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The mortality of community-acquired Legionnaires' disease ranges from 16 to 30 percent if untreated or treated with inactive antibiotics; the mortality for nosocomial Legionnaires' disease can approach 50 percent given the underlying condition of the patient. With the introduction of improved analytical methods leading to earlier diagnosis and livlier therapies, death has been reduced to significantly less than 10 % in patients with community-acquired legionellosis.
The treatment of Legionella infection will soon be reviewed here. The pathogenesis, epidemiology, clinical symptoms, and diagnosis of the enterprise are discussed separately.
Vulnerability ASSESSMENT
In vitro susceptibility answers are not readily interpretable for Legionella since techniques haven't been consistent. Old-fashioned in vitro susceptibility strategies in agar and broth have proven unreliable. For instance, agar is extracted by the charcoal in buffered charcoal yeast used for Legionella isolation binds antibiotics, and therefore, exercise of these antibiotics contrary to the organism is wrongly minimized. Also, many commercially available antibiotics, which have excellent in vitro activity against Legionella by conventional screening (eg, beta-lactam agents and aminoglycosides), have demonstrated to be comparatively ineffective in patients with Legionnaires' disease.
The intracellular site of the pathogen is relevant to the effectiveness of the antibiotic. Antibiotics capable of reaching intracellular levels higher than the minimal inhibitory concentration (MIC) are more effective clinically than medicines with bad intracellular penetration. Medicines with intracellular transmission include the macrolides, quinolones, tetracyclines, and rifampin.
The empiric discovering that tetracycline and erythromycin appeared to be far better than beta-lactam agents and aminoglycosides in early outbreaks of Legionnaires' disease was in keeping with in vitro results in intracellular and animal types of Legionnaires' disease. Determination of the susceptibility of Legionella spp to antimicrobial agents has become based upon animal models and such intracellular of Legionella infection legionella beheersplannen
