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

  • Yaakov DicksteinEmail author
  • Yonatan Oster
  • Orit Shimon
  • Lior Nesher
  • Dafna Yahav
  • Yonit Wiener-Well
  • Regev Cohen
  • Ronen Ben-Ami
  • Miriam Weinberger
  • Galia Rahav
  • Yasmin Maor
  • Michal Chowers
  • Ran Nir-Paz
  • Mical PaulEmail author
Original Article
  • 74 Downloads

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.

Keywords

Bacteremia CNS infection Combination therapy Gentamicin Listeria 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent

Informed consent was not applicable given the retrospective observational nature of the study.

Supplementary material

10096_2019_3666_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yaakov Dickstein
    • 1
    Email author
  • Yonatan Oster
    • 2
  • Orit Shimon
    • 3
  • Lior Nesher
    • 4
  • Dafna Yahav
    • 3
    • 5
  • Yonit Wiener-Well
    • 6
  • Regev Cohen
    • 7
    • 8
  • Ronen Ben-Ami
    • 3
    • 9
  • Miriam Weinberger
    • 3
    • 10
  • Galia Rahav
    • 3
    • 11
  • Yasmin Maor
    • 3
    • 12
  • Michal Chowers
    • 3
    • 13
  • Ran Nir-Paz
    • 2
  • Mical Paul
    • 1
    • 8
    Email author
  1. 1.Institute of Infectious DiseasesRambam Health Care CampusHaifaIsrael
  2. 2.Department of Clinical Microbiology and Infectious DiseasesHadassah-Hebrew University Medical CenterJerusalemIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Infectious Disease Institute, Soroka Medical CenterBen-Gurion University of the NegevBeershebaIsrael
  5. 5.Infectious Diseases Unit, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
  6. 6.Infectious Disease UnitShaare Zedek Medical CenterJerusalemIsrael
  7. 7.Infectious Diseases UnitSanz Medical Center–Laniado HospitalNetanyaIsrael
  8. 8.The Ruth and Bruce Rappaport Faculty of MedicineTechnionHaifaIsrael
  9. 9.Infectious Diseases UnitTel Aviv Sourasky Medical CenterTel AvivIsrael
  10. 10.Infectious Diseases UnitAssaf Harofeh Medical CenterZerifinIsrael
  11. 11.Infectious Disease UnitSheba Medical CenterRamat GanIsrael
  12. 12.Infectious Disease UnitWolfson Medical CenterHolonIsrael
  13. 13.Infectious Diseases UnitMeir Medical CenterKfar SabaIsrael

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