PDF(Pubmed)
Abstract：
BACKGROUND: Severe community-acquired pneumonia (SCAP) is commonly treated with an empiric combination therapy, including a macrolide, or a quinolone and a β-lactam. However, the risk of Legionella pneumonia may lead to a prolonged combination therapy even after negative urinary antigen tests (UAT).
METHODS: We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality.
RESULTS: Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis.
CONCLUSIONS: Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia.
METHODS: We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality.
RESULTS: Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis.
CONCLUSIONS: Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia.
摘要：
背景：重症社区获得性肺炎（SCAP）通常采用经验性联合治疗，包括大环内酯,或喹诺酮和β-内酰胺。然而,即使在尿抗原检测(UAT)阴性后,军团菌肺炎的风险也可能导致长期联合治疗.
方法：我们在法国重症监护病房（ICU）进行了6年的回顾性队列研究，并纳入了所有记录有SCAP的患者。所有患者均接受β-内酰胺加大环内酯或喹诺酮的经验性联合治疗，进行了军团菌UAT。当UAT被证实为阴性时,停用大环内酯或喹诺酮。我们检查了SCAP的临床和流行病学特征，并分析了与ICU死亡率相关的独立因素。
结果：在856例记录有SCAP的患者中，26例患有非典型肺炎：18例嗜肺军团菌（LP）血清组1，3支原体肺炎（MP），和5个鹦鹉衣原体(CP)。UAT诊断出16例（89％）军团菌肺炎，PCR证实了其他非典型肺炎的诊断。仅通过文化没有发现非典型肺炎。在多变量分析中，病原体类型与更高的ICU死亡率无关。
结论：嗜肺军团菌UAT被证明在检测大多数病例方面非常有效，只有微不足道的患者漏诊，但不足以诊断非典型肺炎，和文化没有提供任何补充信息。这些结果表明，在军团菌肺炎发病率较低的国家，当军团菌UAT为阴性时，停用大环内酯类或喹诺酮类药物可能是一种安全的选择。
方法：我们在法国重症监护病房（ICU）进行了6年的回顾性队列研究，并纳入了所有记录有SCAP的患者。所有患者均接受β-内酰胺加大环内酯或喹诺酮的经验性联合治疗，进行了军团菌UAT。当UAT被证实为阴性时,停用大环内酯或喹诺酮。我们检查了SCAP的临床和流行病学特征，并分析了与ICU死亡率相关的独立因素。
结果：在856例记录有SCAP的患者中，26例患有非典型肺炎：18例嗜肺军团菌（LP）血清组1，3支原体肺炎（MP），和5个鹦鹉衣原体(CP)。UAT诊断出16例（89％）军团菌肺炎，PCR证实了其他非典型肺炎的诊断。仅通过文化没有发现非典型肺炎。在多变量分析中，病原体类型与更高的ICU死亡率无关。
结论：嗜肺军团菌UAT被证明在检测大多数病例方面非常有效，只有微不足道的患者漏诊，但不足以诊断非典型肺炎，和文化没有提供任何补充信息。这些结果表明，在军团菌肺炎发病率较低的国家，当军团菌UAT为阴性时，停用大环内酯类或喹诺酮类药物可能是一种安全的选择。
