目的:侵袭性单核细胞增生李斯特菌感染罕见,但在高危患者中可能导致危及生命的并发症。我们的目的是评估因侵袭性单核细胞增生李斯特菌感染住院的成年人的特征和随访。
方法:2004年至2019年在国家转诊中心进行了一项回顾性观察性队列研究。确诊为侵袭性李斯特菌病的患者,由欧洲疾病预防和控制中心标准定义,包括在内。使用医院电子系统进行数据收集和随访,直到最后一次有记录的访问。主要结果是院内全因死亡率,次要结果包括残留的神经症状,脑脓肿的发生,以及重症监护病房(ICU)的入住要求。
结果:总之,确定63例(男性占57.1%,中位年龄58.8±21.7岁),28/63出现复杂的病程(44.4%)。诊断时,38/63(60.3%)出现败血症,54/63(85.7%)中枢神经系统受累,而9/63(14.3%)出现分离菌血症。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%),在56/63(88.9%)中出现免疫功能低下的情况。从血液(37/54,68.5%)和脑脊液(48/55,87.3%)中分离出单核细胞增多性L.显示对氨苄青霉素和美罗培南的体外完全敏感性(各100%),庆大霉素(86.0%)和甲氧苄啶/磺胺甲恶唑(97.7%)。住院全因死亡率为17/63(27.0%),28/63(44.4%)需要入住ICU。出院时,残余神经功能缺损(11/46,23.9%)和脑脓肿形成(6/46,13.0%)常见。
结论:在有合并症的成年住院患者中,侵袭性单核细胞增生性李斯特菌感染与随访期间的高死亡率和神经系统并发症相关。
OBJECTIVE: 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.
CONCLUSIONS: Among hospitalized adult patients with comorbidities, invasive L. monocytogenes infections are associated with high mortality and neurological complications during follow-up.