896. Experience with Legionella Pneumonia during a County Wide Outbreak
Session: Poster Abstract Session: Respiratory Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Patel Ami - Legionella Pneumonia - research_abstract_poster_template v4.pdf (357.4 kB)
  • Background: LegionellaPneumonia (LEP) presents sporadically or in outbreaks, a county wide outbreak occurred during 2008-2010.

    Objective:To evaluate the impact and analyze clinical features during outbreak (OBR) and non –outbreak (NOBR).

    Methods: A retrospective study in a tertiary care hospital, study period 2006-2012. CDC case definition was used for inclusion. Data was collected on demographics, co-morbidities, clinical manifestations; antibiotics used pre and post LEP diagnosis, laboratory data, CXR appearance, ICU admission and outcome. NOBR defined as 2yrs pre and post OBR.

    Results: An OBR of 105 cases of LEP were reported in the county in 2008 -2010, 26/105 (25%) were admitted to our hospital (ADM), mean age 58 yrs. (20-78), 16/26 (61%) were <65 yrs., males 16/26 (61%), African American (AA) 20/26 (77%).  DM in 10/26 (38%), HIV in 2/26 (7%), coronary artery disease (CAD) in 4/26 (15%), solid organ transplant (SOT) in 2/26 (7%). Pts presented with diarrhea in 9/26 (34%), 2/26 (7%) altered mental status (AMS). Chest x-ray (CXR) showed multilobar (MLB) involvement in 5/26 (19%). Hyponatremia 4/26 (15%), acute renal failure (ARF) in 13/26 (50%), ICU care in 10/26 (38%). Use of fluoroquinolones (FLQ) in 11/26 (42%), macrolides 14/26 (54%). One pt expired. In NOBR there were 76 cases of LEP in the county, and 7 and 13 LEP ADM, respectively. Pts in the NOBR ADM mean age 57 (25-84), 14/20 (70%) males and 18/20 (90%) AA.  DM in 6/20 (30%), HIV in 6/20 (30%), 1pt with SOT, CAD in 9/20 (45%). Diarrhea in 8/20 (40%), AMS in 4/20 (20%). CXR showed MLB in 3/20 (15%). Hyponatremia in 1/20 (5%), ARF in 15/20(75%). ICU care in 10/20 (50%).  FLQ use in 12/20 (60%), macrolides use in 5/20 (25%) prior to LEP diagnosis. Four pts. expired.

    HIV and CAD were significantly different between OBR and NOBR pts (p= 0.062 and p=0.046) respectively.  FLQ use prior and after LEP diagnosis was significant (p= 0.089 and p=0.007) respectively.

    Conclusion: ADM with LEP in OBR and NOBR did not differ clinically; significantly more FLQ was used pre and post diagnosis of LEP.

    Ami Patel, MD1, Eliahu Bishburg, MD2, Monica Shah, Pharm D3, Nelson Airewele, MD4 and Christian Engell, MD2, (1)Infectious Disease, Newark Beth Israel Medical Centre, NEWARK, NJ, (2)Infectious Disease, Newark Beth Israel Medical Center, Newark, NJ, (3)Newark Beth Israel Medical Center, Newark, NJ, (4)Internal Medicine, Newark Beth Israel Medical Centre, NEWARK, NJ

    Disclosures:

    A. Patel, None

    E. Bishburg, None

    M. Shah, None

    N. Airewele, None

    C. Engell, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.