Severe pneumonia due to Legionella pneumophila: prognostic factors, impact of delayed appropriate antimicrobial therapy

Gacouin, Arnaud; Tulzo, Yves Le; Lavoué, Sylvain; Camus, Christophe; Hoff, Jack van; Bassen, R.; Arvieux, Cédric; Heurtin, C.; Thomas, R.

doi:10.1007/s00134-002-1304-8

Cited by 118 publications

(77 citation statements)

References 26 publications

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“…The LD fatality rate ranged from 5-25% in immunocompetent hosts [16] to 33% in severe LD [17], 8.5% in a study by DOMINGUEZ et al [7] and 12.9% in the more recent investigation by JESPERSEN et al [18].…”

Section: Discussionmentioning

confidence: 96%

Factors associated with hospital mortality in community-acquired legionellosis in France

Chidiac¹,

Che²,

Pires-Cronenberger³

et al. 2011

Eur Respir J

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The aims of this study were to describe the clinical, biological and radiological features of community-acquired (CA) Legionnaires' disease (LD) and identify the predictors of mortality in hospitalised patients.Demographic data, risk factors, clinical and biological features, medical management, complications, and outcome from 540 hospitalised patients with confirmed CA LD were prospectively recorded.8.1% of patients (44 out of 540) died. The predictors of survival after Kaplan-Meier analysis were male sex (p50.01), age ,60 yrs (p50.02), general symptoms (p50.006), intensive care unit (ICU) stay (p,0.001), and class II-III Pneumonia Severity Index score (p50.004). Six predictors of death were identified by multivariate analysis: age (per 10-yr increment) (relative hazard (RH) 1.50, 95% CI 1.21-1.87), female sex (RH 2.00, 95% CI 1.08-3.69), ICU admission (RH 3.31, 95% CI 1.67-6.56), renal failure (RH 2.73, 95% CI 1.42-5.27), corticosteroid therapy (RH 2.54, 95% CI 1.04-6.20) and C-reactive protein (CRP) .500 mg?L -1 (RH 2.14, 95% CI 1.02-4.48). Appropriate antibiotic therapy was prescribed for 70.8% (292 out of 412) of patients after admission and for 99.8% (537 out of 538) of patients after diagnosis confirmation.In conclusion, female sex, age, ICU stay, renal failure, corticosteroid treatment and increased level of CRP are significant risk factors for mortality in CA LD.

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Section: Discussionmentioning

confidence: 96%

Factors associated with hospital mortality in community-acquired legionellosis in France

Chidiac¹,

Che²,

Pires-Cronenberger³

et al. 2011

Eur Respir J

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“…(10,(137)(138)(139). In addition, despite the sensitivity of L. pneumophila to commonly available antibiotics, LD is associated with greater CAP severity and a higher case-fatality rate (up to ϳ30%) than CAP from other atypical pathogens (121,(140)(141)(142)(143)(144)(145). The U.S. LD case-fatality rate has decreased steadily since the mid-1980s (125), from a high of ϳ34% to 8% on average in the 2000s (15).…”

Section: Epidemiology and Diseasementioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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“…Although 20 species of Legionella are documented as human pathogens (8), up to 90% of clinical cases are caused by Legionella pneumophila and about 84% are due to serogroup 1 strains (7,38). The disease can be fatal unless diagnosed early and treated with specific antibiotics (12). Clinical signs are not specific, which makes prompt and accurate laboratory diagnosis crucial.…”

mentioning

confidence: 99%

Evaluation of a Nested-PCR-Derived Sequence-Based Typing Method Applied Directly to Respiratory Samples from Patients with Legionnaires' Disease

et al. 2009

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Severe pneumonia due to Legionella pneumophila: prognostic factors, impact of delayed appropriate antimicrobial therapy

Abstract: SAPS II score higher than 46, duration of symptoms prior to ICU admission longer than 5 days and intubation were associated with increased mortality. Initiation of fluoroquinolone therapy within 8 h of ICU admission significantly reduced mortality.

Cited by 118 publications

References 26 publications

Factors associated with hospital mortality in community-acquired legionellosis in France

Factors associated with hospital mortality in community-acquired legionellosis in France

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Evaluation of a Nested-PCR-Derived Sequence-Based Typing Method Applied Directly to Respiratory Samples from Patients with Legionnaires' Disease

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