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Introduction <p>The incidence of <i>Legionella pneumophila</i> pneumonia is rising. Since 2012, French guidelines recommend fluoroquinolone monotherapy or combination therapy with a fluoroquinolone and macrolide for severe cases, without favoring a strategy. This study assessed the impact of antibiotic strategies on mortality in severe <i>Legionella pneumophila</i> pneumonia in ICU patients.</p> Materials and methods <p>We conducted a retrospective, observational multicenter cohort study across ICUs at the university hospitals of Rouen, Caen, Amiens, Lille, and Elbeuf General Hospital, covering the period from January 1, 2017, to December 31, 2022. All adult patients admitted to ICUs for <i>Legionella pneumophila</i> were included. Patients were divided into two groups: monotherapy and combination therapy. The combination therapy group included those who received exclusive combination therapy and those who transitioned from monotherapy to combination therapy (non-exclusive combination therapy). The primary endpoint was 28-day mortality after ICU admission. Secondary outcomes included 90-day mortality, ventilation duration, ICU stay length, and antibiotic-related adverse events.</p> Results <p>We included 93 patients: 13 in the monotherapy group and 80 in the combination therapy group, with 24 (30%) receiving non-exclusive and 56 (70%) exclusive combination therapy. In the monotherapy group, 12 patients (92.3%) received fluoroquinolones and 1 (7.7%) received a macrolide. Combination therapy consisted of fluoroquinolones and macrolides in all but one case, treated with fluoroquinolones and rifampicin. High-flow oxygen was required in 59 patients (69.4%), invasive ventilation in 65 patients (69.9%), and acute respiratory distress syndrome occurred in 64 patients (68.8%). The 28-day mortality was not significantly different between the two groups (15.4% vs. 12.5). No significant differences were observed in invasive ventilation duration (16.5 vs. 10 days), ICU stay length (12 vs. 11.5 days), or 90-day mortality (23.1% vs. 16.25%). Adverse events attributed to antibiotherapy were cutaneous rash (<i>n</i> = 7; 87.5%) and confusion (<i>n</i> = 1 ;12.5%) and were not significantly different between the two groups (0% vs. 10%).</p> Conclusion <p>Our study suggests that monotherapy, particularly with fluoroquinolones, may be an alternative to combination therapy in managing severe Legionella pneumophila pneumonia in the ICU. Prospective and randomized studies would be necessary to confirm these results and refine treatment recommendations. </p>

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Monotherapy versus combination therapy in severe Legionella pneumonia: a multicenter retrospective observational study

  • 期刊论文

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  • 发表日期：

    2026年2月28日

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  • Manon Bouteiller,
  • Cyril Cossé,
  • Gaëtan Beduneau,
  • Marion Giry,
  • Christian Caillard,
  • Damien Barrau,
  • Jolan Malherbe,
  • Saad Nseir,
  • Dominique Vodovar,
  • Fabienne Tamion,
  • Grégoire Jolly

摘要

Introduction

The incidence of Legionella pneumophila pneumonia is rising. Since 2012, French guidelines recommend fluoroquinolone monotherapy or combination therapy with a fluoroquinolone and macrolide for severe cases, without favoring a strategy. This study assessed the impact of antibiotic strategies on mortality in severe Legionella pneumophila pneumonia in ICU patients.

Materials and methods

We conducted a retrospective, observational multicenter cohort study across ICUs at the university hospitals of Rouen, Caen, Amiens, Lille, and Elbeuf General Hospital, covering the period from January 1, 2017, to December 31, 2022. All adult patients admitted to ICUs for Legionella pneumophila were included. Patients were divided into two groups: monotherapy and combination therapy. The combination therapy group included those who received exclusive combination therapy and those who transitioned from monotherapy to combination therapy (non-exclusive combination therapy). The primary endpoint was 28-day mortality after ICU admission. Secondary outcomes included 90-day mortality, ventilation duration, ICU stay length, and antibiotic-related adverse events.

Results

We included 93 patients: 13 in the monotherapy group and 80 in the combination therapy group, with 24 (30%) receiving non-exclusive and 56 (70%) exclusive combination therapy. In the monotherapy group, 12 patients (92.3%) received fluoroquinolones and 1 (7.7%) received a macrolide. Combination therapy consisted of fluoroquinolones and macrolides in all but one case, treated with fluoroquinolones and rifampicin. High-flow oxygen was required in 59 patients (69.4%), invasive ventilation in 65 patients (69.9%), and acute respiratory distress syndrome occurred in 64 patients (68.8%). The 28-day mortality was not significantly different between the two groups (15.4% vs. 12.5). No significant differences were observed in invasive ventilation duration (16.5 vs. 10 days), ICU stay length (12 vs. 11.5 days), or 90-day mortality (23.1% vs. 16.25%). Adverse events attributed to antibiotherapy were cutaneous rash (n = 7; 87.5%) and confusion (n = 1 ;12.5%) and were not significantly different between the two groups (0% vs. 10%).

Conclusion

Our study suggests that monotherapy, particularly with fluoroquinolones, may be an alternative to combination therapy in managing severe Legionella pneumophila pneumonia in the ICU. Prospective and randomized studies would be necessary to confirm these results and refine treatment recommendations.