Miyashita Naoyuki, Higa Futoshi, Aoki Yosuke, Kikuchi Toshiaki, Seki Masafumi, Tateda Kazuhiro, Maki Nobuko, Uchino Kazuhiro, Ogasawara Kazuhiko, Kiyota Hiroshi, Watanabe Akira
Department of Internal Medicine 1, Kawasaki Medical School, Okayama, Japan.
National Hospital Organization Okinawa National Hospital, Japan.
J Infect Chemother. 2017 Nov;23(11):727-732. doi: 10.1016/j.jiac.2017.09.001. Epub 2017 Sep 23.
To evaluate scoring systems to predict Legionella pneumonia and therapeutic efficacy against Legionella pneumonia, the Japanese Society of Chemotherapy Legionella committee has collected data on cases of Legionella pneumonia from throughout Japan. We analyzed 176 patients with Legionella pneumonia and compared them with 217 patients with Streptococcus pneumoniae pneumonia and 202 patients with Mycoplasma pneumoniae pneumonia. We evaluated four scoring systems, the Winthrop-University Hospital score, Community-Based Pneumonia Incidence Study Group score, and Japan Respiratory Society score, but they demonstrated limited sensitivity and specificity for predicting Legionella pneumonia. Using six clinical and laboratory parameters (high fever, high C-reactive protein, high lactate dehydrogenase, thrombocytopenia, hyponatremia, and unproductive cough) reported by Fiumefreddo and colleagues, only 6% had Legionnella pneumonia when less than 2 parameters were present. The efficacy rates of antibiotics at the time of termination were 94.6% for intravenous antibiotics, including ciprofloxacin and pazufloxacin, and 95.5% for oral antibiotics, including ciprofloxacin, levofloxacin, garenoxacin, moxifloxacin, and clarithromycin. Our results suggested that the previously reported clinical scoring systems to predict Legionnella pneumonia are not useful, but 6 simple diagnostic score accurately ruled out Legionnella pneumonia, which may help to optimize initial empiric therapy. Quinolones and clarithromycin still showed good clinical efficacy against Legionella pneumonia.
为了评估预测军团菌肺炎的评分系统以及针对军团菌肺炎的治疗效果，日本化疗学会军团菌委员会收集了全日本军团菌肺炎病例的数据。我们分析了176例军团菌肺炎患者，并将他们与217例肺炎链球菌肺炎患者和202例肺炎支原体肺炎患者进行比较。我们评估了四种评分系统，即温思罗普大学医院评分、社区肺炎发病率研究组评分和日本呼吸学会评分，但它们在预测军团菌肺炎方面显示出有限的敏感性和特异性。使用Fiumefreddo及其同事报告的六个临床和实验室参数（高热、高C反应蛋白、高乳酸脱氢酶、血小板减少、低钠血症和干咳），当存在少于2个参数时，只有6%的患者患有军团菌肺炎。静脉用抗生素（包括环丙沙星和帕珠沙星）在停药时的有效率为94.6%，口服抗生素（包括环丙沙星、左氧氟沙星、加替沙星、莫西沙星和克拉霉素）的有效率为95.5%。我们的结果表明，先前报道的预测军团菌肺炎的临床评分系统无用，但6个简单诊断评分可准确排除军团菌肺炎，这可能有助于优化初始经验性治疗。喹诺酮类和克拉霉素对军团菌肺炎仍显示出良好的临床疗效。
