Characterization of a critically ill population with legionella pneumonia during a severe community outbreak in portugal

Results From October to December a community outbreak of Legionnaire’s disease infected 375 patients. Sequencebased typing of clinical and environmental isolates confirmed industrial wet cooling systems as the source of infection. Seventy-six patients were treated at our hospital, of which twenty-four demanded ICU admission, mainly due to severe hypoxemic respiratory failure. Median age were 56.9 ± 11.9 (20-77), with a preponderance of male sex (17 vs. 7). SAPS II score was 41.25 ± 16.61, SOFA at admission was 6.7 ± 3.1 and mean number of failing organs was 2.8 ± 1.4. Sixteen patients (66.7%) demanded invasive mechanical ventilation, and 6 patients had to be rescued by extracorporeal membrane oxygenation (median time of ECMO run of 7.5 ± 2.3). ICU and hospital length of stay were 14.3 ± 4.7 and 25.6 ± 14.0, respectively, and hospital mortality was 8,3% (2 patients). Patients were treated with azithromycin (17) or levofloxacin (7 patients). A moderate correlation was identified between the mean time to a 50% value reduction of C-reactive protein and hospital LOS; degree of hypoxemia at admission (Pa02: Fi02 147.2 ± 86.8) moderately predicted the need for ECMO; SAPS II and C-reactive protein value at admission (45.8 ± 39.9 mg/dl) did not correlate with LOS (ICU or hospital) nor with the need for ECMO.