Consider referring a patient with suspected listeriosis to secondary care immediately if they meet any high risk criteria for sepsis, especially if they are aged 16 or over and are or have recently been pregnant. This includes signs such as hypotension (systolic blood pressure less than 90 mmHg), elevated lactate levels (above 2 mmol/litre), or other clinical indicators of severe infection or sepsis.
Referral should be urgent and via the most appropriate means (usually 999 ambulance) to an acute hospital setting with facilities for resuscitation and emergency care.
In remote or rural settings where transfer times exceed one hour, ensure mechanisms are in place to administer antibiotics promptly before transfer.
For children, especially infants under 3 months, suspected listeriosis warrants hospital referral for appropriate antibiotic therapy including agents active against Listeria (e.g., ampicillin or amoxicillin).