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Spontaneous Listeria monocytogenes peritonitis: a population-based study of 13 cases collected in Spain
Juan Nolla-Salas1, Manuel Almela, Isabel Gasser
1Intensive Care Unit, Hospital del Mar, Barcelona, Spain.
Objectives:
We aimed to assess the incidence, demographic data, clinical features, and outcome of peritoneal infections due to Listeria monocytogenes in individuals with cirrhosis.
Methods:
During a 10-yr study period, 153 cases of invasive listeriosis were recorded in a prospective population-based surveillance project carried out in Barcelona, Spain.
Results:
Thirteen cases were of spontaneous bacterial peritonitis by L. monocytogenes. Ages of the patients ranged between 29 and 85 yr. In addition to cirrhosis, underlying conditions included diabetes mellitus in four and malignancy in three. Bacteremia was present in six cases (46%). Only one patient with bacteremia developed meningitis. Analysis of the peritoneal fluid showed a mean (SD) protein content of 21.5 (9.6) g/L and leukocyte count of 7,273 (9,171) cells/ml. L. monocytogenes serotype 4b was the serogroup predominantly isolated (61%). The mortality rate was 30.7%. Eight patients received empirical antibiotic treatment with cephalosporins.
Conclusions:
In geographical areas with a high incidence of listeriosis, L. monocytogenes should be suspected as a causative pathogen of spontaneous bacterial peritonitis in cirrhosis. Early adjustment of antibiotic therapy is essential to reduce mortality.
Insights
Listeria monocytogenes can cause spontaneous bacterial peritonitis in cirrhosis patients. Prompt antibiotic adjustment is crucial for improving outcomes and reducing mortality in these infections.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Cirrhosis patients are susceptible to infections.
- Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhosis.
- Listeria monocytogenes (L. monocytogenes) is an opportunistic pathogen.
Purpose of the Study:
- To determine the incidence, demographics, clinical features, and outcomes of peritoneal infections caused by L. monocytogenes in individuals with cirrhosis.
- To highlight the importance of considering L. monocytogenes in SBP cases among cirrhotic patients.
Main Methods:
- A 10-year prospective population-based surveillance study in Barcelona, Spain.
- Inclusion of 153 cases of invasive listeriosis.
- Analysis of 13 cases of SBP due to L. monocytogenes.
Main Results:
- L. monocytogenes SBP occurred in 13 patients (29-85 years old) with cirrhosis.
- Comorbidities included diabetes mellitus and malignancy.
- Bacteremia was present in 46% of cases; meningitis in one patient.
- L. monocytogenes serotype 4b was predominant (61%).
- Mortality rate was 30.7%.
Conclusions:
- L. monocytogenes should be suspected in SBP cases among cirrhotic patients, especially in high-incidence areas.
- Early and appropriate antibiotic therapy adjustment is critical for reducing mortality.
- This study underscores the need for vigilance regarding L. monocytogenes in this vulnerable population.