Severe Legionella pneumophila pneumonia carries high mortality, and treatment is challenged by emerging resistance to conventional fluoroquinolones/macrolides and diagnostic delays. Novel agents such as omadacycline and nemonoxacin show theoretical promise, yet robust clinical evidence in legionellosis is lacking. We report a 59-year-old man with severe community-acquired pneumonia(sCAP) who initially received empiric ceftazidime-avibactam plus nemonoxacin. Respiratory failure did not improve, and the inflammatory markers did not decline. Subsequent bronchoalveolar lavage fluid metagenomic next-generation sequencing(BALF-mNGS) and urinary Legionella antigen confirmed Legionella pneumonia. We then switched to dual therapy with omadacycline and nemonoxacin. The combination led to rapid improvements in inflammatory markers, hypoxemia, and creatine kinase levels. This case provides a clinical rationale for using omadacycline plus nemonoxacin as salvage therapy in severe Legionella pneumonia when conventional regimens fail.

Background and objectives Sepsis remains a leading cause of mortality among children worldwide. This study aimed to describe clinical profile, intensive care needs, outcome, and predictors of mortality among children with severe sepsis. Methods This secondary analysis of FerriPedS study was conducted in a tertiary pediatric intensive care units (PICU) in North India involving 115 children (3 months-12 yr) with severe sepsis. Data were collected regarding clinical details, laboratory investigations, organ dysfunction, intensive care needs, and outcome. Univariate and multinomial logistic regression analyses were used to determine predictors of mortality among severity score, organ dysfunction, serum ferritin, and PICU needs. Results The median (IQR) age was 3 (1-7) years, and common diagnoses were community acquired pneumonia (CAP) (n=45 39.1%), scrub typhus (n=16, 13.9%), and CNS infections (n=12,10.4%). Mortality was 27.8% (n=32). Non-survivors had significantly higher Pediatric Risk of Mortality-III (PRISM III) score, serum ferritin, and daily Pediatric logistic organ dysfunction-2 (PeLOD-2) score. Higher proportion of non-survivors had positive blood culture at admission, coagulopathy, hepatic dysfunction, shock, acute respiratory distress (ARDS), acute kidney injury (AKI), and multiple organ dysfunction score (MODS); and required invasive mechanical ventilation, vasoactive drugs, blood products, and RRT. On multinomial logistic regression analysis, PRISM-III, ARDS, and AKI were independent predictors of mortality. Interpretation and conclusions In children with severe sepsis, the common etiologies included CAP, scrub typhus, and CNS infections, and characterised by high mortality (27.8%). PRISM-III score, ARDS, and AKI were independent predictors of mortality.

[This corrects the article DOI: 10.1371/journal.pone.0344171.].