Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study
Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study
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DOI：
10.1016/s1473-3099(16)30521-7
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发表时间：
2017-05-01
影响因子：
56.3
通讯作者：
Lecuit, Marc
中科院分区：
文献类型：
--
作者：
Charlier, Caroline;Perrodeau, Elodie;Lecuit, Marc
背景 李斯特菌病是一种严重的食源性感染，在法国是一种法定传染病。我们进行了一项全国性前瞻性研究来表征其临床特征和预后因素。方法 MONALISA 是一项全国性前瞻性观察队列研究。我们纳入了2009年11月3日至2013年7月31日期间在强制报告范围内向国家李斯特菌参考中心申报的合格病例（全部经过微生物学证明）。结果是分析临床特征、李斯特菌分离株的特征，并使用逻辑回归确定 3 个月死亡率或持续性损伤的预测因子。还对神经系统和菌血症病例进行了主要成分的层次聚类。该研究在 ClinicalTrials.gov 上注册，编号为 NCT01520597。 结果 我们招募了来自 372 个中心的 818 例病例，其中包括 107 例孕产妇新生儿感染病例、427 例菌血症病例和 252 例神经李斯特菌病病例。 107 名孕妇中只有 5 名 (5%) 的结局平安无事。 107 名母亲中有 26 名 (24%) 经历过胎儿流产，但从未在妊娠 29 周后或入院 2 天后发生。 252 名患者中有 212 名（84%）神经李斯特菌病表现为脑膜脑炎； 252 名患者中，仅 42 名 (17%) 报道有脑干受累。菌血症的 3 个月死亡率高于神经李斯特菌病（风险比 [HR] 0.54 [95% CI 0.41-0.69]，p
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.Methods MONALISA was a national prospective observational cohort study. We enrolled eligible cases declared to the National Reference Center for Listeria (all microbiologically proven) between Nov 3, 2009, and July 31, 2013, in the context of mandatory reporting. The outcomes were analysis of clinical features, characterisation of Listeria isolates, and determination of predictors of 3-month mortality or persisting impairment using logistic regression. A hierarchical clustering on principal components was also done for neurological and bacteraemic cases. The study is registered at ClinicalTrials.gov, number NCT01520597.Findings We enrolled 818 cases from 372 centres, including 107 maternal neonatal infections, 427 cases of bacteraemia, and 252 cases of neurolisteriosis. Only five (5%) of 107 pregnant women had an uneventful outcome. 26 (24%) of 107 mothers experienced fetal loss, but never after 29 weeks of gestation or beyond 2 days of admission to hospital. Neurolisteriosis presented as meningoencephalitis in 212 (84%) of 252 patients; brainstem involvement was only reported in 42 (17%) of 252 patients. 3-month mortality was higher for bacteraemia than neurolisteriosis (hazard ratio [HR] 0.54 [95% CI 0.41-0.69], p