title: How often is a work-up for Legionella pursued in patients with pneumonia? a retrospective study.
abstract: BACKGROUND
  It is unclear how often patients with pneumonia are assessed for Legionella in endemic areas. Additionally, the sensitivity of the IDSA/ATS criteria for recommended Legionella testing is undefined.
  
  
  METHODS
  We performed a single-center, retrospective study of patients diagnosed with Legionella pneumonia at our hospital to determine: 1) how often Legionella diagnostic testing is obtained on patients with pneumonia at the time of hospitalization or when pneumonia developed during hospitalization; and 2) how often patient's with Legionella pneumonia met at least one of the five criteria in the IDSA/ATS guidelines recommending a work-up for Legionella. Patients with Legionella pneumonia were identified using an infection control software program. Medical records of these patients were then reviewed.
  
  
  RESULTS
  Thirty-five percent of patients with a discharge diagnosis of pneumonia had Legionella urine antigen testing and/or a Legionella culture performed. Forty-four percent of patients who had a bronchoscopic specimen sent for microbiologic testing had a Legionella culture performed on the bronchoscopic specimen and/or Legionella urine antigen testing. Of 37 adult patients with Legionella pneumonia, 22 (59%) met the IDSA-ATS criteria recommending Legionella testing.
  
  
  CONCLUSIONS
  Following current recommendations for Legionella testing missed 41% of Legionella cases in adults in our single-center study. A work-up for Legionella (i.e., urine antigen test and/or culture) was performed in less than half of patients who have a bronchoscopic specimen sent for microbiologic testing.
authors: Department of Epidemiology and Infection Control, Rhode Island Hospital, Providence, RI 02903, USA.
authors: Brian
authors: B
authors: Hollenbeck
authors: Irene
authors: I
authors: Dupont
authors: Leonard A
authors: LA
authors: Mermel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007875:Legionella / Q000302:isolation & purification*; D007876:Legionellosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis*; D012189:Retrospective Studies; D055815:Young Adult