The treatment of Listeria monocytogenes septicaemia

Thirty cases of Listeria monocytogenes septicaemia occurred in Denmark between 1981 and 1986. The aim of this study was to consider the treatment of these patients, 18 males and 12 females aged from 20 to 87 years: average (AV) 65 years. One or more predisposing factors (PF) were found in 90% of the patients, mainly cancer (16), steroid treatment (12), cirrhosis and/or alcoholism (8), and diabetes mellitus (3). Follow-up varied from 3 months to 5 years. Ampicillin (AMP) alone or with an aminoglycoside (AMI) was the treatment in 9 and 16 cases, respectively. One patient was successfully treated with penicillin G and another received oral co-trimoxazol after recovered with carbenicillin plus AMI. AMP doses were lower than used in listerial meningitis (AV 5 g/day vs. 16 g/day), and the duration was variable: from one to 21 days (AV 8 days). The mortality rate was 50%. No significant differences between survivors and non-survivors were observed either in the antibiotic treatment (doses, duration, administration, and use of AMI), or the number and kind of PF found. The cause of septicaemia could not be established in most cases but 3 endocarditis, 2 perianal abscesses and one pericarditis were found in the non-survivors. Pulmonary involvement was present in 13 patients and CNS infection suspected in 10. Early diagnosis, adequate doses and duration of antibiotic treatment, and the use of drugs capable to penetrate purulent collections (microabscess and abscess formations) should improve the prognosis of L. monocytogenes septicaemia.