住院患者侵袭性李斯特菌感染的临床和微生物学特征及随访：来自匈牙利 16 年的真实世界经验。
Clinical and microbiological characteristics and follow-up of invasive Listeria monocytogenes infection among hospitalized patients: real-world experience of 16 years from Hungary.
机构信息
Faculty of Medicine, Semmelweis University, H-1085 Ulloi ut 26, Budapest, Hungary.
South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, H-1097 Albert Florian ut 5-7, Budapest, Hungary.
出版信息
BMC Microbiol. 2024 Sep 6;24(1):325. doi: 10.1186/s12866-024-03478-z.
PURPOSE
Invasive Listeria monocytogenes infection is rare, but can lead to life-threatening complications among high-risk patients. Our aim was to assess characteristics and follow-up of adults hospitalized with invasive L. monocytogenes infection.
METHODS
A retrospective observational cohort study was conducted at a national referral center between 2004 and 2019. Patients with proven invasive listeriosis, defined by the European Centre for Disease Prevention and Control criteria, were included. Data collection and follow-up were performed using the hospital electronic system, up until the last documented visit. The primary outcome was in-hospital all-cause mortality, secondary outcomes included residual neurological symptoms, brain abscess occurrence, and requirement for intensive care unit (ICU) admission.
RESULTS
Altogether, 63 cases were identified (57.1% male, median age 58.8 ± 21.7 years), and 28/63 developed a complicated disease course (44.4%). At diagnosis, 38/63 (60.3%) presented with sepsis, 54/63 (85.7%) had central nervous system involvement, while 9/63 (14.3%) presented with isolated bacteremia. Frequent clinical symptoms included fever (53/63, 84.1%), altered mental state (49/63, 77.8%), with immunocompromised conditions apparent in 56/63 (88.9%). L. monocytogenes was isolated from blood (37/54, 68.5%) and cerebrospinal fluid (48/55, 87.3%), showing in vitro full susceptibility to ampicillin and meropenem (100% each), gentamicin (86.0%) and trimethoprim/sulfamethoxazole (97.7%). In-hospital all-cause mortality was 17/63 (27.0%), and ICU admission was required in 28/63 (44.4%). At discharge, residual neurological deficits (11/46, 23.9%) and brain abscess formation (6/46, 13.0%) were common.
CONCLUSION
Among hospitalized adult patients with comorbidities, invasive L. monocytogenes infections are associated with high mortality and neurological complications during follow-up.
目的
侵袭性李斯特菌感染较为罕见，但可能导致高危患者出现危及生命的并发症。本研究旨在评估成人侵袭性李斯特菌感染住院患者的特征和随访结果。
方法
在 2004 年至 2019 年期间，在一家国家转诊中心进行了一项回顾性观察性队列研究。纳入符合欧洲疾病预防控制中心标准的确诊侵袭性李斯特菌感染患者。通过医院电子系统采集和随访数据，直至最后一次有记录的就诊。主要结局为院内全因死亡率，次要结局包括残留神经系统症状、脑脓肿发生和需要入住重症监护病房（ICU）。
结果
共纳入 63 例患者（57.1%为男性，中位年龄 58.8±21.7 岁），28/63 例患者发生了复杂的疾病过程（44.4%）。诊断时，38/63 例（60.3%）患者出现败血症，54/63 例（85.7%）患者中枢神经系统受累，9/63 例（14.3%）患者表现为单纯菌血症。常见的临床症状包括发热（53/63，84.1%）、精神状态改变（49/63，77.8%），56/63 例（88.9%）患者存在免疫抑制状态。李斯特菌从血液（37/54，68.5%）和脑脊液（48/55，87.3%）中分离出来，对氨苄西林和美罗培南（各 100%）、庆大霉素（86.0%）和复方磺胺甲噁唑（97.7%）具有体外完全敏感性。院内全因死亡率为 17/63（27.0%），28/63（44.4%）例患者需要入住 ICU。出院时，常见的残留神经系统缺陷（11/46，23.9%）和脑脓肿形成（6/46，13.0%）。
结论
在合并症的住院成年患者中，侵袭性李斯特菌感染与高死亡率和随访期间的神经系统并发症相关。
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