A retrospective review of Listeria monocytogenes infection at Tygerberg Children's Hospital, Cape Town, South Africa, from 2006 to 2016: Is empirical ampicillin still indicated after the first month of life?

BACKGROUND: Ampicillin to treat Listeria monocytogenes (LM) infection is empirically added to the treatment of infants (<3 months) with suspected sepsis or meningitis.

OBJECTIVES: In view of limited LM cases, the paucity of South African (SA) data and an ampicillin shortage, our objective was to describe the occurrence of LM infections at Tygerberg Hospital (TBH), Cape Town, 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 cerebrospinal fluid (CSF) culture for LM was conducted.

RESULTS: Of 26 children with positive cultures for LM, 23 (88.5%) were <3 months of age; all were <10 days old. Approximately half (56.5%, 13/23) were born at or referred to TBH. Presentation was on the day of delivery in 46.2% (6/13), 92.3% were admitted to the neonatal intensive care unit (NICU), and 61.5% (8/13) died. Neonates treated at peripheral hospitals were statistically more likely than those treated at TBH to have a CSF culture obtained (90.0% v. 30.8%; p=0.005), and had higher platelet counts (239 × 109/L v. 107 × 109/L; p=0.004), lower C-reactive protein levels (64 mg/L v. 137 mg/L; p=0.013) and a lower mortality rate (0% v. 61.5%; p=0.002). The incidence of LM at TBH was 0.04/1 000 live births and 2.3/1 000 NICU admissions.

CONCLUSIONS: As in other countries, the local neonatal LM incidence is low. Neonates present in the first week of life with severe disease and a high mortality rate. These data support a change in antibiotic policy, in keeping with international guidelines, limiting empirical ampicillin prescription to infants <1 month of age.