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Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?
  1. Ifeanyichukwu O Okike1,2,
  2. Adedoyin Awofisayo3,
  3. Bob Adak3,
  4. Paul T Heath1
  1. 1 Vaccine Institute & Institute for Infection and Immunity, St George's, University of London, London, UK
  2. 2 Honorary Research Fellow, Healthcare Associated Infection & Antimicrobial Resistance Department, Public Health England, London, UK
  3. 3 Gastrointestinal, Emerging & Zoonotic Infections Department, Public Health England, London, UK
  1. Correspondence to Dr Ifeanyichukwu O Okike, Vaccine Institute & Institute for Infection and Immunity, St George's, University of London, London SW17 0RE, UK; iokike{at}sgul.ac.uk; Ifeanyichukwu.okike{at}phe.gov.uk

https://doi.org/10.1136/archdischild-2014-307059

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    Listeria monocytogenes is a Gram-positive bacterium which can cause invasive infection in the immunocompromised, pregnant women and young infants. Listeria are not susceptible to the third generation cephalosporins (such as cefotaxime or ceftriaxone) usually given as empirical antibiotic treatment to unwell children. Amoxicillin or ampicillin is thus added for infants less than 3 months of age with suspected serious bacterial infection. However empirical antibiotic cover for L. monocytogenes infection beyond the neonatal period may not be needed.

    Current recommendation

    The National Institute of Health and Care Excellence (NICE) clinical guidelines on ‘Feverish illness in children’ (2007)1 and ‘Bacterial meningitis and meningococcal septicaemia’ (2010)2 recommend that the empirical antibiotic cover for infants 0–3 months of age admitted from home with suspected serious bacterial infection should be amoxicillin and cefotaxime.1 ,2 This recommendation reflects the range of bacterial pathogens that cause these serious infections in the first 3 months of life. The inclusion of amoxicillin specifically acknowledges the importance of L. monocytogenes and highlights its non-susceptibility to third-generation cephalosporins.

    Current epidemiology

    Population-based surveillance undertaken in England and Wales in the 1980s and 1990s showed that the aetiology and incidence of neonatal bacterial meningitis changed very little over this period with Group B streptococci and Escherichia coli being the leading causative organisms, followed by L. monocytogenes.3 ,4 A more recent population-based surveillance study of bacterial meningitis in infants aged <90 days in the UK and Ireland undertaken between July 2010 and July 2011 showed that these three causative bacteria remained dominant, and that their frequency varied significantly by month of life. In the first 30 days of life, L. monocytogenes was the third most common bacteria, responsible for 6% of cases (compared with 7% and 5% (for the first 28 days) in the previous national studies). The median age of meningitis due to L. monocytogenes was …

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    Footnotes

    • Funding The BPSU meningitis study was supported by the Meningitis Research Foundation. We received no specific grant from any funding agency in the public, commercial or not-for-profit sectors for this analysis or the preparation of this manuscript.

    • Competing interests None.

    • Ethics approval Ethical approval for the BPSU bacterial meningitis study was granted by the Cambridgeshire 2 Research Ethics Committee (reference 10/H0308/45), and permission was also granted to collect patient identifiable information by the National Information Governance Board (reference S251 Support PIAG 6-06(FT1)/2008). PHE has legal permission to collect data for infectious disease surveillance in England and Wales. For this study, all data were anonymised before analyses.

    • Provenance and peer review Not commissioned; externally peer reviewed.