Risk factors for nosocomial Legionella pneumophila pneumonia

Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):625-9. doi: 10.1164/ajrccm.149.3.8118629.

Abstract

Over a 5-yr period, from January 1985 to January 1990, we prospectively studied 300 episodes of nosocomial pneumonia in a 1,000-bed teaching hospital. All cases had an accurate bacteriologic diagnosis obtained by means of highly reliable techniques. Legionella pneumophila caused a total of 36 episodes; 22 were endemic and 14 occurred during an epidemic outbreak. No patient with Legionella pneumonia had been intubated before infection. To identify risk factors for nosocomial L. pneumophila pneumonia, we compared the 22 endemic cases of nosocomial pneumonia due to L. pneumophila with the 264 cases due to other bacteria. After adjusting for other variables by means of logistic regression analysis, cytotoxic chemotherapy (OR = 5.2; 95% CI, 1.5 to 17.9) and use of corticosteroids (OR = 4.6; 95% CI, 1.5 to 14.1) were positively associated with L. pneumophila pneumonia, whereas previous antibiotic therapy (OR = 0.2; 95% CI, 0.1 to 0.8) and lowered consciousness (OR = 0.2; 95% CI, 0.07 to 0.8) were negatively associated. The major risk factors for Legionella pneumonia delineated in this study should be considered in the clinical approach to and empiric therapy of patients with suspected nosocomial pneumonia.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Adult
  • Aged
  • Anti-Bacterial Agents / adverse effects
  • Antineoplastic Agents / adverse effects
  • Bronchoscopy
  • Coma / complications
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Cross Infection / microbiology
  • Cross Infection / prevention & control
  • Disease Outbreaks*
  • Female
  • Hospital Bed Capacity, 500 and over
  • Hospitals, Teaching / statistics & numerical data*
  • Humans
  • Infection Control
  • Legionnaires' Disease / epidemiology*
  • Legionnaires' Disease / etiology
  • Legionnaires' Disease / microbiology
  • Legionnaires' Disease / prevention & control
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antineoplastic Agents