Drug | Recommendation |
The drug of choice by virtually all authorities in the field - based on in vitro data, animal models and a small clinical experience. The evidence that it is superior to penicillin is not convincing. The evidence that it is better than cephalosporins is very convincing. Ampicillin is allegedly bacteriostatic to Listeria, which is why many advocate adding an aminoglycoside. IV amoxicillin is available outside of the US and used in place of ampicillin | |
Cephalosporins do not have activity against Listeria. This is important to remember in the empiric selection of drugs for pyogenic meningitis. | |
Ceftriaxone/cefotaxime. Cephalosporins do not have activity against Listeria. This is important to remember in the empiric selection of drugs for pyogenic meningitis. | |
Often added to ampicillin to achieve synergy. It is not clear that this is necessary. | |
It may serve as an alternative or adjunctive drug. Experience largely limited to individual case reports | |
It may be effective. Experience mainly limited to individual case reports | |
Good in vitro activity, but very limited clinical experience and dangerous for monotherapy of any infection. OK, to add. | |
TMP/SMX is the preferred drug in patients who cannot take ampicillin. This combination has good in vitro activity and is bactericidal vs. Listeria. | |
We do not recommend use. However, there are clinical successes in bacteremia-only cases, not effective for CNS involvement. Some patients developed Listeria meningitis while receiving vancomycin. |
Comment: Large prospective study of invasive listeriosis in France. A detailed picture of clinical manifestations and outcomes is provided in this important study. Evidence provided that dexamethasone is associated with worse outcomes
Comment: Updated guidelines on bacterial meningitis that include etiologies of CNS infection (including Listeria) in different age groups and provide treatment recommendations.
Comment: Recommendations regarding pregnant women who are exposed to Listeria. Presumptive testing and treatment are recommended.
Comment: IDSA Guidelines for meningitis: For L. monocytogenes meningitis - preferred is Penicillin G or ampicillin (consider adding gentamicin ). Alternatives are TMP-SMX or meropenem. Doses: Amp - 12gm/d, gent 5mg/kg/d, TMP-SMX 10-20mg/kg (TMP)/d.
Comment: Keep ready-to-eat food cold
Comment: From these sources that likely drive human infection, these authors found that the most prevalent antibiotic resistance found in the majority of included studies were tetracycline, clindamycin, penicillin, ampicillin, and oxacillin (I2 = 86.66%, 95% CI = 73.20-93.36, p < 0.0001). Oxacillin was the least effective, with 100% resistance rates. TCN resistance appears to correlate with PCN and amoxicillin resistance.
Comment: A case report of successful use of linezolid for treatment of Listeria endophthalmitis.
Comment: A Listeria scholar has a comprehensive look at the disease and its sources.
Comment: Report of multiple outbreaks of listeriosis associated with consumption of soft cheeses. Highest risk are Latin-style cheeses.
Comment: Review of mechanisms by which Listeria can adapt to a range of environmental conditions and the impact that this adaptability has upon acquisition of infection in humans
Comment: Another paper from the MONALISA study found no specific findings indicative of neurolisterosis; however, those with brain image findings had a lower 3-month survival rate. In this cohort, they found meningeal enhancement (25/71, 35%), abscess(es), or nodular image(s) evocative of an abscess (10/71, 14%), hemorrhages (11/71, 15%), contrast-enhancing ventricles, or hydrocephalus (7/71, 10%). White-matter images (42/71, 59%), dilated Virchow-Robin spaces (22/71, 31%), and cerebral atrophy were also reported (34/71, 48%). Brainstem involvement (meningeal enhancement, abscess) was reported in only 7/71 cases (10%).
Comment: This study compared risk factors for Listeria meningitis with those for peumococcal meningitis. Reciept of an immunosuppressive agent and liver disease where independently associated with listeriosis.
Comment: An outbreak of listeriosis from contaminated cheese from multiple sources. Molecular analysis connected multiple cheese sources, possibly due to cross-contamination.
Comment: The review from France includes listeriosis in 606 listeria infections. The outcome showed a fetal loss in 27%, live-born neonatal listeriosis in 58%, and premature birth in 14%.
Comment: The major risk was infliximab, based on FDA records showing 266 cases of listeriosis in patients getting biologies. Mortality rates: 11-27%.
Rating: Important
Comment: In a review of reported listeria to the CDC for 2009-2011 (n=1,651), 14% were pregnant, and 74% had immunosuppression from malignancy or treatment. Soft cheese was the most common source.
Rating: Important
Comment: The review was 1959 cases of listeriosis in France from 2001-2008. The risk was >1000 fold with chronic lymphocytic leukemia; risk was 100-1000 fold with liver cancer, myeloma, acute leukemia, giant cell arteritis, organ transplantation and pregnancy.
Comment: The authors review 43 cases of L. monocytogenes bone and joint infections. The most common treatment was amoxicillin (80%) with aminoglycosides (48%) for a median of 15 weeks. Prosthetic joints accounted for 36 (84%) at a median of 9 years post-insertion.
Comment: CDC review of non-outbreak cases in 249 patients. New food sources -- melons and hummus.
Rating: Important
Comment: Review of 30 cases of Listeria meningitis - all were immunocompromised or > 50 years of age. Gram stain of CSF was pos in 7/25 (28%), Mortality 5/30 (17%).
Rating: Important
Comment: Review 7,775 stools submitted for culture - 17 yielded L. monocytogenes. PFGE showed no clusters. Cases tended to have pre-existing GI conditions. The recommendation is to not culture stool for Listeria.
Comment: Review of 7 outbreaks of foodborne gastroenteritis due to L. monocytogenes. Symptoms occur 24 hrs after ingesting large inoculum with fever, watery diarrhea, nausea, headache and arthralgias. Most cases clear within 2 days and don’t require antibiotics; consider ampicillin or TMP-SMX in susceptible hosts.
Comment: Analysis of 861 bulk tank milk from 21 states showed Listeria in 56 (6.5%); of these, 93% were serotypes commonly found in human disease.
Comment: The authors describe A NEW VIRULENCE FACTOR for L. monocytogenes - a surface protein that binds to E - E-cadherin of enterocytes which is a necessary step for translocation.
Comment: An outbreak of L. monocytogenes as a cause of FOODBORNE OUTBREAK among 60 attendees at a Holstein cow show ascribed to post-pasteurization contamination of chocolate milk. The attack rate was 75%; symptoms were diarrhea at 79%, fever at 72% and chills at 65%. The median incubation period was 20hrs, and the median duration of diarrhea was 42 hrs. The contamination level was up to 3x10" bacteria/person.
Comment: This is a BRAINSTEM ENCEPHALITIS, an unusual CNS complication of Listeria that occurs in previously healthy adults. It is analogous to "circling disease" in sheep. Clinical features are biphasic: fever, headache, nausea & vomiting, lasting several days and then cerebellar signs: cranial nerve deficits & hemiparesis. CSF shows increased protein & WBC; culture is positive in 50%. MRI shows rhomboencephalitis.
Comment: This review showed L. monocytogenes accounted for 29 (11%) of 253 cases of community-acquired MENINGITIS and had a mortality rate of 21%.
Comment: Infection in PREGNANCY usually occurs in 3rd trimester, 22% results in stillbirth, susceptibility presumed to be due to compromised CMI of pregnancy, maternal meningitis is rare & early therapy is often effective in protecting the infant.
Comment: Listeria accounts for about 7% of ENDOCARDITIS cases in adults, usually in patients with pre-existing valve disease. The mortality rate in this review was 48%.
Gram positive rods of L. monocytogenes seen in this specimen from a newborn among a background of WBCs.
Source: CDC/Charles N. Farmer