring ICU admission was associated with more subsequent hospitalizations and poorer future health.…”

Legionnaires’ disease: A critical report of the pneumonia of unknown origin outbreak in Argentina

“…Research has shown that pneumonia patients admitted to intensive care with severe illness more frequently re-present to hospital and experience adverse health outcomes, such as chronic and acute kidney disorders, in the five years following initial diagnosis [10].…”