感染症と治療ジャーナル

抽象的な

New Insights in Hospital Acquired Legionnaires Disease: A Retrospective Multicentre Cohort Study

Marco Moretti*

Background: Legionnaires’ disease is a recognised cause of community acquired pneumonia, however legionella is an overlooked pathogen in hospital-acquired pneumonia. Death rate seems to be greater whenever hospitalacquired legionnaires’ disease occurs, however factors related to the poor outcome and preferred treatment strategy are poorly known.

Aim: Investigate mortality in patients admitted for legionnaires’ disease and its associated factors. Additionally, determinant factors of onset of hospital-acquired Legionnaires’ disease were analysed.

Methods: Medical records of the last three years were retrospectively reviewed at three university hospitals (UZ Brussel, CHU Brugmann and CHU Saint Pierre). Hospital-acquired legionnaires’ disease was defined as symptoms onset at ten days or more after admission. Univariate and propensity score adjusted multivariate logistic regressions analyses were performed.

Results: Fifty patients were included in the study, among them 13 (26%) were diagnosed with hospital acquired legionnaires’ disease. Mortality was 22%, mainly driven by patients affected by hospital acquired legionnaires’ disease, with a death rate of 61.54% in this group. Multivariate analysis for prediction of all cause mortality showed significant differences in Sepsis related Organ Failure Assessment (SOFA) score and treatment with respiratory fluoroquinolones based regimen. Complementary adjusted regression analyses for prediction of hospital acquired Legionnaires’ disease pointed out significant differences in chronic respiratory disease and bilateral pulmonary involvement.

Conclusion: In the current cohort, hospital acquired legionnaires’ disease represents a considerable burden as its mortality seems to be elevated. It may affect particularly chronic respiratory disease patients with bilateral lung injuries. SOFA score at diagnosis was associated with higher risk of mortality while use of respiratory fluoroquinolones based treatment was associated with lower mortality