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Am J Med. 2014 Oct;127(10):1010.e11-9. doi: 10.1016/j.amjmed.2014.03.042. Epub 2014 May 6.

Ruling out Legionella in community-acquired pneumonia.

Author information

1
Kantonsspital Aarau, Medical University Clinic, Aarau, Switzerland; University Clinic of Infectious Diseases, University Hospital, Inselspital Bern, Bern, Switzerland. Electronic address: sebastian.haubitz@gmail.com.
2
University of Basel, Basel, Switzerland.
3
Kantonsspital Aarau, Medical University Clinic, Aarau, Switzerland.
4
Division of Infectious Diseases, University of Louisville School of Medicine, Louisville, Ky.
5
Kantonsspital Aarau, Medical University Clinic, Aarau, Switzerland; Kantonsspital Aarau, Clinic for Infectious Diseases, Aarau, Switzerland.

Abstract

BACKGROUND:

Assessing the likelihood for Legionella sp. in community-acquired pneumonia is important because of differences in treatment regimens. Currently used antigen tests and culture have limited sensitivity with important time delays, making empirical broad-spectrum coverage necessary. Therefore, a score with 6 variables recently has been proposed. We sought to validate these parameters in an independent cohort.

METHODS:

We analyzed adult patients with community-acquired pneumonia from a large multinational database (Community Acquired Pneumonia Organization) who were treated between 2001 and 2012 with more than 4 of the 6 prespecified clinical variables available. Association and discrimination were assessed using logistic regression analysis and area under the curve (AUC).

RESULTS:

Of 1939 included patients, the infectious cause was known in 594 (28.9%), including Streptococcus pneumoniae in 264 (13.6%) and Legionella sp. in 37 (1.9%). The proposed clinical predictors fever, cough, hyponatremia, lactate dehydrogenase, C-reactive protein, and platelet count were all associated or tended to be associated with Legionella cause. A logistic regression analysis including all these predictors showed excellent discrimination with an AUC of 0.91 (95% confidence interval, 0.87-0.94). The original dichotomized score showed good discrimination (AUC, 0.73; 95% confidence interval, 0.65-0.81) and a high negative predictive value of 99% for patients with less than 2 parameters present.

CONCLUSIONS:

With the use of a large independent patient sample from an international database, this analysis validates previously proposed clinical variables to accurately rule out Legionella sp., which may help to optimize initial empiric therapy.

KEYWORDS:

Legionella; Pneumonia; Prediction algorithm

PMID:
24813862
DOI:
10.1016/j.amjmed.2014.03.042
[Indexed for MEDLINE]

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