Meropenem as a non-guideline antibiotic: the factor associated with mortality of mortality in Listeria monocytogenes meningitis.

Abstract

Background: Listeria monocytogenes meningitis has high mortality. Evidence on meropenem's real-world efficacy in Chinese adults is lacking.

Methods: This retrospective study of 19 Listeria meningitis cases used CSF/blood culture and ROC analysis for diagnosis, and applied Fisher's exact test to explore the association between meropenem treatment and mortality.

Results: In 19 patients with L. monocytogenes meningitis (median age 56 years, male/female 2.16:1), L. monocytogenes was the second most common cause (70.3% of Listeria infections). Underlying diseases were present in 10 patients, and MRI showed periventricular changes (9 cases), bifrontal lesions (2), hydrocephalus (1), and normal findings (4). Of 10 CSF-positive patients, 2 had concurrent positive blood cultures; mean time to blood culture positivity was 19.3 ± 9.3 h. All tested isolates were susceptible to ampicillin, penicillin, TMP-SMX (Trimethoprim-sulfamethoxazole), and meropenem. Serum PCT (AUC = 0.980), CSF WBC (AUC = 1.000), and CSF protein (AUC = 0.959) showed excellent diagnostic performance. In exploratory univariate analysis, Fisher's exact test identified non-guideline antibiotic administration as the factor associated with mortality of mortality (p = 0.035).

Conclusion: Non-guideline antibiotic use (meropenem) was the factor associated with mortality of mortality in adult L. monocytogenes meningitis (40% mortality). First-line therapy should remain ampicillin/penicillin; meropenem should be reserved for alternative use only based on existing guidelines, not on the findings of this study alone.