Thursday, December 10, 2015

26-year-old woman presents late in the third trimester of her pregnancy with high fevers

26-year-old woman presents late in the third trimester of her pregnancy with high fevers, myalgias, backache, and malaise. She is admitted and started on empirical broad-spectrum antibiotics. Blood cultures return positive for Listeria monocytogenes.

 She delivers a 2.3kg infant 24 hours after admission.

delivery of 2.3 kg preterm baby with noted wrinkles on skin 

Which of the following statements regarding antibiotic treatment for this infection is true?


A. Clindamycin should be used in patients with penicillin allergy.
B. Neonates should receive weight-based ampicillin and gentamicin. 
C. Penicillin plus gentamicin is first-line therapy for the mother.
D. Quinolones should be used for Listeria bacteremia in late-stage pregnancy.
E. Trimethoprim–sulfamethoxazole has no efficacy against Listeria spp.

The answer is B. Neonates should receive weight-based ampicillin and gentamicin. 
.  Listeria bacteremia in pregnancy is a relatively rare but serious
infection both for the mother and fetus. Vertical transmission may occur, with 70%
to 90% of fetuses developing infection from their mothers.

Preterm labor is common.
Prepartum treatment of the mother increases the chances of a healthy delivery. Mortality
among fetuses approaches 50% and is much lower in neonates receiving appropriate antibiotics.
First-line therapy is with ampicillin, with gentamicin often added for synergy.

This recommendation is the same for the mother and child. In patients with true penicillin
allergy, the therapy of choice is trimethoprim–sulfamethoxazole.

There are case reports of successful therapy with vancomycin, imipenem, linezolid, and macrolides, but there is not enough clinical evidence, and there have been some reports of failure that maintain
ampicillin as recommended therapy.

0 comments:

Post a Comment