Abstract
Background
Legionnaires' disease (LD) is a serious sometimes fatal pneumonia caused by Legionella pneumophila. The clinical manifestations of LD may be similar to those by caused by Streptococcus pneumoniae. As both conditions can be serious illnesses but requiring different antimicrobial
therapies, factors that can help differentiate these types of pneumonias can be helpful
in the clinical management of hospitalized patients with bacterial pneumonia. This
study aimed to compare clinical features and indicators of disease progression in
hospitalized patients with community-acquired pneumonia caused by L. pneumophila and bacteremic S. pneumoniae.
Methods
We conducted a retrospective case comparison study of adult patients hospitalized
with LD or S. pneumoniae. Data collected included demographic, clinical characteristics, and comorbidities,
and outcomes. Data were analyzed using SPS vs 24.0. Multivariable analysis was done
using logistic regression with a forward stepwise algorithm.
Results
A total of 106 patients met study criteria. The incidence of LD peaked in summer months
and S. pneumoniae peaked in the winter quarter. From multivariable analysis predictors of LD were male
gender (OR=21.6, p < 0.001), diarrhea (OR=4.5, p = 0.04), body mass index (BMI) (OR=1.13, p = 0.02), hyponatremia (OR=5.6, p = 0.03 and Charlson weighted index of comorbidity (CWIC) score (OR=0.61, p = 0.01). Patients with S. pneumoniae had higher rates of mechanical ventilation, septic shock, and death than those with
LD.
Conclusions
Our data suggests that variables that may distinguish LD from S. pneumoniae include male gender, diarrhea, hyponatremia, higher temperature on admission, higher
BMI and fewer comorbidities. Bacteremic S. pneumoniae was associated with poorer outcomes than LD including higher rates of septic shock,
mechanical ventilation, ICU admission, and death.
Key Indexing Terms
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Article info
Publication history
Published online: March 10, 2022
Accepted:
February 28,
2022
Received:
September 21,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
