Clinical Microbiology and Antimicrobial Chemotherapy. 2010; 12(2):117-126
To determine characteristics of community-acquired Legionella pneumonia depending on severity of the disease, identify adverse reactions of long-term antimicrobial regimens, and calculate equation of prognosis of Legionella pneumonia severity upon hospital admission.
A total of 61 patients with Legionella pneumonia were included and divided into 3 groups depending on the disease severity: Group 1 – 15 patients with non-severe pneumonia without systemic inflammatory response syndrome (SIRS), Group 2 – 32 patients with severe pneumonia and SIRS, Group 3 – 14 patients with very severe pneumonia. Group 1 patients received azithromycin 500 mg/day PO for 7 days (n=10) or levofloxacin 500 mg/day PO for 10 days (n=5). Group 2 and 3 patients received azithromycin 500 mg/day IV for 3 days followed by oral azithromycin for 7 days (n=17) or levofloxacin 750 mg/day IV for 2–3 days followed by oral levofloxacin for 12 days (n=29). Clinical, radiological, and laboratory test results were analyzed in all patients. A multiple correlation analysis of clinical and laboratory variables was performed to determine an early prognosis of the Legionella pneumonia severity.
Severe and very severe Legionella pneumonia was observed more frequently in male patients who were current smokers. Incidence of COPD was significantly higher in patients with very severe pneumonia. Azithromycin or levofloxacin therapy was associated with increased liver enzymes levels with no signs of hepatic insufficiency. «Prognosis of severity» equation (using respiratory rate and percentage of band neutrophils) may significantly determine (males and females separately) indications for admission to ICU (p<0.001).