Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?

Abstract

Listeria monocytogenes is a Gram-positive bacterium which can cause invasive infection in the immunocompromised, pregnant women and young infants. Listeria are not susceptible to the third generation cephalosporins (such as cefotaxime or ceftriaxone) usually given as empirical antibiotic treatment to unwell children. Amoxicillin or ampicillin is thus added for infants less than 3 months of age with suspected serious bacterial infection. However empirical antibiotic cover for L. monocytogenes infection beyond the neonatal period may not be needed. CURRENT RECOMMENDATIONThe National Institute of Health and Care Excellence (NICE) clinical guidelines on 'Feverish illness in children' (2007) 1 and 'Bacterial meningitis and meningococcal septicaemia' (2010) 2 recommend that the empirical antibiotic cover for infants 0-3 months of age admitted from home with suspected serious bacterial infection should be amoxicillin and cefotaxime. 1 2 This recommendation reflects the range of bacterial pathogens that cause these serious infections in the first 3 months of life. The inclusion of amoxicillin specifically acknowledges the importance of L. monocytogenes and highlights its non-susceptibility to thirdgeneration cephalosporins. CURRENT EPIDEMIOLOGYPopulation-based surveillance undertaken in England and Wales in the 1980s and 1990s showed that the aetiology and incidence of neonatal bacterial meningitis changed very little over this period with Group B streptococci and Escherichia coli being the leading causative organisms, followed by L. monocytogenes. 3 4 A more recent population-based surveillance study of bacterial meningitis in infants aged <90 days in the UK and Ireland undertaken between July 2010 and July 2011 showed that these three causative bacteria remained dominant, and that their frequency varied significantly by month of life. In the first 30 days of life, L. monocytogenes was the third most common bacteria, responsible for 6% of cases (compared with 7% and 5% (for the first 28 days) in the previous national studies). The median age of meningitis due to L. monocytogenes was 13 days (IQR 3-18 days) with the oldest infant being 29 days; Listeria meningitis was therefore not seen beyond the 1st month of life. 5 Of the 11 cases of Listeria meningitis, 7 (64%) were female, 2/9 (22%) were born preterm (<37 weeks gestation) and 6/9 (67%) first became unwell when at home. Outcome was known in nine cases and all survived although two cases (22%) had a serious complication at discharge (one baby had hydrocephalus while the second baby had focal neurological signs).A summary of all cases of L. monocytogenes infection (sepsis and meningitis inclusive) in infants <1 year of age reported to Public Health England over the 24 years period between 1990 and 2013 is shown in tables 1 and 2. This data expands on previously published surveillance. 6 Ninety-seven per cent of all cases (351/362), and 99% of all cases occurring in the first 90 days of life (351/356), presented in the first 30 days of life. Clinical presentation was kn...

Prescribing amoxicillin for babies up to 3 months of age: definitely time for change

“…Following the article of Okike et al 2, we present further evidence supporting the suggestion that prescription of routine amoxicillin should be limited solely to infants aged under 30 days.…”

Perinatal listeriosis patients treated at a maternity hospital in Beijing, China, from 2013–2018

“…According to Hof et al [22], when listeriosis is a likely diagnosis, the use of ampicillin, PNG, or vancomycin provides empiric coverage for L. monocytogenes. However, empiric therapy for bacterial meningitis with ampicillin may not be necessary for children beyond the neonatal period [26]. Ampicillin or PNG, with or without aminoglycoside or gentamicin, is recommended for all forms of listeriosis.…”

Perinatal listeriosis patients treated at a maternity hospital in Beijing, China, from 2013-2018

“…According to Hof et al [24] , when listeriosis is a likely diagnosis, the use of ampicillin, PNG, or vancomycin provides empiric coverage for L. monocytogenes. However, empiric therapy for bacterial meningitis with ampicillin may not be necessary for children beyond the neonatal period [28] . Ampicillin or PNG, with or without aminoglycoside or gentamicin, is recommended for all forms of listeriosis.…”