Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study

Caroline Charlier (1, 2, 3) , Elodie Perrodeau (4) , Alexandre Leclercq (2, 3) , François Goffinet (5) , Benoît Cazenave (3) , Benoît Pilmis (1, 3) , Benoît Henry (1, 6, 7) , Amanda Lopes (8) , Mylène M Maury (2, 3) , Alexandra Moura (9) , Olivier Lortholary (1, 10) , Hélène Bracq Dieye (2, 3) , Pierre Thouvenot (2, 3) , Marie-Noëlle Ungeheuer (11) , Philippe Ravaud (12, 13) , Mathieu Tourdjman (14) , Véronique Goulet (14) , Henriette de Valk (14) , Marc Lecuit (1, 2, 3, 13, 9)

1 Centre d'infectiologie Necker-Pasteur [CHU Necker]
2 CNRL - Centre National de Référence Listeria - National Reference Center Listeria
3 CC-OMS / WHO-CC - Centre collaborateur de l'OMS Listeria / WHO Collaborating Centre Listeria
4 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
5 Service de Gynécologie et Obstétrique [Cochin]
6 CHU Pitié-Salpêtrière [AP-HP]
7 UPMC - Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie
8 Département de Médecine interne [Lariboisière]
9 Biologie des Infections - Biology of Infection
10 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
11 ICAReB - Investigation Clinique et d’Accès aux Ressources Biologiques (Plate-forme) - Clinical Investigation and Access to BioResources
12 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
13 UPD5 - Université Paris Descartes - Paris 5
14 Infectious Disease Department [Saint Maurice]

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.

Mots clés: study; prognostic; isolates; bacteraemia; HIV; cirrhosis; diabetes; mellitus; alcoholism; immuno suppressive therapies; study

Mots clés: listeriosis; infection; listeriosis

Domaines: Sciences du Vivant [q-bio]

Caroline Charlier, Elodie Perrodeau, Alexandre Leclercq, François Goffinet, Benoît Cazenave, et al.. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. The Lancet Infectious Diseases, 2017, 17 (5), ⟨10.1016/S1473-3099(16)30521-7⟩. ⟨pasteur-01475849⟩