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Original Research: Chest Infections |

Importance of Legionella pneumophila in the Etiology of Severe Community-Acquired Pneumonia in Santiago, ChileSevere pneumonia by Legionella pneumophila

Francisco Arancibia, MD; Claudia P. Cortes, MD; Marcelo Valdés, MD; Javier Cerda, MD; Antonio Hernández, MD; Luis Soto, MD; Antoni Torres, MD
Author and Funding Information

From the Instituto Nacional del Tórax (Drs Arancibia, Valdés, and Soto), Santiago, Chile; Clínica Santa María (Drs Arancibia and Valdés), Santiago, Chile; School of Medicine (Dr Cortes), University of Chile, Santiago, Chile; Hospital Militar de Santiago (Drs Cerda and Hernández), Santiago, Chile; Hospital San Borja-Arriarán (Dr Cerda), Santiago, Chile; Servei de Pneumologia (Dr Torres), Institut del Tórax, Hospital Clínic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; and Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028)-Instituto de Salud Carlos III (Dr Torres), Madrid, Spain.

Correspondence to: Francisco Arancibia, MD, Instituto Nacional del Tórax, José Manuel Infante 717, Providencia, Santiago, Chile; e-mail: fearancibia@gmail.com


For editorial comment see page 202

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):290-296. doi:10.1378/chest.13-0162
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Background:  In US and European literature, Legionella pneumophila is reported as an important etiologic agent of severe community-acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to determine the incidence and identify predictors of severe CAP caused by L pneumophila in Santiago, Chile.

Methods:  A multicenter, prospective clinical study lasting 18 months was conducted; it included all adult patients with severe CAP admitted to the ICUs of four hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks, or presented with another disease during their hospitalization. All data for the diagnosis of severe CAP were registered, and urinary antigens for L pneumophila serogroup 1 were determined.

Results:  A total of 104 patients with severe CAP were included (mean ± SD age, 58.3 ± 19.3 years; men, 64.4%; APACHE (Acute Physiology and Chronic Health Evaluation) II score, 16.7 ± 6.3; Sepsis-related Organ Failure Assessment score, 6.1 ± 3.2; Pitt Bacteremia Score, 3.4 ± 2.5; Pao2/Fio2, 170.8 ± 87.1). An etiologic agent was identified in 62 patients (59.6%), with the most frequent being Streptococcus pneumoniae (27 patients [26%]) and L pneumophila (nine patients [8.6%]). Logistic regression analysis showed that a plasma sodium level of ≤ 130 mEq/L was an independent predictor for L pneumophila severe CAP (OR, 11.3; 95% CI, 2.5-50.5; P = .002). Global mortality was 26% and 33% for L pneumophila. The Pitt bacteremia score and pneumonia score index were the best predictors of mortality.

Conclusions:  We found that in Santiago, L pneumophila was second to S pneumoniae as the etiologic agent of severe CAP. Severe hyponatremia at admission appears to be an indicator for L pneumophila etiology in severe CAP.


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