title: Clinical outcomes for hospitalized patients with Legionella pneumonia in the antigenuria era: the influence of levofloxacin therapy.
abstract: BACKGROUND
  Although the reduction in case-fatality rate recently observed among patients with Legionella pneumonia has been largely attributed to the progressive utilization of urine antigen testing, other factors, such as changes in empirical antibiotic therapy, may also have contributed. We have analyzed more-recent outcomes of Legionella pneumonia in an institution where urine antigen testing was reflexly performed in cases of community-acquired pneumonia without an etiological diagnosis.
  
  
  METHODS
  From a prospective series of 1934 consecutive cases of community-acquired pneumonia in nonimmunocompromised adults, 139 cases of Legionella pneumophila pneumonia were selected for observational review. Legionella cases were analyzed for outcome with respect to antibiotic treatment, mortality, complications, length of stay, time to defervescence, and stability.
  
  
  RESULTS
  The early case-fatality rate was 2.9% (4 of 139 patients), and the overall case-fatality rate was 5% (7 of 139 patients). One hundred twenty patients (86.3%) received an appropriate initial therapy, which included macrolides (i.e., erythromycin or clarithromycin) in 80 patients and levofloxacin in 40. Levofloxacin progressively replaced macrolides as the initial therapy during the study period. Compared with patients who received macrolides, patients who received levofloxacin had a faster time to defervescence (2.0 vs. 4.5 days; P<.001) and to clinical stability (3 vs. 5 days; P=.002). No differences were found regarding the development of complications (25% vs. 25%; P=.906) and case-fatality rate (2.5% vs. 5%; P=.518). The median length of hospital stay was 8 days in patients treated with levofloxacin and 10 days in those who received macrolides (P=.014).
  
  
  CONCLUSIONS
  Legionella pneumonia is still associated with significant complications in hospitalized patients, but recent mortality is substantially lower than that found in earlier series. Levofloxacin may produce a faster clinical response than older macrolides, allowing for shorter hospital stay.
authors.affiliation: Infectious Disease Service, Institut d'Investigacio Biomedica de Bellvitge, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.
authors.forename: Analia
authors.initials: A
authors.lastname: Mykietiuk
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
authors.forename: Núria
authors.initials: N
authors.lastname: Fernández-Sabé
authors.forename: Jordi
authors.initials: J
authors.lastname: Dorca
authors.forename: Ricard
authors.initials: R
authors.lastname: Verdaguer
authors.forename: Frederic
authors.initials: F
authors.lastname: Manresa
authors.forename: Francesc
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000652:urine; D005260:Female; D006801:Humans; D007877:Legionnaires' Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine; D064704:Levofloxacin; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D018942:Macrolides; D064704:Levofloxacin; D015242:Ofloxacin