Emerging infectious diseases · 2002 · 108 citations · 30 references
Veterinary MedicineInfectious DiseasesClinical EpidemiologyInfectious Disease EpidemiologyMedical MicrobiologyCommunity-acquired Infection TreatmentIntensive Care MedicineAntigen Detection TestsCommunity-acquired Pneumonia TreatmentInfection Risk FactorsIntensive Care Unit MortalityLegionella InfectionLegionnaires' DiseaseOverall MortalityPrognostic Factors Analysis
After a large outbreak of Legionnaires' disease in the Netherlands, we determined risk factors for intensive care unit (ICU) admission and death and the impact of adequate therapy on ICU-free survival among 141 hospitalized patients. Overall mortality rate was 13%, and ICU mortality rate was 36%. Smoking, temperature >38.5 degrees C, and bilateral infiltrates shown on chest x-ray were independent risk factors for ICU admission or death (all p<0.05). Starting adequate therapy within 24 hours after admission resulted in a higher ICU-free survival rate compared to therapy initiation after 24 hours: 78% versus 54%, respectively (p=0.005). However, delay in providing therapy to patients with urinary antigen tests with negative results did not influence outcome. These data suggest that by using the urinary antigen test on admission a more tailored approach to patients with community-acquired pneumonia may be applied.
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David W. Fraser, Theodore R. Tsai, Walter A. Orenstein et al. · New England Journal of Medicine · 1977 · 1.7K citations