<i>Legionella</i>antibiotic susceptibility testing: is it time for international standardization and evidence-based guidance?

Abstract Legionella pneumophila, a Gram-negative bacillus, is the causative agent of Legionnaire’s disease, form severe community-acquired pneumonia. Infection can have high morbidity, with proportion patients requiring ICU admission, and up to 10% mortality, which exacerbated by lack efficacy typical empirical antibiotic therapy against spp. The fastidious nature entire Legionellaceae family historically required inclusion activated charcoal in solid medium remove growth inhibitors, inherently interferes accurate antimicrobial susceptibility determination, an acknowledged methodological shortfall, now rectified new that gives results comparable those microbroth dilution. Here, as international community (with authors representing various reference laboratories, countries clinical stakeholders for diagnosis treatment legionellosis), we set out recommendations standardization testing methods, guidelines strains facilitate improved era resistance determination.