Clinical presentation of Legionella pneumonia: Evaluation of clinical scoring systems and therapeutic efficacy

Autor: Masafumi Seki, Yosuke Aoki, Naoyuki Miyashita, Futoshi Higa, Kazuhiro Tateda, Nobuko Maki, Kazuhiro Uchino, Akira Watanabe, Kazuhiko Ogasawara, Toshiaki Kikuchi, Hiroshi Kiyota
Rok vydání: 2017
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Legionella
030106 microbiology
Legionella Pneumonia
Administration
Oral
Sensitivity and Specificity
Young Adult
03 medical and health sciences
0302 clinical medicine
Japan
Community-acquired pneumonia
Moxifloxacin
Levofloxacin
Clarithromycin
Internal medicine
Pneumonia
Mycoplasma
Humans
Medicine
Pharmacology (medical)
030212 general & internal medicine
Intensive care medicine
Aged
Probability
biology
business.industry
Middle Aged
Pneumonia
Pneumococcal
bacterial infections and mycoses
medicine.disease
biology.organism_classification
Anti-Bacterial Agents
Mycoplasma pneumoniae
respiratory tract diseases
Community-Acquired Infections
Pneumonia
Streptococcus pneumoniae
Treatment Outcome
Infectious Diseases
Administration
Intravenous
Female
Legionnaires' Disease
business
Empiric therapy
medicine.drug
Zdroj: Journal of Infection and Chemotherapy. 23:727-732
ISSN: 1341-321X
DOI: 10.1016/j.jiac.2017.09.001
Popis: To evaluate scoring systems to predict Legionella pneumonia and therapeutic efficacy against Legionella pneumonia, the Japanese Society of Chemotherapy Legionella committee has collected data on cases of Legionella pneumonia from throughout Japan. We analyzed 176 patients with Legionella pneumonia and compared them with 217 patients with Streptococcus pneumoniae pneumonia and 202 patients with Mycoplasma pneumoniae pneumonia. We evaluated four scoring systems, the Winthrop-University Hospital score, Community-Based Pneumonia Incidence Study Group score, and Japan Respiratory Society score, but they demonstrated limited sensitivity and specificity for predicting Legionella pneumonia. Using six clinical and laboratory parameters (high fever, high C-reactive protein, high lactate dehydrogenase, thrombocytopenia, hyponatremia, and unproductive cough) reported by Fiumefreddo and colleagues, only 6% had Legionnella pneumonia when less than 2 parameters were present. The efficacy rates of antibiotics at the time of termination were 94.6% for intravenous antibiotics, including ciprofloxacin and pazufloxacin, and 95.5% for oral antibiotics, including ciprofloxacin, levofloxacin, garenoxacin, moxifloxacin, and clarithromycin. Our results suggested that the previously reported clinical scoring systems to predict Legionnella pneumonia are not useful, but 6 simple diagnostic score accurately ruled out Legionnella pneumonia, which may help to optimize initial empiric therapy. Quinolones and clarithromycin still showed good clinical efficacy against Legionella pneumonia.
Databáze: OpenAIRE
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