Ruling out Legionella in community acquired pneumonia.

Link to article at PubMed

Ruling out Legionella in community acquired pneumonia.

Am J Med. 2014 May 6;

Authors: Haubitz S, Hitz F, Graedel L, Batschwaroff M, Lee Wiemken T, Peyrani P, Ramirez JA, Fux CA, Mueller B, Schuetz P

BACKGROUND: Assessing the likelihood for Legionella spp. in community acquired pneumonia is important due to 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 six variables has recently been proposed. We sought to validate these parameters in an independent cohort.
METHODS: We analysed adult patients with community acquired pneumonia from a large multinational database (CAPO) treated between 2001 and 2012 with more than four of the six pre-specified clinical variables available. Association and discrimination was assessed using logistic regression analysis and area under the receiver-operating characteristics curve (AUC).
RESULTS: Of 1939 included patients, the infectious etiology was known in 594 patients (28.9%) including Streptococcus pneumoniae in 264 patients (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 etiology. A logistic regression analysis including all these predictors showed excellent discrimination with AUC of 0.91 (95%CI 0.87 to 0.94). The original dichotomized score showed still good discrimination (AUC 0.73, 95%CI 0.65 to 0.81) and a high negative predictive value of 99% for patients with below two parameters present.
CONCLUSION: This analysis using a large independent patient sample from an international database validates previously proposed clinical variables to accurately rule out of Legionella spp. which may help to optimise initial empiric therapy.

PMID: 24813862 [PubMed - as supplied by publisher]

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