In the Infectious Diseases Society of American and the American Thoracic Society community-acquired pneumonia guidelines, testing for the urine antigen of Legionella is recommended for patients with severe pneumonia requiring intensive care unit admission; failure of outpatient antibiotics; active alcohol abuse; history of travel within previous two weeks; or pleural effusion. Despite testing patients perceived to be at increased risk of Legionnaires’ disease based on these guidelines, the researchers estimate that more than 40 percent of Legionella cases could be missed.
Researchers studied nearly 4,000 patients with a primary or secondary diagnosis of pneumonia in an 18-month period. Of the patients with pneumonia due to Legionella, only 22 percent met the IDSA/ATC criteria recommending Legionella testing. The researchers suggest more widespread testing for Legionella in patients admitted to hospitals with pneumonia.
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