SEVERE Legionnaires’ disease requiring intensive care unit (ICU) admission shows improved survival compared to earlier reports, according to a multicenter retrospective cohort study of French patients.
The study included 162 individuals admitted to 12 French ICUs with confirmed Legionella pneumonia between 2014 and 2019. Invasive mechanical ventilation was needed in 58% of cases, and nearly half of those developed acute respiratory distress syndrome. The majority of patients (79%) were managed with combination antibiotic therapy, most commonly a fluoroquinolone and a macrolide. Median ICU length of stay was 11 days.
Despite the severity of illness, mortality at 28 days was 12%. Investigators noted that this outcome was more favorable than historical data, which often report higher fatality rates in ICU-managed Legionella pneumonia. Multivariate analysis identified two significant predictors of death: increasing age and elevated Sequential Organ Failure Assessment (SOFA) score within the first 48 hours of admission. Age was associated with a 7% rise in risk per additional year, while each point increase in SOFA score was linked to a 47% rise in mortality risk.
The findings highlight that timely and effective ICU management, including early recognition and combined antibiotic therapy, may contribute to better outcomes in severe Legionnaires’ disease. These results underscore the importance of early risk stratification, as patients presenting with advanced age or high organ failure scores remain at greatest risk of poor prognosis.
Reference:
Dartevel A et al. Clinical features and prognosis of severe legionnaires’ disease requiring intensive care unit admission: a multicentric retrospective cohort study. Pneumonia. 2025;17:21.
