Legionnaires Disease in Solid Organ Transplant Recipients

医学四分位间距内科学移植回顾性队列研究人口环境卫生

作者

Guillaume Thizy,Adrien Flahault,Anne Scemla,Olivier Roux,Sophie Jarraud,David Lebeaux,J. Pouchot,Gabriela Gautier-Vargas,Paolo Malvezzi,Marlène Murris,Fanny Vuotto,Sophie Girerd,Nathalie Pansu,Térésa Antonini,Laure Elkrief,Benoı̂t Barrou,Camille Besch,Mathieu Blot,Aude Boignard,Henri Brenier,Audrey Coilly,Corentin Gouëzel,Hannah Kaminski,Pauline Housssel-Debry,Jérôme Jouan,Hervé Lecuyer,Anne Limelette,Charles Edouard Luyt,B. Melloni,Christophe Pison,Cédric Rafat,Jean-Michel Rebibou,Eric Savier,Betoul Schvartz,Olivier Scatton,Fatouma Touré,Shaïda Varnous,Pauline Vidal,Émilie Savoye,Florence Ader,Olivier Lortholary,Fanny Lanternier,Emmanuel Lafont

出处

期刊：Chest [Elsevier BV]
日期：2023-10-14 卷期号：165 (3): 507-520 被引量：1

链接

nih.govdoi.org

标识

DOI：10.1016/j.chest.2023.09.033

摘要

Background

Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described.

Research Question

What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients?

Study Design and Methods

In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU.

Results

One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54 of 57), ground-glass opacity in 63% of patients (36 of 57), macronodules in 21% of patients (12 of 57), and cavitation in 8.8% of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P = .047), lymphopenia (P = .014), respiratory symptoms (P = .010), and pleural effusion (P = .039). The 30-day and 12-month mortality rates were 8% (8 of 101) and 20% (19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P = .022).

Interpretation

LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.