重症监护病房中的严重李斯特菌病：一项回顾性多中心研究的见解
Severe listeriosis in intensive care units: insights from a retrospective multicentric study.
作者信息
Villa Antoine, Cour Martin, De Prost Nicolas, Guillon Antoine, Sarton Benjamine, Terzi Nicolas, Klouche Kada, Boissier Florence, Nedelec Paul, Cunat Sibylle, Le Marec Julien, Godard Pierre, Vieille Thibault, Jozwiak Mathieu, Contou Damien, Castelain Vincent, le Basnier Eliott, Lecronier Marie, Pène Frédéric, Bourcier Simon, Uhel Fabrice, Schnell David, Dumas Guillaume, Ait-Oufella Hafid
机构信息
Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Sorbonne University, Assistance Publique - Hôpitaux de Paris, 75012, Paris, France.
Service de Médecine Intensive Réanimation, Hospices Civils de Lyon, Lyon, France.
出版信息
Crit Care. 2025 May 19;29(1):201. doi: 10.1186/s13054-025-05421-8.
BACKGROUND
Listeriosis is a rare but severe foodborne infection, particularly affecting immunocompromised individuals and older adults. Severe cases may lead to neurolisteriosis and sepsis, necessitating intensive care unit (ICU) admission. This study aims to analyze the demographic characteristics, clinical presentation, microbiological findings, treatments, and outcomes of critically ill patients with Listeria infections in the ICU.
METHODS
A retrospective multicenter study was conducted across 23 French hospitals over a 10-year period, including ICU patients with culture-confirmed Listeria monocytogenes infections. Data on demographics, comorbidities, ICU admission characteristics, biological and microbiological parameters, treatments, and outcomes were collected. The primary outcome was ICU mortality. A multivariable logistic regression model was used to identify factors associated with mortality in patients with neurological manifestations.
RESULTS
A total of 110 patients were included, with a median age of 68 years; 61% were male, and 71% were immunocompromised. Neurological involvement was present in most cases. Invasive mechanical ventilation was required in 58% of patients, and vasopressor support in 44%. ICU and in-hospital mortality rates were 25% and 32%, respectively. Among patients with neurolisteriosis, each 1-point decrease in Glasgow Coma Scale score at admission was associated with increased mortality (OR, 1.22; 95% CI 1.05-1.45; p = 0.009), as were higher cerebrospinal fluid (CSF) protein levels (OR, 1.56; 95% CI 1.15-2.41; p = 0.028). Steroid use was not significantly associated with reduced mortality (OR, 0.30; 95% CI 0.07-1.05; p = 0.076).
CONCLUSION
Listeriosis requiring ICU admission is associated with high morbidity and mortality, particularly in older and immunocompromised patients. The severity of these infections is reflected by the frequent need for organ support. Further research is needed to clarify the potential role of steroids in neurolisteriosis.
背景
李斯特菌病是一种罕见但严重的食源性感染，尤其易影响免疫功能低下者和老年人。严重病例可能导致神经型李斯特菌病和败血症，需要入住重症监护病房（ICU）。本研究旨在分析ICU中李斯特菌感染重症患者的人口统计学特征、临床表现、微生物学检查结果、治疗方法及预后。
方法
在10年期间对法国23家医院进行了一项回顾性多中心研究，纳入了经培养确诊为单核细胞增生李斯特菌感染的ICU患者。收集了有关人口统计学、合并症、ICU入院特征、生物学和微生物学参数、治疗方法及预后的数据。主要结局指标为ICU死亡率。采用多变量逻辑回归模型确定与有神经学表现患者死亡率相关的因素。
结果
共纳入110例患者，中位年龄为68岁；61%为男性，71%免疫功能低下。大多数病例存在神经受累。58%的患者需要有创机械通气，44%需要血管活性药物支持。ICU死亡率和住院死亡率分别为25%和32%。在神经型李斯特菌病患者中，入院时格拉斯哥昏迷量表评分每降低1分，死亡率增加（比值比[OR]，1.22；95%置信区间[CI] 1.05 - 1.45；p = 0.009），脑脊液（CSF）蛋白水平升高时也是如此（OR，1.56；95% CI 1.15 - 2.41；p = 0.028）。使用类固醇与死亡率降低无显著相关性（OR，0.30；95% CI 0摘要：背景：李斯特菌病是一种罕见但严重的食源性感染，尤其易影响免疫功能低下者和老年人。严重病例可能导致神经型李斯特菌病和败血症，需要入住重症监护病房（ICU）。本研究旨在分析ICU中李斯特菌感染重症患者的人口统计学特征、临床表现、微生物学检查结果、治疗方法及预后。
方法
在10年期间对法国23家医院进行了一项回顾性多中心研究，纳入了经培养确诊为单核细胞增生李斯特菌感染的ICU患者。收集了有关人口统计学、合并症、ICU入院特征、生物学和微生物学参数、治疗方法及预后的数据。主要结局指标为ICU死亡率。采用多变量逻辑回归模型确定与有神经学表现患者死亡率相关的因素。
结果
共纳入110例患者，中位年龄为68岁；61%为男性，71%免疫功能低下。大多数病例存在神经受累。58%的患者需要有创机械通气，4#置信区间[CI] 1.05 - 1.45；p = 0.009），脑脊液（CSF）蛋白水平升高时也是如此（OR，1.56；95% CI 1.15 - 2.41；p = 0.028）。使用类固醇与死亡率降低无显著相关性（OR，0.30；95% CI 0.07 - 1.05；p = 0.076）。
结论
需要入住ICU的李斯特菌病与高发病率和死亡率相关，尤其是在老年和免疫功能低下患者中。这些感染的严重程度体现在频繁需要器官支持上。需要进一步研究以阐明类固醇在神经型李斯特菌病中的潜在作用。07 - 1.05；p = 0.076）。
结论
需要入住ICU的李斯特菌病与高发病率和死亡率相关，尤其是在老年和免疫功能低下患者中。这些感染的严重程度体现在频繁需要器官支持上。需要进一步研究以阐明类固醇在神经型李斯特菌病中的潜在作用。
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