title: Antimicrobial strategy for severe community-acquired legionnaires' disease: a multicentre retrospective observational study.
abstract: Legionnaires' disease (LD) is an important cause of community-acquired pneumonia with high mortality rates in the most severe cases.
  
  
  
  To evaluate the effect of antimicrobial strategy on ICU mortality.
  
  
  
  Retrospective, observational study including patients admitted to 10 ICUs for severe community-acquired LD over a 10 year period (2005-15) and receiving an active therapy within 48 h of admission . Patients were stratified according to the antibiotic strategy administered: (i) fluoroquinolone-based versus non-fluoroquinolone-based therapy; and (ii) monotherapy versus combination therapy. The primary endpoint was in-ICU mortality. A multivariable Cox model and propensity score analyses were used.
  
  
  
  Two hundred and eleven patients with severe LD were included. A fluoroquinolone-based and a combination therapy were administered to 159 (75%) and 123 (58%) patients, respectively. One hundred and forty-six patients (69%) developed acute respiratory distress syndrome and 54 (26%) died in the ICU. In-ICU mortality was lower in the fluoroquinolone-based than in the non-fluoroquinolone-based group (21% versus 39%, P  =   0.01), and in the combination therapy than in the monotherapy group (20% versus 34%, P  =   0.02). In multivariable analysis, a fluoroquinolone-based therapy, but not a combination therapy, was associated with a reduced risk of mortality [HR = 0.41, 95% CI 0.19-0.89; P  =   0.02].
  
  
  
  Patients with severe LD receiving a fluoroquinolone-based antimicrobial regimen in the early course of management had a lower in-ICU mortality, which persisted after adjusting for significant covariates.
authors.affiliation: AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.|Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cecchini
authors.affiliation: AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Tuffet
authors.affiliation: AP-HP, Hôpital Bichat, Service de Réanimation Médicale et Infectieuse, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.affiliation: Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.|AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France.|Sorbonne Université, UPMC Université Paris 06, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.affiliation: AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Roux
authors.affiliation: Hôpital Angers, Service de Réanimation Médicale et Médecine Hyperbare, Angers, France.
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Boissier
authors.affiliation: Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.|Centre Hospitalier Intercommunal de Villeneuve Saint-Georges, Service de Réanimation Polyvalente, Villeneuve Saint-Georges, France.
authors.forename: Martial
authors.initials: M
authors.lastname: Tchir
authors.affiliation: Centre Hospitalier de Longjumeau, Service de Réanimation Médicale et Chirurgicale, Longjumeau, France.
authors.forename: Martial
authors.initials: M
authors.lastname: Thyrault
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.affiliation: Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.|Hôpital Marc Jacquet, Service de Médecine Intensive, Melun, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Jochmans
authors.affiliation: AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.|Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.affiliation: AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.|Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.|Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Prost
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007877:Legionnaires' Disease / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones