Complex clinical and microbiological effects on Legionnaires’ disease outcome; A retrospective cohort study

BMC Infectious Diseases

Research Article

Ariela Levcovich¹  Miriam Weinberger²  Tsilia Lazarovitch³  Eugenia Yakunin⁴  Lea Valinsky⁴  Jacob Moran-Gilad⁵  Chava Peretz⁶ 

[1] Infectious Diseases Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel;Infectious Diseases Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel;Sackler School of Medicine, Tel Aviv University, POB 39040, 69978, Tel Aviv, Israel;Microbiology Laboratory, Assaf Harofeh Medical Center, 70300, Zerifin, Israel;Molecular Laboratory, Central Laboratories, Israel Ministry of Health, POB 34410, 94467, Jerusalem, Israel;National Program for Legionellosis Control and Public Health Services, Israeli Ministry of Health, 39 Yermiyahu St., 5th Floor, Jerusalem, Israel;ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland;Faculty of Health Sciences, Ben-Gurion University of the Negev. Ben-Gurion Boulevard, Beer-Sheva, Israel;School of Public Health, Epidemiology, Sackler School of Medicine, Tel Aviv University, POB 39040, 69978, Tel Aviv, Israel;

关键词: Legionella pneumophila;    Legionnaires’ disease;    risk factors;    mortality;    diagnosis;    logistic model;    molecular typing;   

DOI  :  10.1186/s12879-016-1374-9

 received in 2015-09-23, accepted in 2016-01-22,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundLegionnaires’ disease (LD) is associated with high mortality rates and poses a diagnostic and therapeutic challenge. Use of the rapid urinary antigen test (UAT) has been linked to improved outcome. We examined the association between the method of diagnosis (UAT or culture) and various clinical and microbiological characteristics and outcome of LD.MethodsConsecutive patients with pneumonia and confirmation of Legionella infection by a positive UAT and/or a positive culture admitted between the years 2006–2012 to a university hospital were retrospectively studied. Isolated L. pneumophila strains were subject to serogrouping, immunological subtyping and sequence-based typing. Variables associated with 30-day all-cause mortality were analyzed using logistic regression as well as cox regression.ResultsSeventy-two patients were eligible for mortality analyses (LD study group), of whom 15.5 % have died. Diagnosis based on positive L. pneumophila UAT as compared to positive culture (OR = 0.18, 95 % CI 0.03–0.98, p = 0.05) and administration of appropriate antibiotic therapy within 2 hospitalization days as compared to delayed therapy (OR = 0.16, 95 % CI 0.03–0.90, p = 0.04) were independently associated with reduced mortality. When controlling for intensive care unit (ICU) admissions, the method of diagnosis became non-significant. Survival analyses showed a significantly increased death risk for patients admitted to ICU compared to others (HR 12.90, 95 % CI 2.78–59.86, p = 0.001) and reduced risk for patients receiving appropriate antibiotic therapy within the first two admissions days compared to delayed therapy (HR 0.13, 95 % CI 0.04–0.05, p = 0.001). Legionella cultures were positive in 35 patients (including 29 patients from the LD study group), of whom 65.7 % were intubated and 37.1 % have died. Sequence type (ST) ST1 accounted for 50.0 % of the typed cases and ST1, OLDA/Oxford was the leading phenon (53.8 %). Mortality rate among patients in the LD study group infected with ST1 was 18.2 % compared to 42.9 % for non-ST1 genotypes (OR = 0.30, 95 % CI 0.05-1.91, p = 0.23).ConclusionsThe study confirms the importance of early administration of appropriate antibiotic therapy and at the same time highlights the complex associations of different diagnostic approaches with LD outcome. Infection with ST1 was not associated with increased mortality. Genotype effects on outcome mandate examination in larger cohorts.

【 授权许可】

CC BY   
© Levcovich et al. 2016