Open Access Highly Accessed Research article

Three-year multicenter surveillance of community-acquired listeria monocytogenes meningitis in adults

Rosario Amaya-Villar1*, Emilio García-Cabrera23, Elena Sulleiro-Igual4, Pedro Fernández-Viladrich5, Dionisi Fontanals-Aymerich6, Pilar Catalán-Alonso7, Carlos Rodrigo-Gonzalo de Liria8, Ana Coloma-Conde9, Fabio Grill-Díaz10, Antonio Guerrero-Espejo11, Jerónimo Pachón123 and Guillén Prats-Pastor4

Author Affiliations

1 Intensive Care Unit. Hospital Universitario Virgen del Rocío. Av Manuel Siurot s/n, 41013 Sevilla, Spain

2 Spanish Network for Research in Infectious Disease (REIPI). Hospital Universitario Virgen del Rocío. Av Manuel Siurot s/n, 41013 Sevilla, Spain

3 Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013, Sevilla, Spain

4 Clinical Microbiology Department. Hospital Universitari Vall d'Hebron, Av del Valle de Hebron 119-129, 08035 Barcelona, Spain

5 Infectious Disease Service. Hospial Universitari de Bellvitge, Feixa Larga s/n, 08907 L'Hospitalet de Llobregat, Spain

6 Clinical Microbiology Department. Corporació Sanitària Parc Tauli, Parc Tauli s/n 080208 Sabadell, Spain

7 Department of Clinical Microbiology and Infectious Diseases. Hospital Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain

8 Pediatrics Department. Infectious Disease Unit. Hospital Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain

9 Infectious Disease Service. Hospital de la Santa Creu i Sant Pau, C/Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain

10 Intensive Care Unit Infectious Disease Service. Hospital Ramón y Cajal, Ctra Colmenar Viejo Km 9,1, 28034 Madrid, Spain

11 Internal Medicine Departament. Hospital de la Ribera, Ctra. Corbera Km.1. 46600 Alzira, Valencia, Spain

12 Infectious Disease, Microbiology and Preventive medicine Clinical Unit. Hospital Universitario Virgen del Rocío, Av Manuel Siurot s/n, 41013 Sevilla, Spain

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BMC Infectious Diseases 2010, 10:324  doi:10.1186/1471-2334-10-324

Published: 11 November 2010

Abstract

Background

Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series.

Methods

A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital.

Results

Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosupression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome.

Conclusions

Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.