Elsevier

Medicina Clínica

Volume 129, Issue 6, July 2007, Pages 218-221
Medicina Clínica

Nota clínica
Bacteriemia por Listeria monocytogenes: análisis de 110 casosListeria monocytogenes bacteremia: analysis of 110 episodes

https://doi.org/10.1157/13107920Get rights and content

Fundamento y objetivo

En los últimos años se ha observado un aumento del número de casos de listeriosis atendidos en nuestro centro. El objetivo del presente estudio ha sido analizar la comorbilidad, la forma de presentación clínica y el pronóstico de los episodios de bacteriemia por Listeria monocytogenes diagnosticados a lo largo de 15 años.

Pacientes y método

Entre enero de 1991 y abril de 2005 se recogió de forma prospectiva la historia clínica de 110 pacientes con bacteriemia por L. monocytogenes. En todos los casos se obtuvo información demográfica, sobre la forma de presentación clínica, tratamiento antimicrobiano y evolución de la infección.

Resultados

Entre 1991 y 1995 se presentaron 20 casos (18,2%); entre 1996 y 2000 hubo 27 (24,6%) y entre 2001 y abril de 2005 se registraron 63 (57,3%) (p < 0,05). Cien pacientes (90,9%) tenían una o más enfermedades asociadas a inmunodepresión y 54 (49,9%) recibían corticoides. En 63 casos la infección se presentó en forma de bacteriemia primaria, en 35 se localizó en el sistema nervioso central y en 6, en el líquido ascítico (pacientes con cirrosis hepática). Trece pacientes (11,8%) presentaron shock séptico y 18 (16,3%) fallecieron. La mortalidad de los pacientes con meningitis tratados empíricamente con una cefalosporina de tercera generación fue del 50% (5/10), frente al 12% (3/25) en los que inicialmente recibieron un antibiótico potencialmente activo frente a L. monocytogenes (p = 0,05).

Conclusiones

La frecuencia de infección por L. monocytogenes ha aumentado en los últimos años. Los pacientes inmunodeprimidos deberían conocer las recomendaciones encaminadas a evitar la ingesta de alimentos potencialmente contaminados. En la elección del tratamiento antibiótico empírico en caso de fiebre o meningitis en el paciente inmunodeprimido se debe tener en cuenta la falta de actividad de las cefalosporinas contra L. monocytogenes.

Background and objective

Over the last years, we registered an increase in the number of listeriosis cases. The aim of this study was to analyze the co-morbidity, clinical presentation and prognosis of Listeria monocytogenes bacteremia episodes diagnosed over 15 years.

Patients and method

From January 1991 to April 2005, we prospectively recorded the medical records of 110 patients in whom L. monocytogenes was isolated from one or more blood cultures. In all patients, demographic, clinical presentation, antimicrobial treatment and outcome data were recorded.

Results

Twenty cases (18.2%) were recorded from 1991 to 1995; 27 (24.6%) from 1996 to 2000 and 63 (57.3%) from 2001 to April 2005 (p < 0.05). One hundred patients (90.9%) had one or more underlying diseases or immunosuppressive conditions, and 54 (49.9%) were under steroid therapy. In 63 patients, primary bacteremia developed, in 35 there was a central nervous system infection and 6 patients developed a spontaneous peritonitis (all patients with liver cirrhosis). Thirteen patients (11.8%) developed septic shock, and 18 (16.3%) died. The mortality rate of patients with meningitis who were treated empirically with a third generation cephalosporin was 50% (5 out of 10) whereas the mortality rate of those patients who received initially an antimicrobial agent active against L. monocytogenes was 12% (3 out of 25) (p = 0.05).

Conclusions

The rate of systemic infection due to L. monocytogenes increased over the last years. Immunosuppressed patients should have a better knowledge of the guidelines needed to avoid eating potentially contaminated food. When empiric treatment is to be selected in immunosuppressed patients with unexplained fever and/or meningitis, a lack of activity against L. monocytogenes by cephalosporins should be considered.

Referencias bibliográficas (18)

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