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Listeria monocytogenes-associated spontaneous bacterial peritonitis in France: a nationwide observational study of 208 cases.

Collaborators (567)

Author information

Affiliations

  • 1. Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Antibiotic stewardship team, Department of Infectious Diseases and Tropical Medicine, Cochin Port-Royal University Hospital, APHP, Paris, France; Department of Anesthesiology and Critical Care Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France.
      Authors
    • Blanchard F 1
    (1 author)
  • 2. Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Division of Infectious Diseases and Tropical Medicine, Bicêtre University Hospital, APHP, Le Kremlin-Bicêtre, France.
      Authors
    • Henry B 2
    (1 author)
  • 3. Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France.
      Authors
    • Vijayaratnam S 3
    • Thouvenot P 3
    • Bracq-Dieye H 3
    • Tessaud-Rita N 3
    • Valès G 3
    • Diakité A 3
    • Leclercq A 3
    (7 authors)
  • 4. Antibiotic stewardship team, Department of Infectious Diseases and Tropical Medicine, Cochin Port-Royal University Hospital, APHP, Paris, France.
      Authors
    • Canouï E 4
    (1 author)
  • 5. Listeria National Reference Center and WHO Collaborating Center, Institut Pasteur, Paris, France; Biology of Infection Unit, Institut Pasteur, Université Paris Cité, Inserm U1117, Paris, France.
      Authors
    • Moura A 5
    (1 author)
    • Show all (7)

ORCIDs linked to this article

The Lancet. Infectious Diseases, 09 Apr 2024, 24(7):783-792
https://doi.org/10.1016/s1473-3099(24)00151-8 PMID: 38608698 

Abstract 

Background

Listeriosis is a foodborne infection caused by Listeria monocytogenes. Three main forms of listeriosis are well characterised, but little is known about L monocytogenes-associated spontaneous bacterial peritonitis. We used data from the French national surveillance of listeriosis to perform a nationwide retrospective study.

Methods

All patients with L monocytogenes isolated by culture from a peritoneal fluid sample in France between April 1, 1993, and Dec 31, 2022, were included. Individuals for whom bacterial peritonitis was not confirmed and those who also had another type of invasive listeriosis were excluded. A standardised checklist was used to collect demographic, clinical, and biological data as well as antibiotic treatment and follow-up data. The primary outcome was to determine the characteristics of L monocytogenes-associated spontaneous bacterial peritonitis. We did descriptive analyses and assessed risk factors for 1-month mortality using an exploratory multivariable Cox model analysis.

Findings

Among the 8768 L monocytogenes cases reported, 208 (2%) were patients with L monocytogenes-associated spontaneous bacterial peritonitis. Mean age was 65 years (SD 13), 50 (24%) of 208 patients were female, and 158 (76%) were male (no data on race or ethnicity were available). 200 (98%) of 205 patients with L monocytogenes-associated spontaneous bacterial peritonitis with available data had immunosuppressive comorbidities, including cirrhosis (148 [74%] of 201 with available data), ongoing alcoholism (58 [62%] of 94), and ongoing neoplasia (60 [31%] of 195). Causes of ascites included cirrhosis (146 [70%] of 208), ongoing neoplasia (26 [13%]), end-stage heart failure (13 [6%]), and peritoneal dialysis (11 [5%]). Among those with available data, presentation was pauci-symptomatic and non-specific; only 67 (50%) of 135 patients presented with fever, 49 (37%) of 132 with abdominal pain, and 27 (21%) of 129 with diarrhoea. 61 (29%) of 208 patients were dead at 1 month, 92 (44%) were dead at 3 months, and 109 (52%) were dead at 6 months after diagnosis. Ongoing neoplasia (hazard ratio 2·42 [95% CI 1·05-5·56]; p=0·039), septic shock (8·03 [2·66-24·02]; p=0·0021), and high blood leukocyte count (1·05 [1·00-1·09]; p=0·045) were independently associated with 1-month mortality.

Interpretation

Despite the non-specific and mild presentation of L monocytogenes-associated spontaneous bacterial peritonitis, the outcome is poor and similar to that of neurolisteriosis, and so identification of L monocytogenes in ascitic fluid samples requires urgent parenteral amoxicillin-based treatment to avoid a fatal outcome.

Funding

Institut Pasteur, Inserm, and French Public Health Agency.

Translation

For the French translation of the abstract see Supplementary Materials section.

Full text links 

Read article at publisher's site: https://doi.org/10.1016/s1473-3099(24)00151-8

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Funding 

Funders who supported this work.

Institut Pasteur