Abstract
Introduction
Legionella pneumophila is an important cause of pneumonia, however there is scant literature assessing the
therapeutic benefit of corticosteroids in treatment. We sought to investigate the
association between corticosteroid use and in-hospital mortality for patients hospitalized
with Legionella pneumonia.
Methods
Data was collected retrospectively 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.
Exclusion criteria included age <18, concurrent immunosuppression, and HIV diagnosis.
We assessed the relationship between corticosteroid use and in-hospital mortality.
Statistical analyses were performed in RStudio.
Results
The study included 160 patients, among which 32 (20%) received steroids. Overall mortality
was 7.5% (12.5% among steroid recipients, 6.2% among controls). 25% of patients were
admitted to the ICU (37.5% among steroid recipients, 21.9% among controls). Adjusted
analysis showed steroid recipients did not have significantly different mortality
(aOR = 2.56, p = 0.436). Steroid use was not significantly associated with longer
LOS (p = 0.22). Steroid use was significantly associated with hyperglycemia (aOR = 2.91,
p = 0.018) and GI bleed (OR = 9.0, p = 0.014).
Conclusions
We found that in patients hospitalized with Legionella pneumonia, corticosteroid administration
was not significantly associated with longer hospitalization or mortality. All findings
held true when adjusting for known predictors of pneumonia severity. Corticosteroid
use was associated with increased rates of hyperglycemia and GIB requiring blood transfusion.
The results of this study are consistent with guidelines recommending against routine
use of corticosteroids in CAP.
Keywords
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Article info
Publication history
Published online: May 16, 2023
Accepted:
May 6,
2023
Received in revised form:
April 3,
2023
Received:
January 25,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
