Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
Clin Microbiol Infect. 2016 Aug;22(8):725-30. doi: 10.1016/j.cmi.2016.06.006. Epub 2016 Jun 23.
Invasive Listeria monocytogenes infections carry a high mortality despite antibiotic treatment. The rareness of the infection makes it difficult to improve antibiotic treatment through randomized clinical trials. This observational study investigated clinical features and outcome of invasive L. monocytogenes infections including the efficacy of empiric and definitive antibiotic therapies. Demographic, clinical and biochemical findings, antibiotic treatment and 30-day mortality for all episodes of L. monocytogenes bacteraemia and/or meningitis were collected by retrospective medical record review in the North Denmark Region and the Capital Region of Denmark (17 hospitals) from 1997 to 2012. Risk factors for 30-day all-cause mortality were assessed by logistic regression. The study comprised 229 patients (median age: 71 years), 172 patients had bacteraemia, 24 patients had meningitis and 33 patients had both. Significant risk factors for 30-day mortality were septic shock (OR 3.0, 95% CI 1.4-6.4), altered mental state (OR 3.6, 95% CI 1.7-7.6) and inadequate empiric antibiotic therapy (OR 3.8, 95% CI 1.8-8.1). Cephalosporins accounted for 90% of inadequately treated cases. Adequate definitive antibiotic treatment was administered to 195 patients who survived the early period (benzylpenicillin 72, aminopenicillin 84, meropenem 28, sulfamethoxazole/trimethoprim 6, and piperacillin/tazobactam 5). Definitive antibiotic treatment with benzylpenicillin or aminopenicillin resulted in a lower 30-day mortality in an adjusted analysis compared with meropenem (OR 0.3; 95% CI 0.1-0.8). In conclusion, inadequate empiric antibiotic therapy and definitive therapy with meropenem were both associated with significantly higher 30-day mortality.
尽管进行了抗生素治疗，侵袭性李斯特菌感染仍有很高的死亡率。由于感染的罕见性，很难通过随机临床试验来改善抗生素治疗。本观察性研究调查了侵袭性李斯特菌感染的临床特征和结局，包括经验性和明确抗生素治疗的疗效。通过回顾性病历审查，收集了来自丹麦北部地区和首都地区（17 家医院）1997 年至 2012 年期间所有李斯特菌菌血症和/或脑膜炎病例的人口统计学、临床和生化发现、抗生素治疗和 30 天死亡率。通过逻辑回归评估 30 天全因死亡率的危险因素。该研究包括 229 名患者（中位年龄：71 岁），172 名患者患有菌血症，24 名患者患有脑膜炎，33 名患者同时患有菌血症和脑膜炎。30 天全因死亡率的显著危险因素为感染性休克（OR 3.0，95%CI 1.4-6.4）、精神状态改变（OR 3.6，95%CI 1.7-7.6）和经验性抗生素治疗不足（OR 3.8，95%CI 1.8-8.1）。头孢菌素占治疗不足病例的 90%。195 名幸存早期阶段的患者接受了适当的明确抗生素治疗（青霉素 72 例，氨青霉素 84 例，美罗培南 28 例，磺胺甲恶唑/甲氧苄啶 6 例，哌拉西林/他唑巴坦 5 例）。在调整分析中，与美罗培南相比，青霉素或氨青霉素的明确抗生素治疗与 30 天死亡率较低相关（OR 0.3；95%CI 0.1-0.8）。总之，经验性抗生素治疗不足和使用美罗培南进行明确治疗均与 30 天死亡率显著升高相关。
