{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T01:11:27Z","timestamp":1793149887457,"version":"4.5.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000871","name":"The Mayo Clinic","doi-asserted-by":"publisher","award":["UL1TR002377"],"award-info":[{"award-number":["UL1TR002377"]}],"id":[{"id":"10.13039\/100000871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000871","name":"The Mayo Clinic","doi-asserted-by":"publisher","award":["."],"award-info":[{"award-number":["."]}],"id":[{"id":"10.13039\/100000871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Legionella pneumonia is an important cause of severe pneumonia, yet contemporary data describing its clinical phenotype, diagnostic patterns, and outcomes in the modern era are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter cohort study of adults with laboratory-confirmed Legionella pneumonia across an integrated health system between January 2019 and September 2025. The primary outcome was 30-day mortality. Severe disease was defined as having a requirement for high-flow nasal cannula, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). Univariate and multivariable logistic regression were used to identify predictors of mortality and severe disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 344 patients with laboratory-confirmed Legionella pneumonia during the study period. The median age was 66.6 years, and 45.1% were immunocompromised. Most patients required hospital admission (94.2%), with 36.1% admitted to the intensive care unit; 22.7% required mechanical ventilation and 1.5% ECMO. Thirty- and 90-day mortality were 11.9% and 16.6%, respectively. In multivariable analysis, cirrhosis (OR 10.2, 95% CI 2.15\u201348.3, P = .003), immunocompromised status (odds ratio [OR] 2.24, 95% CI 1.05\u20134.77, P = .036), age (OR 1.03, 95% CI 1.00\u20131.06, P = .031), and lymphopenia at presentation (OR 2.09, 95% CI 1.02\u20134.24, P = .043) were independently associated with increased 30-day mortality. Among patients who were polymerase chain reaction (PCR) or culture positive, urinary antigen testing was positive in only 25.6%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Legionella pneumonia was associated with substantial short-term mortality. Cirrhosis, age, immunocompromised status, and lymphopenia at presentation emerged as independent predictors of 30-day mortality, underscoring the importance of host vulnerability in determining outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag085","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T12:29:00Z","timestamp":1770726540000},"page":"473-480","source":"Crossref","is-referenced-by-count":6,"title":["<i>Legionella<\/i>\n                    Pneumonia in the Modern Era: Clinical Features and Predictors of Mortality"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8225-1361","authenticated-orcid":false,"given":"Aaron M","family":"Pulsipher","sequence":"first","affiliation":[{"name":"Department of Critical Care, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1693-6746","authenticated-orcid":false,"given":"Georges","family":"Khattar","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4302-5729","authenticated-orcid":false,"given":"Hunter","family":"VanDolah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7090-3825","authenticated-orcid":false,"given":"Michael","family":"Gotway","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Radiology, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7085-5530","authenticated-orcid":false,"given":"Kealy","family":"Ham","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5602-2725","authenticated-orcid":false,"given":"Shehabaldin","family":"Alqalyoobi","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Cartin-Ceba","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6344-4141","authenticated-orcid":false,"given":"Robin","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Clinical Microbiology, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6134-151X","authenticated-orcid":false,"given":"Patricia J","family":"Simner","sequence":"additional","affiliation":[{"name":"Division of Clinical Microbiology, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8540-4789","authenticated-orcid":false,"given":"Ayan","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-0349","authenticated-orcid":false,"given":"Holenarasipur R","family":"Vikram","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Transplant Center, Mayo Clinic , Phoenix, Arizona ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"key":"2026100713422301500_ciag085-B1","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1128\/CMR.15.3.506-526.2002","article-title":"Legionella and Legionnaires\u2019 disease: 25 years of investigation","volume":"15","author":"Fields","year":"2002","journal-title":"Clin Microbiol Rev"},{"key":"2026100713422301500_ciag085-B2","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S0140-6736(15)60078-2","article-title":"Legionnaires\u2019 disease","volume":"387","author":"Cunha","year":"2016","journal-title":"Lancet"},{"key":"2026100713422301500_ciag085-B3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.idc.2016.10.002","article-title":"Microbiology and epidemiology of Legionnaire's disease","volume":"31","author":"Burillo","year":"2017","journal-title":"Infect Dis Clin North Am"},{"key":"2026100713422301500_ciag085-B4","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S1473-3099(14)70713-3","article-title":"Epidemiology and clinical management of Legionnaires\u2019 disease","volume":"14","author":"Phin","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2026100713422301500_ciag085-B5","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1086\/590557","article-title":"Increasing incidence of legionellosis in the United States, 1990\u20132005: changing epidemiologic trends","volume":"47","author":"Neil","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2026100713422301500_ciag085-B6","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1086\/341087","article-title":"Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey","volume":"186","author":"Yu","year":"2002","journal-title":"J Infect Dis"},{"key":"2026100713422301500_ciag085-B7","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1378\/chest.113.5.1195","article-title":"Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias","volume":"113","author":"Sopena","year":"1998","journal-title":"Chest"},{"key":"2026100713422301500_ciag085-B8","doi-asserted-by":"crossref","first-page":"ofae529","DOI":"10.1093\/ofid\/ofae529","article-title":"Determinant of 30-day mortality of pulmonary legionellosis: do coinfections matter?","volume":"11","author":"Matsuo","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"2026100713422301500_ciag085-B9","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1016\/j.chest.2020.12.013","article-title":"Risk factors, management, and outcomes of Legionella pneumonia in a large, nationally representative sample","volume":"159","author":"Allgaier","year":"2021","journal-title":"Chest"},{"key":"2026100713422301500_ciag085-B10","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijid.2023.05.065","article-title":"Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing","volume":"134","author":"Serrano","year":"2023","journal-title":"Int J Infect Dis"},{"key":"2026100713422301500_ciag085-B11","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s10096-021-04172-y","article-title":"Community-acquired versus nosocomial Legionella pneumonia: factors associated with Legionella-related mortality","volume":"40","author":"Dagan","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2026100713422301500_ciag085-B12","author":"Centers for Disease Control and Prevention"},{"key":"2026100713422301500_ciag085-B13","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/infdis\/jiy201","article-title":"Eight years of clinical Legionella PCR testing illustrates a seasonal pattern","volume":"218","author":"Rucinski","year":"2018","journal-title":"J Infect Dis"},{"key":"2026100713422301500_ciag085-B14","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2026100713422301500_ciag085-B15","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1186\/s13054-025-05524-2","article-title":"Demographics and outcome of Legionella pneumonia in the intensive care unit: a retrospective multicenter cohort study","volume":"29","author":"Hauffe","year":"2025","journal-title":"Crit Care"},{"key":"2026100713422301500_ciag085-B16","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.chest.2023.09.033","article-title":"Legionnaires disease in solid organ transplant recipients: a decade-long nationwide study in France","volume":"165","author":"Thizy","year":"2024","journal-title":"Chest"},{"issue":"5","key":"2026100713422301500_ciag085-B17","doi-asserted-by":"crossref","first-page":"e12745","DOI":"10.1111\/tid.12745","article-title":"Legionnaires\u2019 disease in transplant recipients: a 15-year retrospective study in a tertiary referral center","volume":"19","author":"Sivagnanam","year":"2017","journal-title":"Transpl Infect Dis"},{"key":"2026100713422301500_ciag085-B18","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13613-024-01252-y","article-title":"Severe Legionnaires\u2019 disease","volume":"14","author":"Rello","year":"2024","journal-title":"Ann Intensive Care"},{"key":"2026100713422301500_ciag085-B19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12941-017-0229-6","article-title":"Diagnostic testing for Legionnaires\u2019 disease","volume":"16","author":"Pierre","year":"2017","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2026100713422301500_ciag085-B20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1128\/CMR.00029-14","article-title":"Current and emerging Legionella diagnostics for laboratory and outbreak investigations","volume":"28","author":"Mercante","year":"2015","journal-title":"Clin Microbiol Rev"},{"key":"2026100713422301500_ciag085-B21","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1086\/345529","article-title":"Diagnosis of Legionella infection","volume":"36","author":"Murdoch","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2026100713422301500_ciag085-B22","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1128\/JCM.01196-07","article-title":"Utility of real-time PCR for diagnosis of Legionnaires\u2019 disease in routine clinical practice","volume":"46","author":"Diederen","year":"2008","journal-title":"J Clin Microbiol"},{"key":"2026100713422301500_ciag085-B23","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/S1473-3099(19)30113-6","article-title":"The burden of Legionnaires\u2019 disease in New Zealand (LegiNZ): a national surveillance study","volume":"19","author":"Priest","year":"2019","journal-title":"Lancet Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag085\/67061325\/ciag085.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/3\/473\/67061325\/ciag085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/3\/473\/67061325\/ciag085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:42:29Z","timestamp":1791394949000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/83\/3\/473\/8494219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,21]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2,21]]},"published-print":{"date-parts":[[2026,10,7]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag085","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9,15]]},"published":{"date-parts":[[2026,2,21]]}}}