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Published on: April 19, 2024
Antimicrobial strategy for severe community-acquired legionnaires' disease: a multicentre retrospective observational
Jérôme Cecchini1,2, Samuel Tuffet1, Romain Sonneville3
1AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France.
Background:
Legionnaires' disease (LD) is an important cause of community-acquired pneumonia with high mortality rates in the most severe cases.
Objectives:
To evaluate the effect of antimicrobial strategy on ICU mortality.
Methods:
Retrospective, observational study including patients admitted to 10 ICUs for severe community-acquired LD over a 10 year period (2005-15) and receiving an active therapy within 48 h of admission . Patients were stratified according to the antibiotic strategy administered: (i) fluoroquinolone-based versus non-fluoroquinolone-based therapy; and (ii) monotherapy versus combination therapy. The primary endpoint was in-ICU mortality. A multivariable Cox model and propensity score analyses were used.
Results:
Two hundred and eleven patients with severe LD were included. A fluoroquinolone-based and a combination therapy were administered to 159 (75%) and 123 (58%) patients, respectively. One hundred and forty-six patients (69%) developed acute respiratory distress syndrome and 54 (26%) died in the ICU. In-ICU mortality was lower in the fluoroquinolone-based than in the non-fluoroquinolone-based group (21% versus 39%, P = 0.01), and in the combination therapy than in the monotherapy group (20% versus 34%, P = 0.02). In multivariable analysis, a fluoroquinolone-based therapy, but not a combination therapy, was associated with a reduced risk of mortality [HR = 0.41, 95% CI 0.19-0.89; P = 0.02].
Conclusions:
Patients with severe LD receiving a fluoroquinolone-based antimicrobial regimen in the early course of management had a lower in-ICU mortality, which persisted after adjusting for significant covariates.
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