Institut Pasteur, Biology of Infection Unit, Paris, France.
Institut Pasteur, French National Reference Center and World Health Organization Collaborating Center Listeria, Paris, France.
Clin Infect Dis. 2022 Jan 7;74(1):8-16. doi: 10.1093/cid/ciab337.
Listeriosis is caused by the foodborne pathogen Listeria monocytogenes. It can present as a maternal-neonatal infection. We implemented a nationwide prospective cohort and analyzed the features of neonatal listeriosis.
We studied all neonates born alive from mothers with microbiologically proven maternal-neonatal listeriosis enrolled from November 2009 to December 2017. We analyzed presentation, neonatal outcome at discharge, and predictors of severe presentation and outcome.
We studied 189 infants; 133 of 189 (70%) had abnormal clinical status at birth, including acute respiratory distress in 106 of 189 (56%). There were 132 of 189 (70%) infants who developed early-onset listeriosis and 12 of 189 (6%) who developed late-onset listeriosis; all presented with acute meningitis. There were 17 of 189 (9%) infants who had major adverse outcomes: 3%, (5 of 189) death; 6% (12 of 189), severe brain injury; and 2% (3 of 189), severe bronchopulmonary dysplasia. Fifteen of 17 infants were born <34 weeks of gestation (P < .0001 vs infants born ≥34 weeks of gestation). Maternal antimicrobial treatment ≥1 day before delivery was associated with a significant decrease in presentation severity for the infant, resulting in significantly fewer inotropic drugs, fluid resuscitation, and mechanical ventilation requirement (odds ratio, 0.23; 95% confidence interval, 0.09-0.51; P < .0001).
Antenatal maternal antimicrobial treatment is associated with reduced neonatal listeriosis severity, justifying the prescription of preemptive maternal antimicrobial therapy when maternal-fetal listeriosis is suspected. Neonatal outcome is better than reported earlier, and its major determinant is gestational age at birth.
NCT01520597.
李斯特菌病是由食源性病原体单核细胞增生李斯特菌引起的。它可表现为母婴感染。我们开展了一项全国性前瞻性队列研究，并分析了新生儿李斯特菌病的特征。
我们研究了 2009 年 11 月至 2017 年 12 月期间所有确诊为母婴李斯特菌病的活产新生儿。我们分析了其临床表现、出院时的新生儿结局以及严重表现和结局的预测因素。
我们研究了 189 例婴儿；其中 133 例（70%）在出生时存在异常临床状态，包括 189 例中的 106 例（56%）急性呼吸窘迫。189 例中有 132 例（70%）发生早发型李斯特菌病，189 例中有 12 例（6%）发生晚发型李斯特菌病；所有患儿均表现为急性脑膜炎。189 例中有 17 例（9%）婴儿出现严重不良结局：3%（5/189）死亡；6%（12/189）严重脑损伤；2%（3/189）严重支气管肺发育不良。17 例患儿中有 15 例（9%）出生于＜34 周（P＜0.0001 与出生于≥34 周的婴儿）。母亲在分娩前≥1 天接受抗菌治疗与婴儿临床表现严重程度显著降低相关，导致使用血管活性药物、液体复苏和机械通气的需求明显减少（比值比，0.23；95%置信区间，0.09-0.51；P＜0.0001）。
产前母亲抗菌治疗与新生儿李斯特菌病严重程度降低相关，因此在怀疑母婴李斯特菌病时，应预防性给予母亲抗菌治疗。新生儿结局优于之前报道的结果，其主要决定因素是出生时的胎龄。
NCT01520597。
