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Peer-reviewedCC BY 4.0Frontiers in Public Health

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

  • Qiangsheng Feng1
  • Yuejuan Song1,2
  • Yuan Xing1
  • Julin Zhan1
  • Tuanjie Che3
  • Xu Heng2
  • Xiliang Bin2
  • Xiaoqin Ha1
  1. 1Department of Clinical Laboratory, The 940th Hospital of Joint Logistics Support Force of People’s Liberation Army, Lanzhou, China
  2. 2School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
  3. 3Innovation Center of Functional Genomics and Molecular Diagnostics Technology of Gansu Province, Lanzhou, China
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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.

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Cite

BibTeXRIS
BibTeX
@article{feng2026meropenem,
  title = {{Meropenem as a non-guideline antibiotic: the factor associated with mortality of mortality in Listeria monocytogenes meningitis}},
  author = {Qiangsheng Feng and Yuejuan Song and Yuan Xing and Julin Zhan and Tuanjie Che and Xu Heng and Xiliang Bin and Xiaoqin Ha},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1895883},
  url = {https://doi.org/10.3389/fpubh.2026.1895883},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Meropenem as a non-guideline antibiotic: the factor associated with mortality of mortality in Listeria monocytogenes meningitis
AU  - Qiangsheng Feng
AU  - Yuejuan Song
AU  - Yuan Xing
AU  - Julin Zhan
AU  - Tuanjie Che
AU  - Xu Heng
AU  - Xiliang Bin
AU  - Xiaoqin Ha
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1895883
UR  - https://doi.org/10.3389/fpubh.2026.1895883
AB  - 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.
SN  - 2296-2565
ER  -