A retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital from 2006 – 2016: is empiric ampicillin still indicated past the early neonatal period
Date
2018-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University, 2018.
Abstract
ENGLISH ABSTRACT: Background:
Ampicillin to treat Listeria Monocytogenes (LM) infection is empirically added to the treatment of infants (<3 months) with suspected sepsis or meningitis. In view of the limited LM cases, paucity of South African data and an ampicillin shortage, we aimed to describe the occurrence of LM infections at Tygerberg Hospital (TBH) with the aim of rationalising the paediatric antibiotic policy.
Methods:
An 11 year (2006-2016) retrospective descriptive study of children (<13 years) from TBH and referral hospitals with a positive blood or cerebral spinal fluid (CSF) culture for LM was conducted.
Results:
Of 26 positive cultures for LM, 23 (88%) occurred in infants <3 months of age, all <10 days old. Approximately half (56.5%, 13/23) were born at or referred to TBH. Presentation occurred on the day of delivery in 46% (6/13) and 92% were admitted to the neonatal intensive care unit (NICU), 8/13 (62%) died. Neonates treated at peripheral hospitals had statically higher cerebral spinal fluid examinations (90% vs 31% (p=0.019)), a higher platelet count (239x109/L vs 107x109/L (p=0.004)), lower CRP (64 mg/L vs 137 mg/L (p=0.01)) and a lower mortality rate (0% vs 62% (p=0.002)). The incidence of LM at TBH was 0.04/1000 live births, and 2.3/1000 NICU admissions.
Conclusion:
As in other countries the local neonatal LM incidence is low. Neonates present in the 1st week of life with severe disease and a high mortality rate. This data supports a change in antibiotic policy, in keeping with international guidelines, limiting empiric ampicillin prescription to infants <1 month old.
AFRIKAANS OPSOMMING: Geen opsomming biskikbaar.
AFRIKAANS OPSOMMING: Geen opsomming biskikbaar.
Description
Thesis (MMed)--Stellenbosch University, 2018.
Keywords
Listeria monocytogenes -- Treatment, Paediatric antibiotic policy, Pregnancy -- Complications, Neonatal infections, UCTD