{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:11:00Z","timestamp":1788779460042,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Legionellosis causes more severe disease than other aetiologies of community\u2010acquired pneumonia (CAP). Early recognition and treatment of\n Legionella<\/jats:italic>\n pneumonia reduce mortality. Urinary antigen testing (UAT) has facilitated rapid and reliable diagnosis of\n Legionella<\/jats:italic>\n pneumonia.\n <\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n \n The aims of this study were as follows: (i) identify characteristics of CAP patients more likely to be associated with a positive\n Legionella<\/jats:italic>\n UAT, (ii) identify clinical features of\n Legionella<\/jats:italic>\n pneumonia associated with higher risk of intensive care unit (ICU) admission and (iii) describe public health interventions resulting from positive\n Legionella<\/jats:italic>\n UATs.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a case\u2013control study of CAP patients admitted at two South\u2010Eastern Sydney hospitals between January 2015 and March 2024 who underwent\n Legionella<\/jats:italic>\n UAT. Multivariable logistic regression was used to identify characteristics associated with a positive\n Legionella<\/jats:italic>\n UAT and ICU admission.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There were 13\u2009697\n Legionella<\/jats:italic>\n UATs during the study period, and 51 (0.4%) were positive. A total of 100% of the\n Legionella<\/jats:italic>\n UAT\u2010positive cases could be detected by conducting\n Legionella<\/jats:italic>\n UAT in CAP patients with at least one of the following characteristics: >20 standard alcoholic drinks\/week, confusion, failure of outpatient antibiotic therapy, diarrhoea, myalgias, temperature >40\u00b0C, serum sodium <137\u2009mmol\/L and CRP >300 mg\/L. CURB\u201065 score, CRP and heart rate were independent factors associated with ICU admission. Positive\n Legionella<\/jats:italic>\n UAT results led to 11 regulatory actions under the Public Health Act.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Our study identified characteristics of CAP patients more likely to be associated with a positive\n Legionella<\/jats:italic>\n UAT. Future prospective studies with greater power and in different populations may assist in refining this model to create a clinical decision\u2010making tool to determine the appropriateness of\n Legionella<\/jats:italic>\n UAT in CAP.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/imj.70506","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:13:17Z","timestamp":1784128397000},"page":"1575-1583","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Legionella pneumophila<\/i>\n pneumonia in South Eastern Sydney: diagnosis, prognosis and public health outcomes"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3843-4376","authenticated-orcid":false,"given":"Sue","family":"Qian","sequence":"first","affiliation":[{"name":"Infectious Diseases Department St George Hospital Sydney New South Wales Australia"},{"name":"UNSW Medicine & Health Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nickson","family":"Ning","sequence":"additional","affiliation":[{"name":"UNSW Medicine & Health Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelli","family":"Snyders","sequence":"additional","affiliation":[{"name":"South Eastern Sydney Local Health District Public Health Unit Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misha","family":"Klingstrom","sequence":"additional","affiliation":[{"name":"South Eastern Sydney Local Health District Public Health Unit Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0166-2287","authenticated-orcid":false,"given":"Pam","family":"Konecny","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department St George Hospital Sydney New South Wales Australia"},{"name":"UNSW Medicine & Health Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Sheppeard","sequence":"additional","affiliation":[{"name":"South Eastern Sydney Local Health District Public Health Unit Sydney New South Wales Australia"},{"name":"The University of Sydney School of Public Health Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Roberts","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department St George Hospital Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Shimmin","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department St George Hospital Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stevens","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department St George Hospital Sydney New South Wales Australia"},{"name":"UNSW Medicine & Health Sydney New South Wales Australia"},{"name":"NSW Health Pathology Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7176-1673","authenticated-orcid":false,"given":"Richard","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department St George Hospital Sydney New South Wales Australia"},{"name":"UNSW Medicine & Health Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Legionellosis (Legionnaire's Disease)","author":"The Victorian Government","year":"2024"},{"key":"e_1_2_8_3_1","first-page":"812","article-title":"Could it be Legionella?","volume":"37","author":"Darby J","year":"2008","journal-title":"Aust Fam Physician"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idh.2024.03.004"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.12919"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1526-0542(04)90033-4"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.113.5.1195"},{"key":"e_1_2_8_9_1","volume-title":"MBS Online \u2013 Medicare Benefits Schedule","author":"Australian Government Department of Health, Disability and Ageing","year":"2025"},{"key":"e_1_2_8_10_1","volume-title":"Community\u2010Acquired Pneumonia (CAP) in Adults","author":"Therapeutic Guidelines","year":"2025"},{"key":"e_1_2_8_11_1","unstructured":"Medicare Benefits Schedule.Australian Government Department of Health and Aged Care Permanent Medicare Benefits Schedule (MBS) items for testing for respiratory pathogens including COVID\u201019 \u2013 factsheet;updated 2024 May 31 (cited 2025 July 20). Available from URL:http:\/\/www6.health.gov.au\/internet\/mbsonline\/publishing.nsf\/Content\/0633A695B50C08ECCA258B3400170349\/$File\/PDF%20\u2010%20Permanent%20Medicare%20Benefits%20Schedule%20items%20for%20testing%20respiratory%20pathogens%20including%20COVID\u201019.pdf"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy826"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.13-2-152"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms11020498"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/376627"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.41.8.635"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1581ST"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2009.121434"},{"key":"e_1_2_8_19_1","volume-title":"Legionella control","author":"Environmental Health, NSW Health","year":"2021"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.06.017"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-020-01565-7"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70506","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70506","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70506","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:34:27Z","timestamp":1788777267000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/imj.70506"],"URL":"https:\/\/doi.org\/10.1111\/imj.70506","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"2025-10-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}