J Carratala, F Gudiol, R Pallares, J Dorca, R Verdaguer, J Ariza and F Manresa
Service of Infectious Disease, Hospital de Bellvitge, University of Barcelona, Spain.

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.

This article has been cited by other articles:

				E. T. Fuse, K. Tateda, Y. Kikuchi, T. Matsumoto, F. Gondaira, A. Azuma, S. Kudoh, T. J. Standiford, and K. Yamaguchi Role of Toll-like receptor 2 in recognition of Legionella pneumophila in a murine pneumonia model J. Med. Microbiol., March 1, 2007; 56(3): 305 - 312. [Abstract] [Full Text] [PDF]

				S. Jeyaseelan, S. K. Young, M. Yamamoto, P. G. Arndt, S. Akira, J. K. Kolls, and G. S. Worthen Toll/IL-1R Domain-Containing Adaptor Protein (TIRAP) Is a Critical Mediator of Antibacterial Defense in the Lung against Klebsiella pneumoniae but Not Pseudomonas aeruginosa J. Immunol., July 1, 2006; 177(1): 538 - 547. [Abstract] [Full Text] [PDF]

				N. Sopena, M. Sabria, and the Neunos 2000 Study Group Multicenter Study of Hospital-Acquired Pneumonia in Non-ICU Patients Chest, January 1, 2005; 127(1): 213 - 219. [Abstract] [Full Text] [PDF]

				P. Bandyopadhyay, B. Byrne, Y. Chan, M. S. Swanson, and H. M. Steinman Legionella pneumophila Catalase-Peroxidases Are Required for Proper Trafficking and Growth in Primary Macrophages Infect. Immun., August 1, 2003; 71(8): 4526 - 4535. [Abstract] [Full Text] [PDF]

				K D Lettinga, S Weijer, P Speelman, J M Prins, T van der Poll, and A Verbon Reduced interferon-{gamma} release in patients recovered from Legionnaires' disease Thorax, January 1, 2003; 58(1): 63 - 67. [Abstract] [Full Text] [PDF]

				J. G. H. Gubler, M. Schorr, V. Gaia, R. Zbinden, and M. Altwegg Recurrent Soft Tissue Abscesses Caused by Legionella cincinnatiensis J. Clin. Microbiol., December 1, 2001; 39(12): 4568 - 4570. [Abstract] [Full Text] [PDF]

				K. Tateda, T. A. Moore, M. W. Newstead, W. C. Tsai, X. Zeng, J. C. Deng, G. Chen, R. Reddy, K. Yamaguchi, and T. J. Standiford Chemokine-Dependent Neutrophil Recruitment in a Murine Model of Legionella Pneumonia: Potential Role of Neutrophils as Immunoregulatory Cells Infect. Immun., April 1, 2001; 69(4): 2017 - 2024. [Abstract] [Full Text] [PDF]

				K. Tateda, T. A. Moore, J. C. Deng, M. W. Newstead, X. Zeng, A. Matsukawa, M. S. Swanson, K. Yamaguchi, and T. J. Standiford Early Recruitment of Neutrophils Determines Subsequent T1/T2 Host Responses in a Murine Model of Legionella pneumophila Pneumonia J. Immunol., March 1, 2001; 166(5): 3355 - 3361. [Abstract] [Full Text] [PDF]

				S. Fiel Guidelines and Critical Pathways for Severe Hospital-Acquired Pneumonia Chest, February 1, 2001; 119(2_suppl): 412S - 418S. [Abstract] [Full Text] [PDF]

				A. D. Joshi and M. S. Swanson Comparative Analysis of Legionella pneumophila and Legionella micdadei Virulence Traits Infect. Immun., August 1, 1999; 67(8): 4134 - 4142. [Abstract] [Full Text] [PDF]

				M. EL-EBIARY, X. SARMIENTO, A. TORRES, S. NOGUÉ, E. MESALLES, M. BODÍ, and J. ALMIRALL Prognostic Factors of Severe Legionella Pneumonia Requiring Admission to ICU Am. J. Respir. Crit. Care Med., November 1, 1997; 156(5): 1467 - 1472. [Abstract] [Full Text]

				J. E. Stout and V. L. Yu Legionellosis N. Engl. J. Med., September 4, 1997; 337(10): 682 - 687. [Full Text] [PDF]