Three-year multicenter surveillance of community-acquired listeria monocytogenes meningitis in adults
Por:
Amaya-Villar, R, Garcia-Cabrera, E, Sulleiro-Igual, E, Fernandez-Viladrich, P, Fontanals-Aymerich, D, Catalan-Alonso, P, de Liria, CRG, Coloma-Conde, A, Grill-Diaz, F, Guerrero-Espejo, A, Pachon, J and Prats-Pastor, G
Publicada:
11 nov 2010
Categoría:
Infectious diseases
Resumen:
Background: Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series.
Methods: A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital.
Results: Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosupression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040). The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome.
Conclusions: Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.
Filiaciones:
Amaya-Villar, R:
Hosp Univ Virgen del Rocio, Intens Care Unit, Seville 41013, Spain
Garcia-Cabrera, E:
Hosp Univ Virgen del Rocio, Spanish Network Res Infect Dis REIPI, Seville 41013, Spain
Univ Seville, CSIC, Hosp Univ Virgen del Rocio, Inst Biomed Sevilla IBIS, Seville 41013, Spain
Sulleiro-Igual, E:
Hosp Univ Vall Hebron, Dept Clin Microbiol, Barcelona 08035, Spain
Fernandez-Viladrich, P:
Hosp Llobregat, Hosp Univ Bellvitge, Infect Dis Serv, Lhospitalet De Llobregat 08907, Spain
Fontanals-Aymerich, D:
Corporacio Sanitaria Parc Tauli, Dept Clin Microbiol, Sabadell 080208, Spain
Catalan-Alonso, P:
Hosp Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid 28007, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Pediat, Infect Dis Unit, Badalona 08916, Spain
Coloma-Conde, A:
Hosp Santa Creu & Sant Pau, Infect Dis Serv, Barcelona 08025, Spain
Grill-Diaz, F:
Hosp Ramon & Cajal, Infect Dis Serv, Intens Care Unit, E-28034 Madrid, Spain
Guerrero-Espejo, A:
Hosp Ribera, Dept Internal Med, Valencia 46600, Spain
Pachon, J:
Univ Seville, CSIC, Hosp Univ Virgen del Rocio, Inst Biomed Sevilla IBIS, Seville 41013, Spain
Hosp Univ Virgen del Rocio, Infect Dis Microbiol & Prevent Med Clin Unit, Seville 41013, Spain
Prats-Pastor, G:
Hosp Univ Vall Hebron, Dept Clin Microbiol, Barcelona 08035, Spain
Green Published, gold
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