Hubbard R B, Mathur R M, MacFarlane J T
Department of Respiratory Medicine, City Hospital, Nottingham.
Q J Med. 1993 May;86(5):327-32.
Legionella pneumophila is the second most common cause of severe community-acquired pneumonia requiring treatment with intermittent positive pressure ventilation. The prognosis of this condition and its complications have not been well documented. Erythromycin is the first-line antibiotic of choice based on clinical experience. Rifampicin has been recommended as an additional agent, though clinical experience has not been reported. We have retrospectively examined 30 cases of severe community-acquired legionella pneumonia. The mean age of the patients was 53 years, 24 were male and eight died (27%, mean age 57 years). During admission 26 patients received erythromycin (eight died) and 15 received rifampicin in addition (five died); four received neither drug and survived. Mean duration of intermittent positive pressure ventilation was 15.9 days for survivors and 14.1 days for fatal cases. Acute renal failure requiring dialysis developed in 13 (43%), of whom five died (38%). Positive inotropic drugs were used in 10 patients and of these six died. Jaundice occurred in 11 patients and was significantly more common (p = 0.028) in patients who received rifampicin (60%) than in those who did not (17%). Excess bilirubin was largely conjugated when measured and there was no consistent hepatitic or obstructive change in the liver enzymes. Severe community-acquired legionella pneumonia has a relatively good outcome with a mortality of 27%, though prolonged intermittent positive pressure ventilation may be required. Acute renal failure is common but reversible in survivors, and jaundice is more common in those who receive rifampicin.
嗜肺军团菌是需要间歇性正压通气治疗的严重社区获得性肺炎的第二大常见病因。这种疾病及其并发症的预后尚无充分记录。根据临床经验，红霉素是一线首选抗生素。尽管尚未有临床经验报告，但利福平已被推荐作为辅助药物。我们回顾性研究了30例严重社区获得性军团菌肺炎病例。患者的平均年龄为53岁，男性24例，8例死亡（27%，平均年龄57岁）。入院期间，26例患者接受了红霉素治疗（8例死亡），15例还接受了利福平治疗（5例死亡）；4例未接受任何一种药物治疗但存活。存活者间歇性正压通气的平均持续时间为15.9天，死亡病例为14.1天。13例（43%）发生了需要透析的急性肾衰竭，其中5例死亡（38%）。10例患者使用了正性肌力药物，其中6例死亡。11例患者出现黄疸，接受利福平治疗的患者中黄疸更为常见（60%），显著高于未接受利福平治疗的患者（17%）（p = 0.028）。测量时过量胆红素主要为结合胆红素，肝酶无一致的肝炎或梗阻性改变。严重社区获得性军团菌肺炎的预后相对较好，死亡率为27%，尽管可能需要延长间歇性正压通气时间。急性肾衰竭很常见，但存活者可逆转，接受利福平治疗的患者黄疸更常见。
