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.
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Fraser DW, Tsai TR, Orenstein W, Parkin WE, Beecham HJ, Sharrar RG, Harris J, Mallison GF, Martin SM, McDade JE, Shepard CC, Brachman PS, The Field Investigation Team: Legionnaires' disease: description of an epidemic of pneumonia. New England Journal of Medicine 1977, 297: 1189–1197.
Pitt JL, Merry DJ, Steele TW: Legionnaires' disease in South Australia: prevalence and diagnosis. Medical Journal of Australia 1980, 1: 365–368.
Niederman MS, Bass JB Jr, Campbell GD, Fein AM, Grossman RF, Mandell LA, Marrie TJ, Sarosi GA, Torres A, Yu VL: Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Review of Respiratory Disease 1993, 148: 1418–1426.
Edelstein PH: Detection of antibodies toLegionella. In: Rose NR, de Macario EC, Fahey JL, Friedman H, Penn GM (ed): Manual of clinical laboratory immunology. American Society for Microbiology, Washington, DC, 1986, p. 459–466.
Winslow WE, Steele TW: Indirect immunofluorescent antibody tests withLegionella longbeachae serogroup 1 antigen in confirmed infections. In: Barbaree JM, Breiman RF, Dufour AP (ed):Legionella: current status and emerging perspectives. American Society for Microbiology, Washington, DC, 1993, p. 17–19.
Steele TW:Legionella in South Australia. Communicable Diseases Intelligence 1989, 13: 2–3.
Yu VL:Legionella pneumophila (Legionnaires' disease). In: Mandell GL, Bennett JE, Dolin R (ed): Principles and practice of infectious diseases. Churchill Livingstone, New York, 1995, p. 2087–2103.
Centers for Disease Control. Legionnaires' disease: diagnosis and management. Annals of Internal Medicine 1978, 88: 363–365.
Yee YC, Yu VL:Legionella. In: Gorbach SL, Bartlett JG, Blacklow NR (ed): Infectious diseases. Saunders, Philadelphia, 1992, p. 1533–1538.
Edelstein PH: Legionnaires' disease. Clinical Infectious Diseases 1993, 16: 741–749.
Bernstein MS, Locksley RM: Legionella infections. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL (ed): Harrison's principles of internal medicine. McGraw-Hill, New York, 1994, p. 654–658.
British Thoracic Society Research Committee: Community-acquired pneumonia in adults in British hospitals in 1982–1983: A survey of aetiology, mortality, prognostic factors and outcome. Quarterly Journal of Medicine 1987, 62:195–220.
Campbell DG: Overview of community-acquired pneumonia: prognosis and clinical features. Medical Clinics of North America 1994, 78: 1035–1048.
Australian National Antibiotic Guideline Committee: Respiratory tract infections. In: Antibiotic guidelines. Victorian Medical Postgraduate Foundation, Therapeutics Committee on Behalf of the Victorian Drug Usage Advisory Committee, Melbourne, 1994–1995, p. 25–40.
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Heath, C.H., Grove, D.I. & Looke, D.F.M. Delay in appropriate therapy ofLegionella pneumonia associated with increased mortality. Eur. J. Clin. Microbiol. Infect. Dis. 15, 286–290 (1996). https://doi.org/10.1007/BF01695659
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DOI: https://doi.org/10.1007/BF01695659