DELAY IN APPROPRIATE THERAPY OF LEGIONELLA-PNEUMONIA ASSOCIATED WITH INCREASED MORTALITY

The prognostic significance of delayed therapy in Legionnaires' diseas e is poorly defined. Thirty-nine consecutive serologically confirmed c ases of Legionnaires' disease were reviewed to examine whether an asso ciation exists between delayed therapy and prognosis. Clinical and lab oratory factors predictive of mortality were also sought. Thirty-one c ases (79%) were classified as having severe pneumonia at diagnosis. Th irty-six patients (92%) had community-acquired infection, and three pa tients (8%) had nosocomial disease. Ten patients died, resulting in a crude mortality rate of 26%. At the first assessment, variables noted for pneumonia associated with death were low diastolic blood pressure (p < 0.02), low serum albumin concentration (p < 0.04), and increased number of days from onset of pneumonia to hospitalisation (prodrome) ( p < 0.021. However, multiple logistic regression analysis revealed tha t the prodrome was the only variable noted at diagnosis that achieved significance (p = 0.024). Mortality also correlated with both delay in the initiation of erythromycin therapy following admission (p < 0.001 ) and the total delay in starting erythromycin therapy (p < 0.001). It is therefore recommended that erythromycin be included early in the e mpiric therapy of severe community-acquired pneumonia.