CC：重症监护病房的严重李斯特菌病：一项回顾性多中心研究的见解

重症监护病房的严重李斯特菌病：
一项回顾性多中心研究的见解

Background

Listeriosis is a rare but severe foodborne infection, particularly affecting immunocompromised individuals and older adults. Severe cases may lead to neurolisteriosis and sepsis, necessitating intensive care unit (ICU) admission. This study aims to analyze the demographic characteristics, clinical presentation, microbiological findings, treatments, and outcomes of critically ill patients with Listeria infections in the ICU.

李斯特菌病是一种罕见但严重的食源性感染，尤其影响免疫功能低下者和老年人。重症病例可能导致神经型李斯特菌病和败血症，需要入住重症监护病房（ICU）。本研究旨在分析ICU内李斯特菌感染危重患者的人口统计学特征、临床表现、微生物学结果、治疗及预后。

Methods

A retrospective multicenter study was conducted across 23 French hospitals over a 10-year period, including ICU patients with culture-confirmed Listeria monocytogenes infections. Data on demographics, comorbidities, ICU admission characteristics, biological and microbiological parameters, treatments, and outcomes were collected. The primary outcome was ICU mortality. A multivariable logistic regression model was used to identify factors associated with mortality in patients with neurological manifestations.

本研究为回顾性多中心研究，在法国23家医院开展，时间跨度为10年，纳入了经培养确诊的李斯特菌单核细胞增生李斯特菌感染的ICU患者。收集了患者的人口统计学数据、共病情况、ICU入院特征、生物学和微生物学参数、治疗及预后信息。主要结局为ICU死亡率。采用多变量logistic回归模型分析神经症状患者死亡的相关因素。

Results

A total of 110 patients were included, with a median age of 68 years; 61% were male, and 71% were immunocompromised. Neurological involvement was present in most cases. Invasive mechanical ventilation was required in 58% of patients, and vasopressor support in 44%. ICU and in-hospital mortality rates were 25% and 32%, respectively. Among patients with neurolisteriosis, each 1-point decrease in Glasgow Coma Scale score at admission was associated with increased mortality (OR, 1.22; 95% CI 1.05–1.45; p = 0.009), as were higher cerebrospinal fluid (CSF) protein levels (OR, 1.56; 95% CI 1.15–2.41; p = 0.028). Steroid use was not significantly associated with reduced mortality (OR, 0.30; 95% CI 0.07–1.05; p = 0.076).

共纳入110例患者，中位年龄68岁；其中61%为男性，71%免疫功能低下。大多数病例存在神经系统受累。58%的患者需要侵入性机械通气，44%需要血管加压药支持。ICU和院内死亡率分别为25%和32%。在神经型李斯特菌病患者中，入院时格拉斯哥昏迷评分（GCS）每降低1分与死亡率增加相关（OR 1.22；95% CI 1.05–1.45；p=0.009），脑脊液（CSF）蛋白水平升高也与死亡率增加相关（OR 1.56；95% CI 1.15–2.41；p=0.028）。激素使用与死亡率降低无显著相关性（OR 0.30；95% CI 0.07–1.05；p=0.076）。

Conclusion

Listeriosis requiring ICU admission is associated with high morbidity and mortality, particularly in older and immunocompromised patients. The severity of these infections is reflected by the frequent need for organ support. Further research is needed to clarify the potential role of steroids in neurolisteriosis.

需ICU治疗的李斯特菌病与高发病率和死亡率相关，尤其在老年和免疫功能低下患者中。这些感染的严重性体现在频繁需要器官支持。需进一步研究明确激素在神经型李斯特菌病中的潜在作用。