Community-acquired Legionella pneumonia:: new insights from the German Competence Network for Community Acquired Pneumonia
Community-acquired Legionella pneumonia:: new insights from the German Competence Network for Community Acquired Pneumonia
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DOI：
10.1086/586741
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发表时间：
2008-05-01
影响因子：
11.8
通讯作者：
Lueck, Christian
中科院分区：
文献类型：
--
作者：
von Baum, Heike;Ewig, Santiago;Lueck, Christian
背景社区获得性肺炎能力网络（CAPNETZ）提供了一个独特的机会，研究整个德国的军团病的流行病学，应用先进的诊断工具。对参加德国CAPNETZ多中心研究的2503例社区获得性肺炎成人患者中军团菌肺炎的发病率、临床特征和转归进行了研究。94名患者（3.8%）被诊断为军团菌肺炎，因此确定军团菌属是引起社区获得性肺炎的最常见病原体之一。在门诊和住院患者中同样常见（分别为3.7%和3.8%）。引起社区获得性肺炎的主要菌种是嗜肺军团菌;然而，10%的病例是由尿抗原检测无法检测到的其他菌种引起的。通过尿抗原检测诊断的患者经历了更严重的临床过程。与住院患者相比，非卧床军团菌肺炎患者的性别分布均等，更年轻，合并症较少，初始抗菌治疗不一致的病例较少，临床病程较轻，无死亡。30%的军团菌肺炎患者接受了不一致的初始抗菌治疗，但死亡率未增加。军团菌是德国社区获得性肺炎的主要病因。在住院患者和门诊患者中需要同等考虑。尿抗原检测的阳性结果与更严重的临床病程相关，并导致对除L外的其他种属的潜在相关识别不足。嗜肺菌军团菌肺炎在门诊患者与住院患者的临床表现和结果有显著差异。初始抗菌治疗的不一致率高得令人无法接受。
Background. The Competence Network for Community Acquired Pneumonia ( CAPNETZ) offers a unique opportunity to study the epidemiology of legionellosis throughout Germany, applying sophisticated diagnostic tools.Methods. The incidence, clinical characteristics, and outcome of Legionella pneumonia in 2503 adult patients with community- acquired pneumonia, participating in the German Multicenter Study of the CAPNETZ, were studied.Results. Legionella pneumonia was diagnosed in 94 patients ( 3.8%), thus identifying Legionella species as one of the most common pathogens to cause community- acquired pneumonia. It was equally common among ambulatory and hospitalized patients ( 3.7% and 3.8%, respectively). The predominant species causing community-acquired pneumonia was Legionella pneumophila; however, 10% of cases were caused by other species not detectable by the urinary antigen test. Patients whose disease was diagnosed by urinary antigen testing experienced a more severe clinical course. Compared with hospitalized patients, ambulatory patients with Legionella pneumonia showed an equal sex distribution, were younger, had fewer comorbidities, fewer cases of discordant initial antimicrobial treatment, and a milder clinical course without fatalities. Thirty percent of patients with Legionella pneumonia received discordant initial antimicrobial treatment without increased mortality.Conclusions. Legionella is a leading cause of community- acquired pneumonia in Germany. It needs to be considered equally in hospitalized and ambulatory patients. A positive result of a urine antigen test is associated with a more severe clinical course and leads to a potentially relevant underrecognition of species other than L. pneumophila. Legionella pneumonia in outpatients differs significantly from that in hospitalized patients in terms of clinical presentation and outcome. There was an unacceptably high rate of discordant initial antimicrobial treatment.