Howden B P, Stuart R L, Tallis G, Bailey M, Johnson P D R
Department of Microbiology, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
Intern Med J. 2003 Nov;33(11):484-8. doi: 10.1046/j.1445-5994.2003.00422.x.
Large outbreaks of Legionella pneumonia are rare, but when they occur provide an opportunity to assess predictors of mortality and efficacy of drug therapy. Although erythromycin has been the treatment of choice for many years, newer antimicrobials with increased activity against Legionella are available. A large outbreak of legionnaires' disease associated with the Melbourne Aquarium occurred in April 2000.
To describe the patterns and impact of Legionella therapy, and predictors of outcome in a large group of hospitalized patients with legionnaires' disease.
A 6-month retrospective audit of hospitalized patients with proven legionnaires' disease around the time of the Melbourne Aquarium outbreak was conducted. Statistical analysis was performed using SAS version 8.0 (SAS Institute Inc., NC, USA).
Data were obtained on 104 patients (71 aquarium related, 33 not related). There were six deaths (mortality rate 5.8%), three of which were attributable directly to progressive legionnaires' disease. The major predictors of death were pre-existing cardiac failure (P = 0.0035) and renal disease (P = 0.026). Erythro-mycin is still the most commonly used antibiotic (80% received i.v. erythromycin) with clinicians prescribing more than one active Legionella drug in the majority of cases (76%). Choice of initial antibiotic therapy did not statistically affect outcome as measured by death, length of hospital stay or time to defervescence, although there was a trend towards improved survival with i.v. erythromycin (P = 0.063). Intravenous erythromycin was associated with a 19% rate of phlebitis, whereas side-effects from other antibiotics were uncommon.
The most commonly used Legionella therapy in Australia remains erythromycin. This continues to be an effective agent, however, side-effects are common.
军团菌肺炎的大规模暴发较为罕见，但一旦发生，便提供了评估死亡率预测因素及药物治疗效果的机会。尽管多年来红霉素一直是首选治疗药物，但如今已有对军团菌活性增强的新型抗菌药物。2000年4月，墨尔本水族馆发生了一起与军团病相关的大规模暴发。
描述一大群住院军团病患者的军团菌治疗模式及影响，以及预后的预测因素。
对墨尔本水族馆暴发期间确诊为军团病的住院患者进行了为期6个月的回顾性审计。使用SAS 8.0版软件（美国北卡罗来纳州SAS研究所）进行统计分析。
获取了104例患者的数据（71例与水族馆相关，33例不相关）。有6例死亡（死亡率5.8%），其中3例直接归因于进展性军团病。死亡的主要预测因素是既往存在心力衰竭（P = 0.0035）和肾病（P = 0.026）。红霉素仍然是最常用的抗生素（80%接受静脉注射红霉素），大多数病例（76%）中临床医生会开具一种以上有效的抗军团菌药物。尽管静脉注射红霉素有改善生存的趋势（P = 0.063），但从死亡、住院时间或退热时间衡量，初始抗生素治疗的选择对预后没有统计学上的影响。静脉注射红霉素的静脉炎发生率为19%，而其他抗生素的副作用并不常见。
澳大利亚最常用的军团菌治疗药物仍然是红霉素。它仍然是一种有效的药物，然而，副作用很常见。
