Legionella und Legionellose

Was ist neu?

Epidemiologie In den letzten Jahren ist eine geringe Zunahme diagnostizierter und gemeldeter Legionella-Pneumonien zu verzeichnen. Dies ist vermutlich auch der häufigeren Diagnostik zuzuschreiben.

Diagnostik Neben dem L. pneumophila Serogruppe 1-Urin-Antigen-Test sollten besonders bei schweren Verläufen zusätzlich Nukleinsäure-Amplifikationsverfahren angewendet werden. Letztere besitzen ein breiteres Spektrum und eine höhere Sensitivität.

Therapie In-vitro Resistenztestungen geben erste Hinweise, dass eine Therapie mit Levofloxacin gegenüber einer Therapie mit Makroliden überlegen sein könnte. Dies deckt sich mit aktuellen klinischen Daten aus Kohortenstudien. Levofloxacin (750–1000 mg/d) gilt bei gesicherter Legionellose als Mittel der Wahl, Alternativen sind Azithromycin oder Moxifloxacin. Eine Therapiedauer von 7 Tagen reicht in der Regel aus. Eine Resistenzentwicklung ist bisher nur vereinzelt beobachtet worden und erfordert keine routinemäßige Resistenztestung.

Abstract

Diagnosed and reported Legionella pneumonias are slightly increasing during recent years. This might at least partially be due to more frequently used diagnostic tests.

In severe pneumonia, nucleic acid amplification based methods should supplement the L. pneumophila serogroup-1 urinary antigen test because of their improved spectrum and sensitivity.

Recent in vitro data suggest enhanced efficacy of levofloxacin when compared to macrolides. This complements recent clinical cohort data. Thus levofloxacin (750–1000 mg/d) is regarded the treatment of choice for confirmed legionellosis. Second line options are azithromycin or moxifloxacin. Treatment duration of 7 days should be sufficient in most cases.

Development of resistance is rare and no routine resistance testing is necessary.

Schlüsselwörter

Legionella - Pneumonie - Mikrobiologie - antimikrobielle Therapie

Key words

legionella - pneumonia - microbiology - antimicrobial treatment

• Literatur

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