Antibiotic treatment for invasive nonpregnancy-associated listeriosis and mortality: a retrospective cohort study

European Journal of Clinical Microbiology & Infectious Diseases volume 38, pages2243–2251(2019)Cite this article

Abstract

Little evidence exists addressing the clinical value of adding gentamicin to ampicillin for invasive listeriosis. A multicenter retrospective observational study of nonpregnant adult patients with invasive listeriosis (primary bacteremia, central nervous system (CNS) disease, and others) in 11 hospitals in Israel between the years 2008 and 2014 was conducted. We evaluated the effect of penicillin-based monotherapy compared with early combination therapy with gentamicin, defined as treatment started within 48 h of culture results and continued for a minimum of 7 days. Patients who died within 48 h of the index culture were excluded. The primary outcome was 30-day all-cause mortality. A total of 190 patients with invasive listeriosis were included. Fifty-nine (30.6%) patients were treated with early combination therapy, 90 (46.6%) received monotherapy, and 44 (22.8%) received other treatments. Overall 30-day mortality was 20.5% (39/190). Factors associated with mortality included lower baseline functional status, congestive heart failure, and higher sequential organ failure assessment score. Source of infection, treatment type, and time from culture taken date to initiation of effective therapy were not associated with mortality. In multivariable analysis, monotherapy was not significantly associated with increased 30-day mortality compared with early combination therapy (OR 1.947, 95% CI 0.691–5.487). Results were similar in patients with CNS disease (OR 3.037, 95% CI 0.574–16.057) and primary bacteremia (OR 2.983, 95% CI 0.575–15.492). In our retrospective cohort, there was no statistically significant association between early combination therapy and 30-day mortality. A randomized controlled trial may be necessary to assess optimal treatment.

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Affiliations

  1. Institute of Infectious Diseases, Rambam Health Care Campus, HaAliya HaShniya St. 8, 3109601, Haifa, Israel

    Yaakov Dickstein & Mical Paul

  2. Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Yonatan Oster & Ran Nir-Paz

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Orit Shimon, Dafna Yahav, Ronen Ben-Ami, Miriam Weinberger, Galia Rahav, Yasmin Maor & Michal Chowers

  4. Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel

    Lior Nesher

  5. Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel

    Dafna Yahav

  6. Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Yonit Wiener-Well

  7. Infectious Diseases Unit, Sanz Medical Center–Laniado Hospital, Netanya, Israel

    Regev Cohen

  8. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Regev Cohen & Mical Paul

  9. Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Ronen Ben-Ami

  10. Infectious Diseases Unit, Assaf Harofeh Medical Center, Zerifin, Israel

    Miriam Weinberger

  11. Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel

    Galia Rahav

  12. Infectious Disease Unit, Wolfson Medical Center, Holon, Israel

    Yasmin Maor

  13. Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel

    Michal Chowers

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  1. Yaakov Dickstein
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  11. Yasmin Maor
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  13. Ran Nir-Paz
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  14. Mical Paul
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Corresponding authors

Correspondence to Yaakov Dickstein or Mical Paul.

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The study was approved by the ethics committees of all participating institutions.

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Data from this article were presented as a poster at the 29th European Congress of Clinical Microbiology and Infectious Diseases, April 2019.

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Dickstein, Y., Oster, Y., Shimon, O. et al. Antibiotic treatment for invasive nonpregnancy-associated listeriosis and mortality: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 38, 2243–2251 (2019). https://doi.org/10.1007/s10096-019-03666-0

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Keywords

  • Bacteremia
  • CNS infection
  • Combination therapy
  • Gentamicin
  • Listeria