Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change?

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. 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. 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 …