Carratala J, Gudiol F, Pallares R, Dorca J, Verdaguer R, Ariza J, Manresa F
Service of Infectious Disease, Hospital de Bellvitge, University of Barcelona, Spain.
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):625-9. doi: 10.1164/ajrccm.149.3.8118629.
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.
在1985年1月至1990年1月的5年期间，我们对一家拥有1000张床位的教学医院中的300例医院获得性肺炎进行了前瞻性研究。所有病例均通过高度可靠的技术获得了准确的细菌学诊断。嗜肺军团菌共导致36例感染；其中22例为散发病例，14例发生在一次流行暴发期间。没有嗜肺军团菌肺炎患者在感染前接受过插管治疗。为了确定医院获得性嗜肺军团菌肺炎的危险因素，我们将22例嗜肺军团菌所致的医院获得性肺炎散发病例与264例其他细菌所致的病例进行了比较。通过逻辑回归分析对其他变量进行校正后，细胞毒性化疗（比值比[OR]=5.2；95%置信区间[CI]，1.5至17.9）和使用皮质类固醇（OR=4.6；95%CI，1.5至14.1）与嗜肺军团菌肺炎呈正相关，而先前的抗生素治疗（OR=0.2；95%CI，0.1至0.8）和意识降低（OR=0.2；95%CI，0.07至0.8）与嗜肺军团菌肺炎呈负相关。在对疑似医院获得性肺炎患者的临床处理和经验性治疗中，应考虑本研究中所描述的嗜肺军团菌肺炎的主要危险因素。
