Legionella Pneumonia in the ICU: A Tertiary Care Center Experience Over 10 Years

Luke Andrea; Peter V Dicpinigaitis; Melissa J Fazzari; Sumit Kapoor

doi:10.1097/CCE.0000000000000508

Legionella Pneumonia in the ICU: A Tertiary Care Center Experience Over 10 Years

Crit Care Explor. 2021 Aug 10;3(8):e0508. doi: 10.1097/CCE.0000000000000508. eCollection 2021 Aug.

Authors

Luke Andrea¹, Peter V Dicpinigaitis¹, Melissa J Fazzari², Sumit Kapoor¹

Affiliations

¹ Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
² Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.

Abstract

Few studies have reported the complications and outcomes of patients with Legionella pneumonia requiring ICU admission. The objective of our study is to report the clinical course, complications, and 30-day mortality of patients with Legionella pneumonia admitted to the critical care units at our medical center over a 10-year period.

Design: Retrospective observational study.

Setting: Tertiary care teaching hospital.

Patients: All adult (≥ 18 yr old) patients with Legionella pneumonia admitted to the ICUs from January 1, 2010, to December 31, 2019.

Interventions: None.

Measurements and main results: A total of 88 patients with Legionella pneumonia were admitted to ICUs over the 10-year period. The majority of infections (n = 80; 90.9%) were community acquired. The median (interquartile range) age of patients was 60 years (51.5-71.0 yr); 58 (66%) were male, and 41 (46.6%) identified their race as Black. The median (interquartile range) Sequential Organ Failure Assessment score at ICU admission was 6 (3-9). The distribution of infections showed seasonal dominance with most cases (86%) occurring in the summer to early fall (May to October). Invasive mechanical ventilation was required in 62 patients (70.5%), septic shock developed in 57 patients (64.8%), and acute respiratory distress syndrome developed in 42 patients (47.7%). A majority of patients developed acute kidney injury (n = 69; 78.4%), with 15 (21.7%) receiving only intermittent hemodialysis and 15 (21.7%) requiring continuous renal replacement therapy. Ten patients required venovenous extracorporeal membrane oxygenation support; eight (80%) survived and were successfully decannulated. Overall 30-day mortality was 26.1% (n = 23). Advanced age, higher Sequential Organ Failure Assessment score at admission, and not receiving Legionella-specific antimicrobial therapy within 24 hours of hospital admission were predictors of 30-day mortality.

Conclusions: Patients with Legionella pneumonia may require ICU admission and major organ support. Legionella-targeted antibiotics should be included in the empiric regimen for any patient with severe pneumonia. Outcomes of extracorporeal membrane oxygenation therapy in this population are encouraging.

Keywords: Legionella; intensive care unit; pneumonia; respiratory; septic; shock.