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Chest. IMPORTANCE OF LEGIONELLA PNEUMOPHILA IN THE ETIOLOGY OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN SANTIAGO, CHILE
[Source: Chest, full page: (LINK). Abstract, edited.]
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Original Research | June 13, 2013
IMPORTANCE OF LEGIONELLA PNEUMOPHILA IN THE ETIOLOGY OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN SANTIAGO, CHILE
Francisco Arancibia, MD; Claudia P. Cortes, MD; Marcelo Valdez, MD; Javier Cerda, MD; Antonio Hern?ndez, MD; Luis Soto, MD; Antoni Torres, MD
Instituto Nacional del T?rax, Chile (Arancibia, Valdez, Soto); Cl?nica Santa Mar?a, Chile (Arancibia, Cortes, Valdez); University of Chile School of Medicine, Chile (Cortes); Hospital Militar de Santiago, Chile (Cerda, Hern?ndez); Hospital San Borja-Arriar?n, Chile (Cerda); Servei de Pneumologia, Institut del Torax, Hospital Cl?nic, Institut d?Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Torres); Centro de Investigaci?n Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028)-Instituto de Salud Carlos III, Spain (Torres)
Correspondence: Francisco Arancibia, MD, Instituto Nacional del T?rax, Jos? Miguel Infante 717, Providencia, Santiago, Chile, E-mail: fearancibia@gmail.com
Chest. 2013. doi:10.1378/chest.13-0162 - Published online
Abstract
Background
In US and European literature Legionella pneumophila is reported as an important etiological agent of severe community acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to evaluate the incidence of severe CAP due for this agent in Santiago, Chile, and identify predictors of Legionella severe CAP.
Methods
A multicentric prospective clinical study lasting 18 months was conducted; it included all adult patients who were admitted for a severe CAP in the Intensive Care Units (ICU) of 4 hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks or presented another disease during their hospitalization. All data for the diagnosis of severe CAP were registered and urinary antigens for L pneumophila serogroup 1 were determined.
Results
104 patients with a severe CAP were included, mean age: 58.3 ?19.3 years; 64.4% males; APACHE II score was: 16.7? 6.3; SOFA: 6.1? 3.2, Pitt Bacteremia Score (PBS): 3.4? 2.5 and PaO2/FiO2: 170.8? 87.1. An etiologic agent was identified in 62 patients (59.6%): S. pneumoniae 27 (26%) and L. pneumophila 9 (8.6%) were the most frequent agents. Logistic regression analysis showed that plasma sodium ≤ 130 mEq/L was an independent predictor for L. pneumophila severe CAP (OR 11.3; 95% CI 2.5-50.5; p= 0.002). Global mortality was 26%, and 33% for L. pneumophila. PBS and Pneumonia Score Index were better predictors of mortality.
Conclusions
We found that in Santiago L. pneumophila was second to S. pneumoniae as etiological agent of severe CAP. Severe hyponatremia at admission appears as an indicator for L. pneumophila etiology in severe CAP.
-IMPORTANCE OF LEGIONELLA PNEUMOPHILA IN THE ETIOLOGY OF SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN SANTIAGO, CHILE
Francisco Arancibia, MD; Claudia P. Cortes, MD; Marcelo Valdez, MD; Javier Cerda, MD; Antonio Hern?ndez, MD; Luis Soto, MD; Antoni Torres, MD
Instituto Nacional del T?rax, Chile (Arancibia, Valdez, Soto); Cl?nica Santa Mar?a, Chile (Arancibia, Cortes, Valdez); University of Chile School of Medicine, Chile (Cortes); Hospital Militar de Santiago, Chile (Cerda, Hern?ndez); Hospital San Borja-Arriar?n, Chile (Cerda); Servei de Pneumologia, Institut del Torax, Hospital Cl?nic, Institut d?Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (Torres); Centro de Investigaci?n Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028)-Instituto de Salud Carlos III, Spain (Torres)
Correspondence: Francisco Arancibia, MD, Instituto Nacional del T?rax, Jos? Miguel Infante 717, Providencia, Santiago, Chile, E-mail: fearancibia@gmail.com
Chest. 2013. doi:10.1378/chest.13-0162 - Published online
Abstract
Background
In US and European literature Legionella pneumophila is reported as an important etiological agent of severe community acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to evaluate the incidence of severe CAP due for this agent in Santiago, Chile, and identify predictors of Legionella severe CAP.
Methods
A multicentric prospective clinical study lasting 18 months was conducted; it included all adult patients who were admitted for a severe CAP in the Intensive Care Units (ICU) of 4 hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks or presented another disease during their hospitalization. All data for the diagnosis of severe CAP were registered and urinary antigens for L pneumophila serogroup 1 were determined.
Results
104 patients with a severe CAP were included, mean age: 58.3 ?19.3 years; 64.4% males; APACHE II score was: 16.7? 6.3; SOFA: 6.1? 3.2, Pitt Bacteremia Score (PBS): 3.4? 2.5 and PaO2/FiO2: 170.8? 87.1. An etiologic agent was identified in 62 patients (59.6%): S. pneumoniae 27 (26%) and L. pneumophila 9 (8.6%) were the most frequent agents. Logistic regression analysis showed that plasma sodium ≤ 130 mEq/L was an independent predictor for L. pneumophila severe CAP (OR 11.3; 95% CI 2.5-50.5; p= 0.002). Global mortality was 26%, and 33% for L. pneumophila. PBS and Pneumonia Score Index were better predictors of mortality.
Conclusions
We found that in Santiago L. pneumophila was second to S. pneumoniae as etiological agent of severe CAP. Severe hyponatremia at admission appears as an indicator for L. pneumophila etiology in severe CAP.
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