Jérôme Cecchini1,2, Samuel Tuffet1, Romain Sonneville3, Muriel Fartoukh2,4,5, Julien Mayaux6, Damien Roux7, Achille Kouatchet8, Florence Boissier9, Martial Tchir2,10, Martial Thyrault11, Eric Maury12, Sebastien Jochmans2,13, Armand Mekontso Dessap1,2, Christian Brun-Buisson1,2, Nicolas de Prost1,2. 1. AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, France. 2. Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique CARMAS, Université Paris Est, 94000 Créteil, France. 3. AP-HP, Hôpital Bichat, Service de Réanimation Médicale et Infectieuse, Paris, France. 4. AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France. 5. Sorbonne Université, UPMC Université Paris 06, Paris, France. 6. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France. 7. AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. 8. Hôpital Angers, Service de Réanimation Médicale et Médecine Hyperbare, Angers, France. 9. AP-HP, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France. 10. Centre Hospitalier Intercommunal de Villeneuve Saint-Georges, Service de Réanimation Polyvalente, Villeneuve Saint-Georges, France. 11. Centre Hospitalier de Longjumeau, Service de Réanimation Médicale et Chirurgicale, Longjumeau, France. 12. AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France. 13. Hôpital Marc Jacquet, Service de Médecine Intensive, Melun, France.
Abstract
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.
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.
Authors: Ana Elena Pérez-Cobas; Christophe Ginevra; Christophe Rusniok; Sophie Jarraud; Carmen Buchrieser Journal: mBio Date: 2020-05-19 Impact factor: 7.867
Authors: Annie S Jasper; Jackson S Musuuza; Jessica S Tischendorf; Vanessa W Stevens; Shantini D Gamage; Fauzia Osman; Nasia Safdar Journal: Clin Infect Dis Date: 2021-06-01 Impact factor: 20.999