title: Severe pneumonia due to Legionella pneumophila: prognostic factors, impact of delayed appropriate antimicrobial therapy.
abstract: OBJECTIVE
  To compare the outcome of patients with severe Legionella pneumonia (LP) according to the presence or absence of prognostic factors currently reported in the literature and delays in initiating fluoroquinolones and macrolides.
  
  
  METHODS
  Retrospective clinical investigation.
  
  
  METHODS
  Intensive care unit (ICU) of an university hospital.
  
  
  METHODS
  Forty-three consecutive cases with no previous treatment with a macrolide or a fluoroquinolone.
  
  
  RESULTS
  The 14 (33%) patients who died of LP were compared with the 29 survivors. Thirty-eight patients (88%) received a fluoroquinolone in combination with a macrolide agent, two patients erythromycin alone and three ofloxacin alone. In univariate analysis, SAPS II more than 46 ( p=0.006) and intubation requirement ( p=0.012) were associated with a higher mortality whereas the administration of fluoroquinolones ( p=0.011) or erythromycin ( p=0.044) within 8 h of arrival on the ICU was associated with better survival. By logistic regression analysis, SAPS II score more than 46 [odds ratio (OR) 8.69; 95% confidence interval (CI) 1.15-66.7; p=0.036], duration of symptoms prior to ICU admission longer than 5 days (OR 7.46; 95% CI 1.17-47.6) were independent risk factors for death. Fluoroquinolone administration within 8 h of ICU arrival (OR 0.16; 95% CI 0.03-0.96; p=0.035) was associated with a reduced mortality.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Rue Henri Le Guilloux, 35033 Rennes Cedex, France. arnaud.gacouin@chu-rennes.fr
authors.forename: A
authors.initials: A
authors.lastname: Gacouin
authors.forename: Y
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: S
authors.initials: S
authors.lastname: Lavoue
authors.forename: C
authors.initials: C
authors.lastname: Camus
authors.forename: J
authors.initials: J
authors.lastname: Hoff
authors.forename: R
authors.initials: R
authors.lastname: Bassen
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
authors.forename: C
authors.initials: C
authors.lastname: Heurtin
authors.forename: R
authors.initials: R
authors.lastname: Thomas
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D007362:Intensive Care Units; D016952:Legionella pneumophila; D007877:Legionnaires' Disease / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D018942:Macrolides; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D018942:Macrolides