Nosocomial and Community Acquired Legionella Pneumophila Pneumonia.

Overview

Legionnaire's disease (LD) is a major cause of both community acquired and nosocomial pneumonia, with Legionella pneumophila serogroup A (Lp1) being the most virulent and the greatest cause of disease. Sample culture of low respiratory tract is considered the gold standard in the diagnosis of LD, however its sensitivity seems to be poor and its performance is technically demanding. The introduction of urinary antigen detection testing (LUA) brought a major advance in LD diagnosis, with upt to 95% of cases in Europe being diagnosed with this method. Despite the high sensitivity of LUA for Lp1, ranging from 80-90%, its negative predictive value is low in other serogroup than Lp1 and therefore, Legionella may be unrecognized as agent of pneumonia. Although underdiagnosed and underreported, LD represents the second most common cause of pneumonia requiring admission in intensive care unit (ICU). Average fatality rate of LD in Europe reaches 10%, but its mortality is considered to be even higher in nosocomial patients. Despite the higher fatality rate in hospitalized LD patients, poor is the knowledge on the risk factors that could induce disease and that increase mortality in the hospitalized population affected by LD. In order to shed more light on this topic a cohort of patients diagnosed with LD in the last 3 years will be retrospectively examined.

Full Title of Study: “Nosocomial and Community Acquired Legionella Pneumophila Pneumonia, a Retrospective Case Series”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: December 25, 2020

Interventions

  • Other: Data extraction from medical files
    • Data extraction from medical files

Arms, Groups and Cohorts

  • Legionnaires’ disease
    • All confirmed human cases of Legionnaires’ disease diagnosed within the CHU Brugmann hospital within the last 3 years: from 01/01/2016 till 31/12/2018. A similar approach will be followed for the St Pierre Hospital and the UZ Brussel Hospital.

Clinical Trial Outcome Measures

Primary Measures

  • All cause mortality
    • Time Frame: 3 years
    • All cause mortality
  • Severity respiratory failure
    • Time Frame: 3 years
    • Arterial pression of oxygen inferior to 600mmHg at diagnosis

Secondary Measures

  • Age
    • Time Frame: One day
    • Age at diagnosis
  • Sex
    • Time Frame: One day
    • Sex
  • Charlson comorbidity index
    • Time Frame: One day
    • This is a health tool that assesses the comorbidity risk associated to a series of conditions in order to offer medical specialists an informed decision making process in terms of specific screenings or medical procedures.The index accounts for the patient age and 16 different conditions, and ranges from 0 till 37.
  • Smoking status
    • Time Frame: One day
    • Smoking (yes/no) at diagnosis
  • Nosocomial disease (yes/no)
    • Time Frame: One day
    • Nosocomial cases of Legionnaires’ disease are defined in this study as having an onset of symptoms more than 10 days after hospitalization.
  • C reactive protein
    • Time Frame: One day
    • C reactive protein level at diagnosis
  • White blood cells
    • Time Frame: One day
    • White blood cells level at diagnosis
  • Creatinine
    • Time Frame: One day
    • Creatinine level at diagnosis
  • Urea
    • Time Frame: One day
    • Urea level at diagnosis
  • Chest X Ray
    • Time Frame: One day
    • Descriptive analysis of Chest X Ray findings at diagnosis
  • Method of diagnosis
    • Time Frame: One day
    • Name of the method of diagnosis (urinary antigen, seroconversion, cultures).
  • Intensive care unit hospitalization
    • Time Frame: One day
    • Intensive care unit hospitalization (yes/no)
  • Antibiotics
    • Time Frame: One day
    • Name of antibiotics given
  • Antibiotic treatment duration
    • Time Frame: up to 40 days
    • Antibiotic treatment duration

Participating in This Clinical Trial

Inclusion Criteria

All confirmed human cases of Legionnaires' disease diagnosed within the CHU Brugmann hospital within the last 3 years, from 01/01/2016 till 31/12/2018. A similar approach will be followed for the St Pierre and the UZ Brussel Hospitals. Exclusion Criteria:

Pregnant women.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Dr Philippe CLEVENBERGH
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: Dr Philippe CLEVENBERGH, Head of Infectious Diseases Department – Brugmann University Hospital
  • Overall Official(s)
    • Marco Moretti, MD, Principal Investigator, CHU Brugmann
  • Overall Contact(s)
    • Marco Moretti, MD, 3224773508, marco.moretti@chu-brugmann.be

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