Predictors of intensive care unit admission in patients with Legionella pneumonia: role of the time to appropriate antib
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ORIGINAL PAPER
Predictors of intensive care unit admission in patients with Legionella pneumonia: role of the time to appropriate antibiotic therapy Marco Falcone1 · Alessandro Russo1 · Giusy Tiseo1 · Mario Cesaretti1 · Fabio Guarracino2 · Francesco Menichetti1 Received: 15 September 2020 / Accepted: 30 November 2020 © The Author(s) 2020
Abstract Purpose Legionella spp. pneumonia (LP) is a cause of community-acquired pneumonia (CAP) that requires early intervention. The median mortality rate varies from 4 to 11%, but it is higher in patients admitted to intensive care unit (ICU). The objective of this study is to identify predictors of ICU admission in patients with LP. Methods A single-center, retrospective, observational study conducted in an academic tertiary-care hospital in Pisa, Italy. Adult patients with LP consecutively admitted to study center from October 2012 to October 2019. Results During the study period, 116 cases of LP were observed. The rate of ICU admission was 20.7% and the overall 30-day mortality rate was 12.1%. Mortality was 4.3% in patients hospitalized in medical wards versus 41.7% in patients transferred to ICU (p 24 h from admission) underwent urinary antigen test later compared to those who received early active antibiotic therapy (2 [2–4] vs. 1 [1–2] days, p 38.0 °C), tachycardia,
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chills, dyspnea, coughing, chest pain; (2) presence of new consolidation(s) on chest X-ray; (3) diagnosis of Legionella spp. infection, defined by Legionella pneumophila serogroup 1 antigen in urine. The study was conducted according to the principles stated in the Declaration of Helsinki. The local Ethical Committee approved the study (approval number 1446). Data on demographic characteristics, comorbidities, antibiotic, and concomitant therapy were retrospectively collected. Stratification of the severity of pneumonia at presentation was quantified by the Pneumonia Severity Index (PSI) and CURB-65 score [5]. CAP and hospital acquired pneumonia (HAP) were defined according to standard definitions [6]. Sepsis and septic shock were defined according to Sepsis-3 definition [7]. Cardiovascular event (CVE) included: (1) non-ST elevation myocardial infarction (NSTEMI); (2) ST elevation myocardial infarction (STEMI); (3) stroke; (4) a new episode of atrial fibrillation (AF); (5) deep venous thrombosis (DVT) and/or pulmonary embolism (PE); (6) new or worsening heart failure (HF); or (7) cardiovascular death [8]. Patients with pneumonia at the time of diagnosis underwent collection of blood cultures, detection of Legionella pneumophila serogroup 1 antigen in urine performed by immunochromatographic method (NOW Legionella Urinary Antigen Test; Binax Inc., Portland, ME), and culture of respiratory specimens. To identify risk factors associated with the primary endpoint (ICU admission), univariate and multivariate analyses were performed. To detect significant differences between groups, we used the chi square test or Fisher’s exact test for categorical variables and the two-tailed t test
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