NOT SO ATYPICAL: LEGIONNAIRES DISEASE IN THE COMMUNITY

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Pneumonia caused by Legionella spp, also known as Legionnaires’ disease, is clinically and radiographically similar to other forms of community acquired pneumonia. The incidence is about 1.4 cases per 100,000 persons and mortality rates up to 10%. Suspicion is usually high during periods of outbreaks associated with contaminated water supplies in large facilities. Up to 44% of patients require medical intensive care unit (MICU) admission. We conducted a case series to describe the clinical presentations and outcomes of patients admitted for Legionella Pneumonia to a community hospital in Queens, NY. METHODS: We conducted a retrospective evaluation of patients who were admitted to NewYork-Presbyterian Queens from May 2018 to November 2018 with the diagnosis of Legionella pneumonia. The diagnosis was considered definite if Legionella was isolated by respiratory culture or urine antigen testing. Patient records were reviewed to retrieve demographic, clinical, radiographic, and laboratory data. RESULTS: A total of 14 cases were identified. 92% tested positive on urinary antigen testing and 35% on respiratory culture. The mean age was 63 with 57% being female. The majority of cases (93%) came from home. 50% of the cases were immunocompromised. The most common symptoms were fevers (64%) and shortness of breath (50%), followed by weakness (36%) and diarrhea (36%). Initial labs were significant for leukocytosis (93%), hyponatremia (57%) and acute renal failure (50%). A minority of the patients had a transaminitis (14%) or acute thrombocytopenia (14%). 71% required admission to the MICU with 29% requiring mechanical ventilation. 36% of the patients required vasopressor therapy. 14% of the patients required CVVH or initiation of new renal replacement therapy. Mean hospital length of stay (LOS) was 18 days. Mean MICU LOS was 13 days. On chest x-ray 14% had evidence of cavitary pneumonia. The average delay in appropriate antibiotic initiation was 1 day. 64% received dual antibiotic coverage for legionella. Mortality was 14%. CONCLUSIONS: In our study the overwhelming majority of our patients presented from home without recent exposure to healthcare or contaminated water, but half were immunocompromised. A large proportion of patients required MICU admission, mechanical ventilation, and vasopressor support. CLINICAL IMPLICATIONS: When considering Legionnaires Disease, we expect patients to have a history of exposure whether it be environmental or health care related but the vast majority of our patients did not have such exposures. It is important to consider legionella in all patients presenting with severe pneumonia since early detection and appropriate antibiotic management is vital to decreasing mortality. DISCLOSURES: No relevant relationships by Dennis Genin, source=Web Response No relevant relationships by Tereza Izakovich, source=Web Response No relevant relationships by Erik Perez, source=Web Response no disclosure on file for Lourdes Sanso