Antimicrobial strategy for severe community-acquired legionnaires’ disease: a multicentre retrospective observational study

<span class="paragraphSection"><strong>Background:</strong> Legionnaires’ disease (LD) is an important cause of community-acquired pneumonia with high mortality rates in the most severe cases.<strong>Objectives:</strong> To evaluate the effect of antimicrobial strategy on ICU mortality.<strong>Methods:</strong> 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<span style="font-style:italic;">.</span> 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.<strong>Results:</strong> 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%, <span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>0.01), and in the combination therapy than in the monotherapy group (20% versus 34%, <span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>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; <span style="font-style:italic;">P </span>=<span style="font-style:italic;"> </span>0.02].<strong>Conclusions:</strong> 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.</span>

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2pe4Nn8
via IFTTT