Delay in appropriate therapy ofLegionella pneumonia associated with increased mortality

Abstract

The prognostic significance of delayed therapy in Legionnaires' disease is poorly defined. Thirty-nine consecutive serologically confirmed cases of Legionnaires' disease were reviewed to examine whether an association exists between delayed therapy and prognosis. Clinical and laboratory factors predictive of mortality were also sought. Thirty-one cases (79%) were classified as having severe pneumonia at diagnosis. Thirty-six patients (92%) had community-acquired infection, and three patients (8%) had nosocomial disease. Ten patients died, resulting in a crude mortality rate of 26%. At the first assessment, variables noted for pneumonia associated with death were low diastolic blood pressure (p < 0.02), low serum albumin concentration (p < 0.04), and increased number of days from onset of pneumonia to hospitalisation (prodrome) (p < 0.02). However, multiple logistic regression analysis revealed that the prodrome was the only variable noted at diagnosis that achieved significance (p = 0.024). Mortality also correlated with both delay in the initiation of erythromycin therapy following admission (p < 0.001) and the total delay in starting erythromycin therapy (p < 0.001). It is therefore recommended that erythromycin be included early in the empiric therapy of severe community-acquired pneumonia.

Chest CT Findings and Clinical Features in Mild Legionella Pneumonia

“…In the early phase of LP, 10% of the chest X-rays taken is almost normal (13). According to Heath et al (9), eight of 39 patients did not have severe pneumonia. In four of the present patients, although pulmonary infiltrates were present in chest X-ray and chest CT, there were no respiratory symptoms (cough, sputum, dyspnea, etc), indicating that whenthere are no respiratory symptoms other than fever, there is the possibility that chest X-ray is not performed.…”

“…sociated with increased mortality due to LP (8). Moreover, delay in the initiation of appropriate therapy is correlated with mortality (9). From these results, we considered both the delay in appropriate therapy and age as important risk factors for severe LP.…”

Legionnaires′ Disease ‐ Results of a Multicenter Canadian Study

“…Heath et al (29) studied 39 patients with Legionnaires' disease (36 were community-acquired) and found that the mortality rate was 26%. They noted that survivors had therapy with erythromycin started a median of six days from onset of symptoms compared with 11 days for those who died.…”

Acute respiratory distress syndrome in patients with Legionella pneumonia

“…Delay in appropriate antibiotic treatment (34) has been associated with increased mortality in patients with Legionnaires' disease. In our study, patients who developed ARDS had longer time from symptom onset to initiation of appropriate antibiotic treatment although the difference was not statistically significant.…”