李斯特菌相关的血管内感染：71 例连续病例研究。

Listeria monocytogenes-associated endovascular infections: A study of 71 consecutive cases.

机构信息

Institut Pasteur, French National Reference Center, WHO Collaborating Center for Listeria, Paris, France; Université de Paris, Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire Necker-Enfants Malades, Paris, France.

Institut Pasteur, French National Reference Center, WHO Collaborating Center for Listeria, Paris, France; Institut Pasteur, Biology of Infection Unit, 28 rue du Dr Roux, 75015 Paris, France; INSERM U1117, Paris, France.

出版信息

J Infect. 2019 Oct;79(4):322-331. doi: 10.1016/j.jinf.2019.07.013. Epub 2019 Jul 31.

DOI:10.1016/j.jinf.2019.07.013

PMID:31376457

Abstract

BACKGROUND

Listeria monocytogenes-associated endovascular infections are not well characterized.

METHODS

Retrospective study of 71 culture-proven cases reported to the French National Reference Center for Listeria from 1993 to 2018.

RESULTS

Seventy-one cases were identified: 42 with vascular aneurysms/prosthetic infections, 27 with endocarditis, 2 with both. Fifty-eight were men (82%); median age was 75 years [46-92]; 93% reported co-morbidities (66/71), including 50% with immunosuppressive conditions. Vascular infections consisted of infected aneurysms (68%) or prosthetic graft infections (32%); vascular rupture was reported in 25/42 (60%). Tissue samples grew L. monocytogenes in 98% (43/44) and blood cultures in 64% (27/42). Endocarditis cases involved prosthetic or native valves or intracardiac devices in respectively 62% (18/29), 28% (8/29) and 10% (3/29). Infected valves were aortic (62%, 16/26), mitral (31%, 8/26) or both (8%, 2/26); 38% patients required surgery; 45% displayed heart failure; 17% had concomitant neurolisteriosis. In-hospital mortality in vascular infections was 12% (5/42) and 41% (12/29) for Lm-associated endocarditis.

CONCLUSIONS

Endovascular listeriosis is a rare but severe infection. It manifests as vascular infections and endocarditis, mostly in older patients with vascular or cardiac valve prosthetic devices and co-morbidities. Mortality in Lm-associated endocarditis is twice higher than with other pathogens, requiring prompt recognition and treatment.

摘要

背景

李斯特菌属相关的血源感染尚未得到很好的描述。

方法

回顾性研究了 1993 年至 2018 年向法国李斯特菌国家参考中心报告的 71 例培养阳性病例。

结果

共发现 71 例病例：42 例血管动脉瘤/人工假体感染，27 例心内膜炎，2 例兼有。58 例为男性（82%）；中位年龄为 75 岁[46-92]；93%的患者有合并症（66/71），包括 50%的免疫抑制状态。血管感染包括感染性动脉瘤（68%）或人工假体感染（32%）；25/42（60%）例发生血管破裂。组织样本中李斯特菌的检出率为 98%（43/44），血液培养的检出率为 64%（27/42）。心内膜炎病例分别涉及人工瓣膜或自体瓣膜或心内装置，分别占 62%（18/29）、28%（8/29）和 10%（3/29）。感染的瓣膜为主动脉瓣（62%，16/26）、二尖瓣（31%，8/26）或两者均有（8%，2/26）；38%的患者需要手术；45%有心衰；17%有并发神经李斯特菌病。血管感染的院内死亡率为 12%（5/42），李斯特菌相关性心内膜炎的死亡率为 41%（12/29）。