Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Med Intensiva. 2013 Jun-Jul;37(5):320-6. doi: 10.1016/j.medin.2012.05.010. Epub 2012 Jul 31.
To compare intensive care unit (ICU) mortality in patients with severe community-acquired pneumonia (SCAP) caused by Legionella pneumophila receiving combined therapy or monotherapy.
A prospective multicenter study was made, including all patients with sporadic, community-acquired Legionnaires' disease (LD) admitted to the ICU. Admission data and information on the course of the disease were recorded. Antibiotic prescriptions were left to the discretion of the attending physician and were not standardized.
Twenty-five cases of SCAP due to L. pneumophila were included, and 7 patients (28%) out of 25 died after a median of 7 days of mechanical ventilation. Fifteen patients (60%) presented shock. Levofloxacin and clarithromycin were the antibiotics most commonly used in monotherapy, while the most frequent combination was rifampicin plus clarithromycin. Patients subjected to combination therapy presented a lower mortality rate versus patients subjected to monotherapy (odds ratio for death [OR] 0.15; 95%CI 0.02-1.04; p=0.08). In patients with shock, this association was stronger and proved statistically significant (OR for death 0.06; 95%CI 0.004-0.86; p=0.04).
Combined antibiotic therapy decreases mortality in patients with SCAP and shock caused by L. pneumophila.
比较因嗜肺军团菌引起的严重社区获得性肺炎（SCAP）患者接受联合治疗与单一疗法的重症监护病房（ICU）死亡率。
进行了一项前瞻性多中心研究，包括所有入住 ICU 的散发性、社区获得性军团病（LD）患者。记录入院数据和疾病过程信息。抗生素处方由主治医生决定，未标准化。
共纳入 25 例因嗜肺军团菌引起的 SCAP，25 例中有 7 例（28%）在接受机械通气中位时间为 7 天后死亡。15 例（60%）患者出现休克。单一疗法中最常使用左氧氟沙星和克拉霉素，而最常见的联合疗法是利福平加克拉霉素。与单一疗法相比，接受联合治疗的患者死亡率较低（死亡比值比 [OR] 0.15；95%CI 0.02-1.04；p=0.08）。在休克患者中，这种关联更强，且具有统计学意义（死亡比值比 [OR] 0.06；95%CI 0.004-0.86；p=0.04）。
联合抗生素疗法可降低因嗜肺军团菌引起的 SCAP 和休克患者的死亡率。
