{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:40:56Z","timestamp":1794278456185,"version":"4.9.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T00:00:00Z","timestamp":1607904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007514","name":"Universit\u00e0 di Pisa","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007514","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p><jats:italic>Legionella<\/jats:italic> spp. pneumonia (LP) is a cause of community-acquired pneumonia (CAP) that requires early intervention. The median mortality rate varies from 4 to 11%, but it is higher in patients admitted to intensive care unit (ICU). The objective of this study is to identify predictors of ICU admission in patients with LP.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A single-center, retrospective, observational study conducted in an academic tertiary-care hospital in Pisa, Italy. Adult patients with LP consecutively admitted to study center from October 2012 to October 2019.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>During the study period, 116 cases of LP were observed. The rate of ICU admission was 20.7% and the overall 30-day mortality rate was 12.1%. Mortality was 4.3% in patients hospitalized in medical wards versus 41.7% in patients transferred to ICU (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The majority of patients (74.1%) received levofloxacin as definitive therapy, followed by macrolides (16.4%), and combination of levofloxacin plus a macrolide (9.5%). In the multivariate analysis, diabetes (OR 8.28, CI 95% 2.11\u201335.52, <jats:italic>p<\/jats:italic>\u2009=\u20090.002), bilateral pneumonia (OR 10.1, CI 95% 2.74\u201337.27, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), and cardiovascular events (OR 10.91, CI 95% 2.83\u201342.01, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), were independently associated with ICU admission, while the receipt of macrolides\/levofloxacin therapy within 24\u00a0h from admission was protective (OR 0.20, CI 95% 0.05\u20130.73, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Patients who received a late anti-<jats:italic>Legionella<\/jats:italic> antibiotic (&gt;\u200924\u00a0h from admission) underwent urinary antigen test later compared to those who received early active antibiotic therapy (2 [2\u20134] vs. 1 [1\u20132] days, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Admission to ICU carries significantly increased mortality in patients with diagnosis of LP. Initial therapy with an antibiotic active against <jats:italic>Legionella<\/jats:italic> (levofloxacin or macrolides) reduces the probability to be transferred to ICU and should be provided in all cases until <jats:italic>Legionella<\/jats:italic> etiology is excluded.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s15010-020-01565-7","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T10:04:45Z","timestamp":1607940285000},"page":"321-325","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Predictors of intensive care unit admission in patients with Legionella pneumonia: role of the time to appropriate antibiotic therapy"],"prefix":"10.1007","volume":"49","author":[{"given":"Marco","family":"Falcone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Russo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusy","family":"Tiseo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Cesaretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Guarracino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Menichetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,12,14]]},"reference":[{"key":"1565_CR1","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1097\/QCO.0000000000000468","volume":"31","author":"LA Herwaldt","year":"2018","unstructured":"Herwaldt LA, Marra AR. 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