The association of antibiotic treatment regimen and hospital mortality in patients hospitalized with legionella pneumonia

Hayley B. Gershengorn, Adam B. Keene, Amy L. Dzierba, Hannah Wunsch

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Guidelines recommend azithromycin or a quinolone antibiotic for treatment of Legionella pneumonia. No clinical study has compared these strategies. Methods: We performed a retrospective cohort analysis of adults hospitalized in the United States with a diagnosis of Legionella pneumonia in the Premier Perspectives database (1 July 2008-30 June 2013). Our primary outcome was hospital mortality; we additionally evaluated hospital length of stay, development of Clostridium difficile colitis, and total hospital cost.We used propensity-based matching to compare patients treated with azithromycin vs a quinolone. All analyses were repeated on a subgroup of more severely ill patients, defined as requiring intensive care unit admission or mechanical ventilation or having a predicted probability of hospital mortality in the top quartile for all patients. Results: Legionella pneumonia was diagnosed in 3152 adults across 437 hospitals. Quinolones alone were used in 28.8%, azithromycin alone was used in 34.0%, and 1.8% received both. Crude hospital mortality was similar: 6.6% (95% confidence interval [CI], 5.0%-8.2%) for quinolones vs 6.4% (95% CI, 5.0%-7.9%) for azithromycin (P = .87); after propensity matching (n = 813 in each group), mortality remained similar (6.3% [95% CI, 4.6%-7.9%] vs 6.5% [95% CI, 4.8%-8.2%], P = .84 for the whole cohort, and 14.9% [95%CI, 10.0%-19.8%] vs 18.3%[95% CI, 13.0%-23.6%], P = .36 for the more severely ill). There was no difference in hospital length of stay, development of C. difficile, or total hospital cost. Conclusions: Use of azithromycin alone or a quinolone alone for treatment of Legionella pneumonia was associated with similar hospital mortality. Few patients receive combination therapy.

Original languageEnglish (US)
Pages (from-to)e66-e79
JournalClinical Infectious Diseases
Volume60
Issue number11
DOIs
StatePublished - Jun 1 2015

Fingerprint

Legionella
Hospital Mortality
Azithromycin
Quinolones
Pneumonia
Confidence Intervals
Anti-Bacterial Agents
Length of Stay
Clostridium difficile
Hospital Costs
Therapeutics
Colitis
Artificial Respiration
Intensive Care Units
Cohort Studies
Databases
Guidelines
Mortality

Keywords

  • azithromycin
  • hospital mortality
  • Legionella
  • pneumonia
  • quinolones

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

The association of antibiotic treatment regimen and hospital mortality in patients hospitalized with legionella pneumonia. / Gershengorn, Hayley B.; Keene, Adam B.; Dzierba, Amy L.; Wunsch, Hannah.

In: Clinical Infectious Diseases, Vol. 60, No. 11, 01.06.2015, p. e66-e79.

Research output: Contribution to journalArticle

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abstract = "Background: Guidelines recommend azithromycin or a quinolone antibiotic for treatment of Legionella pneumonia. No clinical study has compared these strategies. Methods: We performed a retrospective cohort analysis of adults hospitalized in the United States with a diagnosis of Legionella pneumonia in the Premier Perspectives database (1 July 2008-30 June 2013). Our primary outcome was hospital mortality; we additionally evaluated hospital length of stay, development of Clostridium difficile colitis, and total hospital cost.We used propensity-based matching to compare patients treated with azithromycin vs a quinolone. All analyses were repeated on a subgroup of more severely ill patients, defined as requiring intensive care unit admission or mechanical ventilation or having a predicted probability of hospital mortality in the top quartile for all patients. Results: Legionella pneumonia was diagnosed in 3152 adults across 437 hospitals. Quinolones alone were used in 28.8{\%}, azithromycin alone was used in 34.0{\%}, and 1.8{\%} received both. Crude hospital mortality was similar: 6.6{\%} (95{\%} confidence interval [CI], 5.0{\%}-8.2{\%}) for quinolones vs 6.4{\%} (95{\%} CI, 5.0{\%}-7.9{\%}) for azithromycin (P = .87); after propensity matching (n = 813 in each group), mortality remained similar (6.3{\%} [95{\%} CI, 4.6{\%}-7.9{\%}] vs 6.5{\%} [95{\%} CI, 4.8{\%}-8.2{\%}], P = .84 for the whole cohort, and 14.9{\%} [95{\%}CI, 10.0{\%}-19.8{\%}] vs 18.3{\%}[95{\%} CI, 13.0{\%}-23.6{\%}], P = .36 for the more severely ill). There was no difference in hospital length of stay, development of C. difficile, or total hospital cost. Conclusions: Use of azithromycin alone or a quinolone alone for treatment of Legionella pneumonia was associated with similar hospital mortality. Few patients receive combination therapy.",
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