Limin Xu,1 Ying Xiong,2 Changquan Fang2 

1Department of Geriatrics, Huizhou First Hospital, Huizhou, Guangdong Province, Peoples’ Republic of China; 2Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huizhou, Guangdong Province, Peoples’ Republic of China

Correspondence: Changquan Fang, Department of Pulmonary and Critical Care Medicine, Huizhou Central People’s Hospital, Huicheng District, Huizhou City, Guangdong Province, 516000, Peoples’ Republic of China, Tel +86 137 5155 1071, Email 314499072@qq.com

Background: Fluoroquinolones and macrolides are the preferred antibiotics for treating Legionnaires’ disease. However, the limited utility of these antibiotics in cases of organ dysfunction is a major problem. Omadacycline is a novel tetracycline antibiotic with a good safety profile and in vitro antibacterial activity against Legionella, but it lacks validation by clinical data.
Case Description: Here, we report a case of severe pneumonia caused by Legionella infection. The patient was empirically treated with antibiotics, after admission but had a poor clinical outcome with severe hepatic and renal insufficiency. After Legionella infection was confirmed by metagenomic next-generation sequencing, the patient was switched to omadacycline antibiotic therapy and eventually discharged after recovery.
Conclusion: The results of this study suggest that metagenomic next-generation sequencing can facilitate early diagnosis of Legionnaires’ disease, and omadacycline can be an alternative antibiotic treatment for severe Legionnaires’ disease, especially in patients experiencing multiple organ failure.

Keywords: Legionella pneumonia, Legionnaires‘disease, metagenomic next-generation sequencing, omadacycline, antibiotic therapy