PDF(Pubmed)
Abstract：
Many Legionella pneumonia patients do not produce sputum, and it is unknown whether purulent sputum is required for the identification of Legionella species. This study aimed to evaluate the identification rate of Legionella species based on sputum quality and the factors predictive of Legionella infection. This study included Legionella pneumonia patients at Kurashiki Central Hospital from November 2000 to December 2022. Sputum quality, based on gram staining, was classified as the following: Geckler 1/2, 3/6 and 4/5. Geckler 4/5 was defined as purulent sputum. The sputa of 104 of 124 Legionella pneumonia patients were cultured. Fifty-four patients (51.9%) were identified with Legionella species, most of which were Legionella pneumophila serogroup 1 (81.5%). The identification rates of Legionella species according to sputum quality were 57.1% (16/28) in Geckler 1/2 sputum, 50.0% (34/68) in Geckler 3/6 sputum, and 50.0% (4/8) in Geckler 4/5 sputum, which were not significantly different (P = 0.86). On multivariate analysis, pre-culture treatment with anti-Legionella antimicrobials (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.06-0.91), Pneumonia Severity Index class ≥IV (OR 2.57 [95% CI 1.02-6.71]), and intensive care unit admission (OR 3.08, 95% CI 1.06-10.09) correlated with the ability to identify Legionella species, but sputum quality did not (OR 0.88, 95% CI 0.17-4.41). The identification rate of Legionella species in non-purulent sputum was similar to that in purulent sputum. For the diagnosis of Legionella pneumonia, sputum should be collected before administering anti-Legionella antibiotics and cultured regardless of sputum quality.
摘要：
许多军团菌肺炎患者不产生痰，尚不清楚是否需要化脓性痰来鉴定军团菌。本研究旨在根据痰液质量和军团菌感染的预测因素评估军团菌的种属鉴定率。这项研究包括2000年11月至2022年12月在仓县中心医院的军团菌肺炎患者。痰液质量,基于革兰氏染色，被分类为：Geckler1/2、3/6和4/5。Geckler4/5定义为脓性痰。对124例军团菌肺炎患者中的104例进行了培养。54名患者（51.9%）被确定为军团菌，其中大多数是嗜肺军团菌血清组1(81.5%)。Geckler1/2痰中军团菌菌种的检出率为57.1%(16/28),Geckler3/6痰中50.0%(34/68),Geckler4/5痰中50.0%(4/8)，差异无统计学意义(P=0.86)。在多变量分析中，使用抗军团菌抗菌药物进行培养前治疗（比值比[OR]0.26，95％置信区间[CI]0.06-0.91），肺炎严重程度指数≥IV级（OR2.57[95%CI1.02-6.71]），和重症监护病房入院（OR3.08，95％CI1.06-10.09）与识别军团菌物种的能力相关，但痰液质量没有（OR0.88，95％CI0.17-4.41）。非脓性痰中军团菌的鉴定率与脓性痰中军团菌的鉴定率相似。军团菌肺炎的诊断，在使用抗军团菌抗生素之前，应收集痰液，并进行培养，无论痰液质量如何。
