Listeria monocytogenes coverage is essential for which patient groups during empiric meningitis therapy?

• A. Healthy young adults
• B. Pregnant women only
• C. Neonates
• D. Older adults or immunocompromised

Answer: (D)

Listeria monocytogenes is not covered by cephalosporins, so when starting empiric meningitis therapy you add coverage for Listeria in patients who are at higher risk for this pathogen. The groups with the strongest risk among adults are older adults and those who are immunocompromised. In these patients, including ampicillin (often with an aminoglycoside) targets Listeria and helps prevent a missed diagnosis with potentially severe outcomes. Healthy young adults have a low risk for Listeria meningitis, so Listeria coverage isn’t routinely required for them. Neonates and pregnant women are also at risk, but the emphasis in many adult guidelines is on older or immunocompromised individuals, making this group the best-fit answer.