The Association of Antibiotic Treatment Regimen and Hospital Mortality in Patients Hospitalized with Legionella Pneumonia.
Clin Infect Dis. 2015 Feb 25;
Authors: Gershengorn HB, Keene A, Dzierba AL, Wunsch H
BACKGROUND: Guidelines recommend azithromycin or a quinolone antibiotic for treatment of Legionella pneumonia. No clinical study has compared the strategies.
METHODS: We performed a retrospective cohort analysis of adults hospitalized in the U.S. with a diagnosis of Legionella pneumonia in the Premier Perspectives database (July 1, 2008 - June 30, 2013). Our primary outcome was hospital mortality; we additionally evaluated hospital length of stay, development of Clostridium difficile colitis, and total hospital cost. We used propensity-based matching to compare patients treated with azithromycin versus a quinolone. All analyses were repeated on a subgroup of more severely ill patients defined as requiring intensive care unit admission or mechanical ventilation or having a predicted probability of hospital mortality in the top quartile for all patients.
RESULTS: Legionella pneumonia was diagnosed in 3,152 adults across 437 hospitals. Quinolones alone were used in 28.8%, azithromycin alone was used in 34.0%, and 1.8% received both. Crude hospital mortality was similar: 6.6% (95% confidence interval: 5.0-8.2%) for quinolones versus 6.4% (5.0-7.9%) for azithromycin (p=0.87); after propensity matching (n=813 in each group), mortality remained similar (6.3% (4.6-7.9%) versus 6.5% (4.8-8.2%), p=0.84 for the whole cohort; 14.9% (10.0-19.8%) versus 18.3% (13.0-23.6%), p=0.36 for the more severely ill). There was no difference in hospital length of stay, development of C. difficile, or total hospital cost.
CONCLUSIONS: Use of azithromycin alone or a quinolone alone for treatment of Legionella pneumonia was associated with similar hospital mortality. Few patients receive combination therapy.
PMID: 25722195 [PubMed - as supplied by publisher]