Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study
2017
Charlier, Caroline | Perrodeau, Elodie | Leclercq, Alexandre | Goffinet, François | Cazenave, Benoît | Pilmis, Benoît | Henry, Benoît | Lopes, Amanda | Maury, Mylène, M | Moura, Alexandra | Lortholary, Olivier | Bracq Dieye, Hélène | Thouvenot, Pierre | Ungeheuer, Marie-Noëlle | Ravaud, Philippe | Tourdjman, Mathieu | Goulet, Véronique | de Valk, Henriette | Lecuit, Marc | Centre d'infectiologie Necker-Pasteur [CHU Necker] ; Institut Pasteur [Paris] (IP)-Hôpital Necker - Enfants Malades [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Centre National de Référence Listeria - National Reference Center Listeria (CNRL) ; Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria (CC-OMS / WHO-CC) ; Institut Pasteur [Paris] (IP)-Organisation Mondiale de la Santé / World Health Organization Office [Genève, Suisse] (OMS / WHO) | Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques (CRESS (U1153 / UMR_A 1125)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Service de Gynécologie et Obstétrique [Cochin] ; Hôpital Cochin [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | CHU Pitié-Salpêtrière [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) | Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC) ; Université Pierre et Marie Curie - Paris 6 (UPMC) | Département de Médecine interne [Lariboisière] ; Hôpital Lariboisière-Fernand-Widal [APHP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7) | Biologie des Infections - Biology of Infection ; Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources (ICAReB) ; Institut Pasteur [Paris] (IP) | Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)) ; Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Université Paris Descartes - Paris 5 (UPD5) | Infectious Disease Department [Saint Maurice] ; Agence Nationale de la Santé Publique [Saint-Maurice] (ANSP) | Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency. | MONALISA study group
International audience
Afficher plus [+] Moins [-]anglais. Evidence before this study We searched PubMed on June 30, 2016, for English-language cohort studies published since Jan 1, 1980, of patients with invasive listeriosis worldwide with the keywords " listeria " , " listeriosis " , " maternal " , and " neurolisteriosis ". Studies had to include epidemiological or clinical data on listeriosis. All clinical forms of infection were included (bacteraemia, neurolisteriosis, and maternal–neonatal infection). Host risk factors for listeriosis have been well identified, but the clinical features and prognostic factors of the disease are based on retrospective studies compiling heterogeneous data or random collected cases. Furthermore, no clinical trial has ever been done and medical management is not evidence based. Added value of the study Our study is the first prospective clinical study focusing on all forms of invasive listeriosis. The study is based on a national mandatory system that allowed the nearly complete capture of microbiologically proven cases. The study shows a higher burden of listeriosis than reported before: more than 80% of infected mothers experienced major fetal or neonatal complications (fetal loss, very high prematurity, early or late onset disease); only 39% of patients with neurolisteriosis survived and fully recovered. The study provides important new data to improve management and predict outcome in listeriosis, such as determination of the time window for fetal losses (<29 weeks of gestation and <3 days of adequate management) and new factors independently associated with mortality. Our data show the deleterious effect of adjunctive dexamethasone in neurolisteriosis, and argue for the use of beta-lactam and gentamicin or co-trimoxazole over other antimicrobials for bacteraemia and neurolisteriosis. Implications of all the available evidence Given the practical difficulties in completing clinical trials in listeriosis, these results could guide clinical practice and suggest that combined amoxicillin and gentamicin should be considered the first-line combination in invasive listeriosis, and that adjunctive dexamethasone should be avoided in cases of confirmed listeriosis. ABSTRACT Background: Listeriosis is a severe foodborne infection and a notifiable disease in France. We did a nationwide prospective study to characterise its clinical features and prognostic factors.
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