Naoyuki Miyashita1, Nobuyuki Horita2, Futoshi Higa3, Yosuke Aoki4, Toshiaki Kikuchi5, Masafumi Seki6, Kazuhiro Tateda7, Nobuko Maki8, Kazuhiro Uchino9, Kazuhiko Ogasawara10, Hiroshi Kiyota11, Akira Watanabe12. 1. First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan. Electronic address: miyashin@hirakata.kmu.ac.jp. 2. Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan. 3. National Hospital Organization Okinawa National Hospital, Japan. 4. Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan. 5. Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan. 6. Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Japan. 7. Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan. 8. Taisho Toyama Pharmaceutical Co., Ltd, Japan. 9. Daiichi Sankyo Co., Ltd, Japan. 10. First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan. 11. Department of Urology, The Jikei University Katsushika Medical Center, Japan. 12. Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Japan.
Abstract
BACKGROUND: Community-acquired pneumonia (CAP) due to Legionella has a high mortality rate in patients who do not receive adequate antibiotic therapy. In a previous study, we developed a simple Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis. In the present study, we validated this Legionella Score for the presumptive diagnosis of Legionella CAP. METHODS: This validation cohort included 109 patients with Legionella CAP and 683 patients with non-Legionella CAP. The Legionella Score includes six parameters by assigning one point for each of the following items: being male, absence of cough, dyspnea, C-reactive protein (CRP) ≥ 18 mg/dL, lactate dehydrogenase (LDH) ≥ 260 U/L, and sodium < 134 mmol/L. RESULTS: When the Legionella CAP and non-Legionella CAP were compared by univariate analysis, most of the evaluated symptoms and laboratory test results differed substantially. The six parameters that were used for the Legionella Score also indicated clear differences between the Legionella and non-Legionella CAP. All Legionella patients had a score of 2 points or higher. The median Legionella Scores were 4 in the Legionella CAP cases and 2 in the non-Legionella CAP cases. A receiver operating characteristics curve showed that the area under the curve was 0.93. The proposed best cutoff, total score ≥3, had sensitivity of 93% and specificity of 75%. CONCLUSION: Our Legionella Score was shown to have good diagnostic ability with a positive likelihood of 3.7 and a negative likelihood of 0.10.
BACKGROUND: Community-acquired pneumonia (CAP) due to Legionella has a high mortality rate in patients who do not receive adequate antibiotic therapy. In a previous study, we developed a simple Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis. In the present study, we validated this Legionella Score for the presumptive diagnosis of Legionella CAP. METHODS: This validation cohort included 109 patients with Legionella CAP and 683 patients with non-Legionella CAP. The Legionella Score includes six parameters by assigning one point for each of the following items: being male, absence of cough, dyspnea, C-reactive protein (CRP) ≥ 18 mg/dL, lactate dehydrogenase (LDH) ≥ 260 U/L, and sodium < 134 mmol/L. RESULTS: When the Legionella CAP and non-Legionella CAP were compared by univariate analysis, most of the evaluated symptoms and laboratory test results differed substantially. The six parameters that were used for the Legionella Score also indicated clear differences between the Legionella and non-Legionella CAP. All Legionellapatients had a score of 2 points or higher. The median Legionella Scores were 4 in the Legionella CAP cases and 2 in the non-Legionella CAP cases. A receiver operating characteristics curve showed that the area under the curve was 0.93. The proposed best cutoff, total score ≥3, had sensitivity of 93% and specificity of 75%. CONCLUSION: Our Legionella Score was shown to have good diagnostic ability with a positive likelihood of 3.7 and a negative likelihood of 0.10.
Authors: Rosalie R A L Beekman; Ruud R Duijkers; Dominic D Snijders; Menno M van der Eerden; Martijn M Kross; Wim W G Boersma Journal: BMC Infect Dis Date: 2022-05-09 Impact factor: 3.667
Authors: Michael B Rothberg; Peter B Imrey; Ning Guo; Abhishek Deshpande; Thomas L Higgins; Peter K Lindenauer Journal: J Hosp Med Date: 2022-07-26 Impact factor: 2.899