Ola Elnadoury, Pharm.D., BCCCP
Clinical Pharmacotherapy Specialist
NYU Langone, United States
Disclosure information not submitted.
Anthony Lubinsky, MD,
Clinical Associate Professor, Medical Director of Respiratory Care
NYU Langone Medical Center and School of Medicine, United States
Disclosure information not submitted.
Title: Effects of Corticosteroids in Hospitalized Patients with Legionella Pneumonia Cohort Study
Introduction: Legionella pneumophila is an important cause of both community and hospital-acquired pneumonia. Despite this, little literature has assessed the therapeutic benefit of corticosteroid use and no specific guidelines exist. We sought to investigate the association between corticosteroid use and in-hospital mortality for patients hospitalized with Legionella pneumonia.
Methods: Data was retrospectively collected from January 2012 to July 2019 at a 705 bed hospital in New York City. Patients were included if they received a positive Legionella test via serology, urine antigen, or culture. Exclusion criteria included prior immunosuppressive therapy, prior systemic corticosteroid use, and HIV diagnosis. We assessed the relationship between corticosteroid use and in-hospital mortality, ICU admission, and length of hospitalization. Statistical analyses were performed in RStudio.
Results: The study included 160 patients, among which 32 (20%) received corticosteroids. Overall mortality was 7.5% (12.5% among corticosteroid recipients, 6.2% among controls). 25% of patients were admitted to the ICU (37.5% among corticosteroid recipients, 21.9% among controls). Case-controlled logistic regression showed corticosteroid use was not significantly associated with mortality (aOR = 2.48 [95% CI: 0.24, 25.9], p=.45) with a trend towards increased ICU admissions (aOR = 2.21 [0.87, 5.61], p=.09). Linear regression showed corticosteroid use was not significantly associated with a change in hospitalization length (Adjusted Coefficient: 1.65 days [-1.00, 4.31], p=.22).
Conclusions: We found that in patients hospitalized with Legionella pneumonia, patients who were given corticosteroids were not significantly associated with longer hospitalization, mortality, or ICU admissions. All findings held true when adjusting for known predictors of pneumonia severity. It is possible that differences in outcomes were due to underlying variation in demographics or illness severity not captured by known confounds. Because pneumonia generally has a low mortality rate, it is difficult to adequately power studies to capture therapeutic benefit. Legionella often goes undiagnosed and the true burden may not be fully understood. Further randomized studies are necessary to elucidate specific patient populations that may benefit from therapy.