title: Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia.
abstract: 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.
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Thønnings
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: J D
authors.initials: JD
authors.lastname: Knudsen
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: H C
authors.initials: HC
authors.lastname: Schønheyder
authors.affiliation: Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Søgaard
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Arpi
authors.affiliation: Centre for Clinical Epidemiology, South, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: K O
authors.initials: KO
authors.lastname: Gradel
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark. Electronic address: coa@dadlnet.dk.
authors.forename: C
authors.initials: C
authors.lastname: Østergaard
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008584:Meningitis, Listeria / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Bacteraemia; Listeria monocytogenes; Meningitis; Mortality