Legionella Pneumonia in the ICU: A Tertiary Care Center Experience Over 10 Years

Andrea, Luke; Dicpinigaitis, Peter V.; Fazzari, Melissa; Kapoor, Sumit

doi:10.1097/cce.0000000000000508

Cited by 14 publications

(20 citation statements)

References 33 publications

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“…5 The mortality rate in patients with Legionella pneumonia who are admitted to an intensive care unit is between 9.1% and 41.7%. [6][7][8] Furthermore, there are certain patient populations (those with immunosuppression, chronic lung disease, history of smoking, or age over 50) that are more susceptible to severe CAP from Legionella. 4 For example, Legionella pneumonia patients with cancer can have a case-fatality rate as high as 31%.…”

Section: ■ Clinical Characteristics Of Legionella Pneumoniamentioning

confidence: 99%

Should urine antigen testing forLegionella pneumophilabe ordered for all hospitalized patients with community-acquired pneumonia?

Cheek

Jackson

Velagapudi

et al. 2023

CCJM

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Section: ■ Clinical Characteristics Of Legionella Pneumoniamentioning

confidence: 99%

Should urine antigen testing forLegionella pneumophilabe ordered for all hospitalized patients with community-acquired pneumonia?

Cheek

Jackson

Velagapudi

et al. 2023

CCJM

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“…Morbidity and mortality in Legionnaires' disease remains high. Intensive care unit (ICU) admission rates reported in studies range from 20 to 27% [ 1 , 7 , 14 – 16 ]. Andrea et al [ 14 ] also found elevated frequency of invasive mechanical ventilation, septic shock, acute respiratory distress syndrome, and acute kidney injury among those patients requiring ICU admission.…”

Section: The Scale Of the Problemmentioning

confidence: 99%

“…Intensive care unit (ICU) admission rates reported in studies range from 20 to 27% [ 1 , 7 , 14 – 16 ]. Andrea et al [ 14 ] also found elevated frequency of invasive mechanical ventilation, septic shock, acute respiratory distress syndrome, and acute kidney injury among those patients requiring ICU admission. Moreover, Legionnaires' disease has an overall mortality rate of 4–18% [ 7 , 14 – 18 ].…”

Section: The Scale Of the Problemmentioning

confidence: 99%

“…Andrea et al [ 14 ] also found elevated frequency of invasive mechanical ventilation, septic shock, acute respiratory distress syndrome, and acute kidney injury among those patients requiring ICU admission. Moreover, Legionnaires' disease has an overall mortality rate of 4–18% [ 7 , 14 – 18 ]. However, mortality is higher in patients with nosocomial Legionella pneumonia, immunocompromised individuals, and those requiring ICU admission.…”

Section: The Scale Of the Problemmentioning

confidence: 99%

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Legionnaires’ Disease: Update on Diagnosis and Treatment

et al. 2022

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Legionellosis is the infection caused by bacteria of the genus Legionella , including a non-pneumonic influenza-like syndrome, and Legionnaires’ disease is a more serious illness characterized by pneumonia. Legionellosis is becoming increasingly important as a public health problem throughout the world; although it is an underreported disease, studies have consistently documented a high incidence. In addition, health costs associated with the disease are high. Diagnosis of Legionnaires’ disease is based mainly on the detection of Legionella pneumophila serogroup 1 antigen in urine. However, there have been advances in detection tests for patients with legionellosis. New methodologies show greater sensitivity and specificity, detect more species and serogroups of Legionella spp., and have the potential for use in epidemiological studies. Testing for Legionella spp. is recommended at hospital admission for severe community-acquired pneumonia, and antibiotics directed against Legionella spp. should be included early as empirical therapy. Inadequate or delayed antibiotic treatment in Legionella pneumonia has been associated with a worse prognosis. Either a fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) is the recommended first-line therapy for Legionnaires’ disease; however, little information is available regarding adverse events or complications, or about the duration of antibiotic therapy and its association with clinical outcomes. Most published studies evaluating antibiotic treatment for Legionnaires’ disease are observational and consequently susceptible to bias and confounding. Well-designed studies are needed to assess the usefulness of diagnostic tests regarding clinical outcomes, as well as randomized trials comparing fluoroquinolones and macrolides or combination therapy that evaluate outcomes and adverse events.

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“…In severe cases, patients may develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. Rates of invasive mechanical ventilation (IMV) and mortality is high in patients admitted to the ICU, ranging from 54.5-82.3% and 9.1-41.7% respectively (3)(4)(5). Acute kidney injury (AKI), multiorgan failure and shock are frequently seen and failure to initiate Legionella-speci c antibiotic therapy is associated with worse outcomes (3).…”

mentioning

confidence: 99%

Venovenous Extracorporeal Membrane Oxygenation After Cardiac Arrest for Acute Respiratory Distress Syndrome Caused by Legionella: A Case Report

Grotberg

Schulte

Schumer

et al. 2022

Preprint

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Background: Legionella remains underdiagnosed in the intensive care unit and can progress to acute respiratory distress syndrome (ARDS), multiorgan failure and death. In severe cases, venovenous extracorporeal membrane oxygenation (VV-ECMO) allows time for resolution of disease with Legionella-targeted therapy. VV-ECMO outcomes for Legionella are favorable with reported survival greater than 70%. Rapid molecular polymerase chain reaction (PCR) testing of the lower respiratory tract aids in diagnosing Legionella with high sensitivity and specificity. We present a unique case of a patient with a positive COVID-19 test and ARDS who suffered a cardiac arrest. The patient was subsequently cannulated for VV-ECMO, and after lower respiratory tract PCR testing, Legionella was determined to be the cause. She was successfully treated and decannulated from VV-ECMO after 8 days. Case Presentation: A 53-year-old female presented with 1 week of dyspnea and a positive COVID-19 test. She was hypoxemic, hypotensive and had bilateral infiltrates on imaging. She received supplemental oxygen, intravenous fluids, vasopressors, broad spectrum antibiotics, and was transferred to a tertiary care center. She developed progressive hypoxemia and suffered a cardiac arrest, requiring 10 minutes of CPR and endotracheal intubation to achieve return of spontaneous circulation (ROSC). Despite mechanical ventilation and paralysis, she developed refractory hypoxemia and was cannulated for VV-ECMO. Dexamethasone and remdesivir were given for presumed COVID-19. Bronchoscopy with bronchoalveolar lavage (BAL) performed with PCR testing was positive for Legionella pneumophila and negative for COVID-19. Steroids and remdesivir were discontinued and she was treated with azithromycin. Her lung compliance improved, and she was decannulated after 8 days on VV-ECMO. She was discharged home on hospital day 16 breathing room air and neurologically intact. Conclusions: This case illustrates the utility of rapid PCR testing to diagnose Legionella in patients with respiratory failure and the early use of VV-ECMO in this patient population. Moreover, many patients encountered in the ICU may have prior COVID-19 immunity, and though a positive COVID-19 test may be present, further investigation with lower respiratory tract PCR testing may provide alternative diagnoses. Patients with ARDS should undergo Legionella-specific testing, and if positive, early VV-ECMO should be considered in patients with refractory hypoxemia.

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Legionella Pneumonia in the ICU: A Tertiary Care Center Experience Over 10 Years

Cited by 14 publications

References 33 publications

Should urine antigen testing forLegionella pneumophilabe ordered for all hospitalized patients with community-acquired pneumonia?

Should urine antigen testing forLegionella pneumophilabe ordered for all hospitalized patients with community-acquired pneumonia?

Legionnaires’ Disease: Update on Diagnosis and Treatment

Venovenous Extracorporeal Membrane Oxygenation After Cardiac Arrest for Acute Respiratory Distress Syndrome Caused by Legionella: A Case Report

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