Omadacycline for the treatment of severe Legionella pneumophila pneumonia complicated with multiple organ dysfunction: a case report

•Exploring the efficacy and safety of omadacycline against severe L.pneumophila pneumonia.•Providing new insights into optimal treatment strategies for severe L.pneumophila infection accompanied with hepatorenal insufficiency or prolonged QT interval by such special pathogen.•A severe L.pneumonia pneumonia patient complicated with multiple organ dysfunction was diagnosed early by mNGS. Omadacycline is a novel tetracycline antibiotic that has a strong in vitro antibacterial activity against atypical pathogen such as Legionella. It is approved for the treatment of adults with community-acquired bacterial pneumonia, including Legionella pneumonia. However, clinical data on the use of omadacycline in Legionella pneumonia is limited. In the present paper, we report a case of severe pneumonia induced by Legionella pneumophila (L.pneumophila) presenting with septic shock and multiple organ dysfunction including lung, liver and kidney. With omadacycline treaetment, inflammation indices of the patient markedly decreased, and the patient significantly improved with multiple organ dysfunction and was discharged from home. Due to its strong antibacterial activity against L.pneumophila, good safety profile and no dosage adjustment in patients with severe hepatic or renal impairment, omadacycline can be considered as an optimal treatment strategies for severe infections by such special pathogen. Whereas, more case reports are needed to support this conclusion.