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Riley M, Lambrelli D, Graham S, Henry O, Sutherland A, Schmidt A, Sawalhi-Leckenby N, Donaldson R, Stoszek SK. Facilitating safety evaluation in maternal immunization trials: a retrospective cohort study to assess pregnancy outcomes and events of interest in low-risk pregnancies in England. BMC Pregnancy Childbirth 2022; 22:461. [PMID: 35650569 PMCID: PMC9157029 DOI: 10.1186/s12884-022-04769-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal characteristics like medical history and health-related risk factors can influence the incidence of pregnancy outcomes and pregnancy-related events of interest (EIs). Data on the incidence of these endpoints in low-risk pregnant women are needed for appropriate external safety comparisons in maternal immunization trials. To address this need, this study estimated the incidence proportions of pregnancy outcomes and pregnancy-related EIs in different pregnancy cohorts (including low-risk pregnancies) in England, contained in the Clinical Practice Research Datalink (CPRD) Pregnancy Register linked to Hospital Episode Statistics (HES) between 2005 and 2017. METHODS The incidence proportions of 7 pregnancy outcomes and 15 EIs were calculated for: (1) all pregnancies (AP) represented in the CPRD Pregnancy Register linked to HES (AP cohort; N = 298 155), (2) all pregnancies with a gestational age (GA) ≥ 24 weeks (AP24+ cohort; N = 208 328), and (3) low-risk pregnancies (LR cohort; N = 137 932) with a GA ≥ 24 weeks and no diagnosis of predefined high-risk medical conditions until 24 weeks GA. RESULTS Miscarriage was the most common adverse pregnancy outcome in the AP cohort (1 379.5 per 10 000 pregnancies) but could not be assessed in the other cohorts because these only included pregnancies with a GA ≥ 24 weeks, and miscarriages with GA ≥ 24 weeks were reclassified as stillbirths. Preterm delivery (< 37 weeks GA) was the most common adverse pregnancy outcome in the AP24+ and LR cohorts (742.9 and 680.0 per 10 000 pregnancies, respectively). Focusing on the cohorts with a GA ≥ 24 weeks, the most common pregnancy-related EIs in the AP24+ and LR cohorts were fetal/perinatal distress or asphyxia (1 824.3 and 1 833.0 per 10 000 pregnancies), vaginal/intrauterine hemorrhage (799.2 and 729.0 per 10 000 pregnancies), and labor protraction/arrest disorders (752.4 and 774.5 per 10 000 pregnancies). CONCLUSIONS This study generated incidence proportions of pregnancy outcomes and pregnancy-related EIs from the CPRD for different pregnancy cohorts, including low-risk pregnancies. The reported incidence proportions of pregnancy outcomes and pregnancy-related EIs are largely consistent with external estimates. These results may facilitate the interpretation of safety data from maternal immunization trials and the safety monitoring of maternal vaccines. They may also be of interest for any intervention studied in populations of pregnant women.
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Affiliation(s)
- Megan Riley
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, Washington, USA.
| | | | - Sophie Graham
- Evidera, 201 Talgarth Rd, Hammersmith, London, W6 8BJ, UK
| | - Ouzama Henry
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, Washington, USA
| | - Andrea Sutherland
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, Washington, USA
- Moderna, Cambridge, MA, USA
| | - Alexander Schmidt
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, Washington, USA
- Bill & Melinda Gates Medical Research Institute, Cambridge, MA, USA
| | | | | | - Sonia K Stoszek
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, Washington, USA
- Moderna, Cambridge, MA, USA
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102
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Zhou K, Xie L, Xu X, Sun J. Comparative Genomic Analysis of Type VII Secretion System in Streptococcus agalactiae Indicates Its Possible Sequence Type-Dependent Diversity. Front Cell Infect Microbiol 2022; 12:880943. [PMID: 35663471 PMCID: PMC9160427 DOI: 10.3389/fcimb.2022.880943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Streptococcus agalactiae causes sepsis and meningitis in neonates, presenting substantial clinical challenges. Type VII secretion system (T7SS), an important secretion system identified in Mycobacterium sp. and Gram-positive bacteria, was recently characterized in S. agalactiae and considered to contribute to its virulence and pathogenesis. In the present study, 128 complete genomic sequences of S. agalactiae were retrieved from GenBank to build a public dataset, and their sequences, capsular types, and clonal complexes were determined. Polymerase chain reaction (PCR) screening and genomic sequencing were conducted in an additional clinical dataset. STs and capsular types were determined using PCR. Eleven different types of T7SS were detected with similarities in gene order but differences in gene content. Strains with incomplete T7SS or lack of T7SS were also identified. Deletion, insertion, and segmentation of T7SS might be related to insertion sequences. The genetic environment of T7SS in S. agalactiae was also investigated and different patterns were identified downstream the T7SS, which were related to the diversity of T7SS putative effectors. The T7SS demonstrated possible sequence type (ST)-dependent diversity in both datasets. This work elucidated detailed genetic characteristics of T7SS and its genetic environment in S. agalactiae and further identified its possible ST-dependent diversity, which gave a clue of its mode of transmission. Further investigations are required to elucidate the underlying mechanisms and its functions.
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Affiliation(s)
- Kaixin Zhou
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Lianyan Xie
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaogang Xu, ; Jingyong Sun,
| | - Jingyong Sun
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Xiaogang Xu, ; Jingyong Sun,
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Abstract
Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.
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Affiliation(s)
- Teresa Tavares
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Liliana Pinho
- Centro Hospitalar Universitário do Porto, Centro Materno Infantil do Norte, Porto, Portugal
| | - Elva Bonifácio Andrade
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
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104
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Brokaw A, Nguyen S, Quach P, Orvis A, Furuta A, Johansson-Lindbom B, Fischer PB, Rajagopal L. A Recombinant Alpha-Like Protein Subunit Vaccine (GBS-NN) Provides Protection in Murine Models of Group B Streptococcus Infection. J Infect Dis 2022; 226:177-187. [PMID: 35429401 PMCID: PMC9890916 DOI: 10.1093/infdis/jiac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) transmission during pregnancy causes preterm labor, stillbirths, fetal injury, or neonatal infections. Rates of adult infections are also rising. The GBS-NN vaccine, engineered by fusing N-terminal domains of GBS Alpha C and Rib proteins, is safe in healthy, nonpregnant women, but further assessment is needed for use during pregnancy. Here, we tested GBS-NN vaccine efficacy using mouse models that recapitulate human GBS infection outcomes. METHODS Following administration of GBS-NN vaccine or adjuvant, antibody profiles were compared by ELISA. Vaccine efficacy was examined by comparing infection outcomes in GBS-NN vaccinated versus adjuvant controls during systemic and pregnancy-associated infections, and during intranasal infection of neonatal mice following maternal vaccination. RESULTS Vaccinated mice had higher GBS-NN-specific IgG titers versus controls. These antibodies bound alpha C and Rib on GBS clinical isolates. Fewer GBS were recovered from systemically challenged vaccinated mice versus controls. Although vaccination did not eliminate GBS during ascending infection in pregnancy, vaccinated dams experienced fewer in utero fetal deaths. Additionally, maternal vaccination prolonged neonatal survival following intranasal GBS challenge. CONCLUSIONS These findings demonstrate GBS-NN vaccine efficacy in murine systemic and perinatal GBS infections and suggest that maternal vaccination facilitates the transfer of protective antibodies to neonates.
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Affiliation(s)
- Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Shayla Nguyen
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Phoenicia Quach
- Present affiliation: Phoenicia Quach, Universal Cells, Seattle 98121, Washington
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Lakshmi Rajagopal
- Correspondence: L. Rajagopal, PhD, Department of Pediatrics, University of Washington, Seattle Children’s Hospital Research Institute, 307 Westlake Ave N, Seattle, WA 98109 ()
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105
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Etti M, Calvert A, Galiza E, Lim S, Khalil A, Le Doare K, Heath PT. Maternal vaccination: a review of current evidence and recommendations. Am J Obstet Gynecol 2022; 226:459-474. [PMID: 34774821 PMCID: PMC8582099 DOI: 10.1016/j.ajog.2021.10.041] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/11/2022]
Abstract
Maternal vaccination is an effective means of protecting pregnant women, their fetuses, and infants from vaccine-preventable infections. Despite the availability of sufficient safety data to support the use of vaccines during pregnancy, maternal immunization remains an underutilized method of disease prevention, often because of concerns from both healthcare providers and pregnant women about vaccine safety. Such concerns have been reflected in the low uptake of the COVID-19 vaccine among pregnant women seen in many parts of the world. Here, we present an update of the current recommendations for the use of vaccines during pregnancy, including the evidence supporting the use of novel vaccine platforms. We also provide an overview of the data supporting the use of COVID-19 vaccines in pregnancy and an update of the status of vaccines that are currently under development for use in pregnant women.
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Affiliation(s)
- Melanie Etti
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom.
| | - Anna Calvert
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Eva Galiza
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Suzy Lim
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Paul T Heath
- Vaccine Institute and Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
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Epidemiology of group B streptococcal disease in infants younger than 1 year in Japan: a nationwide surveillance study 2016-2020. Eur J Clin Microbiol Infect Dis 2022; 41:559-571. [PMID: 35048277 DOI: 10.1007/s10096-021-04396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
We aimed to define the burden and clinical features of invasive group B streptococcus (GBS) disease in infants younger than 1 year in Japan, to explore transmission route of late-onset disease (LOD), and to identify risk factors associated with recurrent GBS disease. We conducted a retrospective, questionnaire-based nationwide surveillance study between 2016 and 2020. A total of 875 GBS cases were identified, including 186 early-onset disease, 628 LOD, and 61 ultra-late-onset disease. Case fatality rate in each age category was 6.5%, 3.0%, and 3.3%, respectively. Patients with meningitis had neurodevelopmental sequelae in 21.5% (64/297). Annual incidence in infants younger than 1 year and in LOD significantly increased from 0.28 to 0.45/1000 livebirths (p = 0.021) and from 0.19 to 0.29/1000 livebirths (p = 0.046), respectively. Maternal colonization status at the LOD diagnosis was available for 148 mothers, of whom 21/58 (36.2%) had positive rectovaginal swabs and 42/117 (36.2%) had GBS in breastmilk culture. These two sites are potentially infectious routes in LOD. The four leading disease-causing serotypes III, Ia, Ib, and V represented 95% of the available serotypes. Thirty-one recurrent cases were identified, accounting for 3.7% of total patients. A multivariate regression analysis showed that prematurity (p = 0.029) and antepartum maternal GBS colonization (p = 0.032) were significantly associated with risk for the recurrence. Our findings indicated that GBS disease burden still remains with considerable mortality and morbidity in Japan, and provided important information for developing better strategies for the prevention of GBS disease, including maternal vaccination.
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107
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Sapugahawatte DN, Li C, Liyanapathirana V, Kandauda C, Gihan C, Zhu C, Lo NWS, Wong KT, Ip M. Colonization of Group B Streptococcus in Pregnant Women and Their Neonates from a Sri Lankan Hospital. Pathogens 2022; 11:pathogens11040386. [PMID: 35456061 PMCID: PMC9029214 DOI: 10.3390/pathogens11040386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 01/25/2023] Open
Abstract
We investigated the molecular epidemiology of Streptococcus agalactiae (Group B Streptococcus, GBS) from carriage in a cohort of pregnant mothers and their respective newborns in a Teaching Hospital in Sri Lanka. GBS vaginal carriage was assessed on pregnant mothers at pre-delivery (n = 250), post-delivery (n = 130), and from peri-rectal swabs of neonates (n = 159) in a prospective study. All colonizing, non-duplicate GBS isolates (n = 60) were analyzed for antimicrobial susceptibilities, capsular serotyping, and whole-genome sequencing (WGS). The percentage of GBS carriage in mothers in the pre-delivery and post-delivery cohorts were 11.2% (n = 28) and 19.2% (n = 25), respectively, and 4.4% (n = 7) in neonates. GBS isolates predominantly belonged to serotype VI (17/60, 28.3%). The isolates spanned across 12 sequence types (STs), with ST1 (24/60, 40%) being the most predominant ST. Concomitant resistance to erythromycin, tetracyclines, and gentamicin was observed in eight strains (13.3%). WGS revealed the presence of antimicrobial resistance genes including ermA (5/60), mefA (1/60), msrD (1/60), and tetLMO (2/60, 28/60, and 1/60, respectively) among 60 strains. The study provides insight into the diversity of vaccine targets of GBS since serotype VI is yet to be covered in the vaccine development program.
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Affiliation(s)
- Dulmini Nanayakkara Sapugahawatte
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.N.S.); (C.L.); (C.Z.); (N.W.S.L.); (K.T.W.)
| | - Carmen Li
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.N.S.); (C.L.); (C.Z.); (N.W.S.L.); (K.T.W.)
| | - Veranja Liyanapathirana
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Chaminda Kandauda
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka; (C.K.); (C.G.)
| | - Champika Gihan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka; (C.K.); (C.G.)
| | - Chendi Zhu
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.N.S.); (C.L.); (C.Z.); (N.W.S.L.); (K.T.W.)
| | - Norman Wai Sing Lo
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.N.S.); (C.L.); (C.Z.); (N.W.S.L.); (K.T.W.)
| | - Kam Tak Wong
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.N.S.); (C.L.); (C.Z.); (N.W.S.L.); (K.T.W.)
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (D.N.S.); (C.L.); (C.Z.); (N.W.S.L.); (K.T.W.)
- Correspondence: ; Tel.: +852-3505-3333
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Furuta A, Brokaw A, Manuel G, Dacanay M, Marcell L, Seepersaud R, Rajagopal L, Adams Waldorf K. Bacterial and Host Determinants of Group B Streptococcal Infection of the Neonate and Infant. Front Microbiol 2022; 13:820365. [PMID: 35265059 PMCID: PMC8899651 DOI: 10.3389/fmicb.2022.820365] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Group B streptococci (GBS) are Gram-positive β-hemolytic bacteria that can cause serious and life-threatening infections in neonates manifesting as sepsis, pneumonia, meningitis, osteomyelitis, and/or septic arthritis. Invasive GBS infections in neonates in the first week of life are referred to as early-onset disease (EOD) and thought to be acquired by the fetus through exposure to GBS in utero or to vaginal fluids during birth. Late-onset disease (LOD) refers to invasive GBS infections between 7 and 89 days of life. LOD transmission routes are incompletely understood, but may include breast milk, household contacts, nosocomial, or community sources. Invasive GBS infections and particularly meningitis may result in significant neurodevelopmental injury and long-term disability that persists into childhood and adulthood. Globally, EOD and LOD occur in more than 300,000 neonates and infants annually, resulting in 90,000 infant deaths and leaving more than 10,000 infants with a lifelong disability. In this review, we discuss the clinical impact of invasive GBS neonatal infections and then summarize virulence and host factors that allow the bacteria to exploit the developing neonatal immune system and target organs. Specifically, we consider the mechanisms known to enable GBS invasion into the neonatal lung, blood vessels and brain. Understanding mechanisms of GBS invasion and pathogenesis relevant to infections in the neonate and infant may inform the development of therapeutics to prevent or mitigate injury, as well as improve risk stratification.
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Affiliation(s)
- Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Gygeria Manuel
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Matthew Dacanay
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Lauren Marcell
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Ravin Seepersaud
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Kristina Adams Waldorf
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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109
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Streptococcus agalactiae-associated Urinary Tract Infections amongst Male Patients at a Tertiary Care Setting in Southwest India. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2022. [DOI: 10.52547/jommid.10.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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110
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Daniels J, Dixon EF, Gill A, Bishop J, D'Amico M, Ahmed K, Dodds J, Tryposkiadis K, Wilks M, Millar M, Husain S, Gray J, Whiley A, Moore PV, Munetsi RL, Hemming K, Roberts T, Plumb J, Deeks J, Khan KS, Thangaratinam S. A rapid intrapartum test for group B Streptococcus to reduce antibiotic usage in mothers with risk factors: the GBS2 cluster RCT. Health Technol Assess 2022; 26:1-82. [PMID: 35195519 DOI: 10.3310/bicf1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mother-to-baby transmission of group B Streptococcus (Streptococcus agalactiae) is the main cause of early-onset infection. OBJECTIVES We investigated if intrapartum antibiotic prophylaxis directed by a rapid intrapartum test reduces maternal and neonatal antibiotic use, compared with usual care (i.e. risk factor-directed antibiotics), among women with risk factors for vertical group B Streptococcus transmission, and examined the accuracy and cost-effectiveness of the rapid test. DESIGN An unblinded cluster randomised controlled trial with a nested test accuracy study, an economic evaluation and a microbiology substudy. SETTING UK maternity units were randomised to either a strategy of rapid test or usual care. PARTICIPANTS Vaginal and rectal swabs were taken from women with risk factors for vertical group B Streptococcus transmission in established term labour. The accuracy of the GeneXpert® Dx IV GBS rapid testing system (Cepheid, Maurens-Scopont, France) was compared with the standard of selective enrichment culture in diagnosing maternal group B Streptococcus colonisation. MAIN OUTCOME MEASURES Primary outcomes were rates of intrapartum antibiotic prophylaxis administered to prevent early-onset group B Streptococcus infection and accuracy estimates of the rapid test. Secondary outcomes were maternal antibiotics for any indication, neonatal antibiotic exposure, maternal antibiotic duration, neonatal group B Streptococcus colonisation, maternal and neonatal antibiotic resistance, neonatal morbidity and mortality, and cost-effectiveness of the strategies. RESULTS Twenty-two maternity units were randomised and 20 were recruited. A total of 722 mothers (749 babies) participated in rapid test units and 906 mothers (951 babies) participated in usual-care units. There were no differences in the rates of intrapartum antibiotic prophylaxis for preventing early-onset group B Streptococcus infection in the rapid test units (41%, 297/716) compared with the usual-care units (36%, 328/906) (risk ratio 1.16, 95% confidence interval 0.83 to 1.64). There were no differences between the groups in intrapartum antibiotic administration for any indication (risk ratio 0.99, 95% confidence interval 0.81 to 1.21). Babies born in the rapid test units were 29% less likely to receive antibiotics (risk ratio 0.71, 95% confidence interval 0.54 to 0.95) than those born in usual-care units. The sensitivity and specificity of the rapid test were 86% (95% confidence interval 81% to 91%) and 89% (95% confidence interval 85% to 92%), respectively. In 14% of women (99/710), the rapid test was invalid or the machine failed to provide a result. In the economic analysis, the rapid test was shown to be both less effective and more costly and, therefore, dominated by usual care. Sensitivity analysis indicated potential lower costs for the rapid test strategy when neonatal costs were included. No serious adverse events were reported. CONCLUSIONS The Group B Streptococcus 2 (GBS2) trial found no evidence that the rapid test reduces the rates of intrapartum antibiotic prophylaxis administered to prevent early-onset group B Streptococcus infection. The rapid test has the potential to reduce neonatal exposure to antibiotics, but economically is dominated by usual care. The accuracy of the test is within acceptable limits. FUTURE WORK The role of routine testing for prevention of neonatal infection requires evaluation in a randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN74746075. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jane Daniels
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily F Dixon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alicia Gill
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Maria D'Amico
- Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Khaled Ahmed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Julie Dodds
- Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kostas Tryposkiadis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mark Wilks
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael Millar
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shahid Husain
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angela Whiley
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Patrick V Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruvimbo L Munetsi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Khalid S Khan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and System Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Rosa-Fraile M, Alós JI. Group B Streptococcus neonatal infections, the ongoing history. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ma X, Wu M, Wang C, Li H, Fan A, Wang Y, Han C, Xue F. The pathogenesis of prevalent aerobic bacteria in aerobic vaginitis and adverse pregnancy outcomes: a narrative review. Reprod Health 2022; 19:21. [PMID: 35090514 PMCID: PMC8796570 DOI: 10.1186/s12978-021-01292-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Aerobic vaginitis is a common cause of vaginal discharge in reproductive-age women, increasing the risk of negative pregnancy outcomes such as premature delivery, abortion, premature rupture of membranes and stillbirth. However, the aetiology and pathogenesis of aerobic vaginitis causing negative pregnancy outcomes are still unclear, and there is no unified and standardized treatment method for aerobic vaginitis in the pregnancy period. Methods We conducted a literature search of published studies in the English language focusing on aerobic vaginitis and its association with adverse pregnancy outcomes utilizing PubMed and Web of Science from January 1973 through June 2021. The common pathogenic bacteria of aerobic vaginitis during pregnancy, such as group B Streptococcus, Escherichia coli, Staphylococcus aureus, Enterococcus faecalis and Klebsiella pneumoniae, as well as the related adverse pregnancy outcomes and existing treatments were reviewed. Results A total of 4534 articles were identified, and 97 studies that had inclusion criteria were subjected to careful review. The pathogenic bacteria of aerobic vaginitis can produce different toxins or affect the local immunity of patients and then lead to the occurrence of infection. Fresh wet mount microscopy is the preferred diagnostic method for aerobic vaginitis. Clindamycin is a common antibiotic used for aerobic vaginitis in pregnant women. The use of products combining probiotics has achieved excellent treatment success. Conclusions Future research in this field can provide insights regarding the mechanism of aerobic vaginitis-induced adverse pregnancy outcomes in humans and ways to prevent their occurrence. Aerobic vaginitis is an infection of the vagina that increases the risk of negative pregnancy outcomes. The aetiology and pathogenesis of aerobic vaginitis causing negative pregnancy outcomes are still unclear. This paper reviews the common pathogenic bacteria of aerobic vaginitis during pregnancy, and the related adverse pregnancy outcomes. We also review the existing treatment. Currently, it is believed that the microflora in aerobic vaginitis is composed of commensal aerobic microorganisms of intestinal origin, and the most frequently encountered bacteria are group B Streptococcus, Escherichia coli, Staphylococcus aureus, Enterococcus faecalis and Klebsiella pneumoniae. The pathogenic bacteria of aerobic vaginitis can produce different toxins or affect the local immunity of patients and then lead to the occurrence of infection. Fresh wet mount microscopy is the preferred diagnostic method for aerobic vaginitis. Clindamycin is a common antibiotic used for aerobic vaginitis in pregnant women. The use of products combining probiotics has achieved excellent treatment success. This study provides a reference for future research and early diagnosis and treatment during pregnancy. Future research in this field can provide insights regarding the mechanisms of aerobic vaginitis-induced adverse pregnancy outcomes in humans and ways to prevent their occurrence.
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Affiliation(s)
- Xiaotong Ma
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China
| | - Ming Wu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China
| | - Chen Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China
| | - Aiping Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China.,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China
| | - Cha Han
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China. .,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China.
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin, 300052, China. .,Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China.
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Harden LM, Leahy S, Lala SG, Paul P, Chandna J, Lowick S, Mbatha S, Jaye T, Laughton B, Ghoor A, Sithole P, Msayi J, Kumalo N, Msibi TN, Madhi SA, Lawn JE, Dangor Z. South African Children: A Matched Cohort Study of Neurodevelopmental Impairment in Survivors of Invasive Group B Streptococcus Disease Aged 5 to 8 Years. Clin Infect Dis 2022; 74:S5-S13. [PMID: 34725706 PMCID: PMC8776309 DOI: 10.1093/cid/ciab814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a 5-country study. METHODS We identified children aged 5-8 years with a history of iGBS and children with no history of iGBS between October 2019 and January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate or Severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing, and vision. Secondary outcomes included mild NDI, any emotional-behavioral problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. RESULTS In total, 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Among iGBS survivors 13 (30.2%) had meningitis, and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and 5 (4.3%) non-iGBS children had moderate or severe NDI. Children who survived iGBS were 5.56 (95% confidence interval [CI]: 1.07-28.93; P = .041) times more likely to have moderate or severe NDI at 5-8 years than non-iGBS children. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (P < .05), as well as a lower median DQ for the language GMDS-ER subscale and performance GMDS-ER subscale (P < .05). CONCLUSIONS Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5-8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns.
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Affiliation(s)
- Lois M Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamara Jaye
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Sithole
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Msayi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntombifuthi Kumalo
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepiso N Msibi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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van Kassel MN, Gonçalves BP, Snoek L, Sørensen HT, Bijlsma MW, Lawn JE, Horváth-Puhó E. Sex Differences in Long-term Outcomes After Group B Streptococcal Infections During Infancy in Denmark and the Netherlands: National Cohort Studies of Neurodevelopmental Impairments and Mortality. Clin Infect Dis 2022; 74:S54-S63. [PMID: 34725694 PMCID: PMC8775649 DOI: 10.1093/cid/ciab822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Male infants have a higher incidence of invasive group B Streptococcus disease (iGBS) compared with female infants; however, data on sex differences in mortality and long-term outcomes after iGBS are lacking. We assessed whether a child's sex influences the effects of iGBS on mortality and risk of neurodevelopmental impairments (NDIs). METHODS We used Danish and Dutch registry data to conduct a nationwide cohort study of infants with a history of iGBS. A comparison cohort, children without a history of iGBS, was randomly selected and matched on relevant factors. Effect modification by sex was assessed on additive and multiplicative scales. RESULTS Our analyses included data from children with a history of iGBS in Denmark (period 1997 -2017; n = 1432) and the Netherlands (2000 -2017; n = 697) and from 21 172 children without iGBS. There was no clear evidence of between-sex heterogeneity in iGBS-associated mortality. Boys had a higher risk of NDI, with evidence for effect modification on additive scale at the age of 5 years for any NDI (relative excess risk due to interaction = 1.28; 95% confidence interval [CI], -0.53 to 3.09 in Denmark and 1.14; 95% CI, -5.13 to 7.41 in the Netherlands). A similar pattern was observed for moderate/severe NDI at age 5 years in Denmark and age 10 years in the Netherlands. CONCLUSION Boys are at higher risk of NDI ; our results suggest this is disproportionally increased in those who develop iGBS. Future studies should investigate mechanisms of this effect modification by sex.
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Affiliation(s)
- Merel N van Kassel
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bronner P Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Linde Snoek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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115
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Chandna J, Liu WH, Dangor Z, Leahy S, Sridhar S, John HB, Mucasse H, Bassat Q, Bardaji A, Abubakar A, Nasambu C, Newton CR, Sánchez Yanotti C, Libster R, Milner K, Paul P, Lawn JE. Emotional and Behavioral Outcomes in Childhood for Survivors of Invasive Group B Streptococcus Disease in Infancy: Findings From 5 Low- and Middle-Income Countries. Clin Infect Dis 2022; 74:S35-S43. [PMID: 34725686 PMCID: PMC8776308 DOI: 10.1093/cid/ciab821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Survivors of invasive group B Streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopmental impairment. However, the limited studies to date have a median follow-up to 18 months and have mainly focused on moderate or severe neurodevelopmental impairment, with no previous studies on emotional-behavioral problems among iGBS survivors. METHODS In this multicountry, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique, and South Africa. Children without an iGBS history were matched to iGBS survivors for sex and age. Our primary outcomes were emotional-behavioral problems and psychopathological conditions as measured with the Child Behavior Checklist (CBCL). The CBCL was completed by the child's primary caregiver. RESULTS Between October 2019 and April 2021, 573 children (mean age, 7.18 years) were assessed, including 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention, and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of clinically significant psychopathological conditions defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). CONCLUSIONS Our findings suggested that school-aged iGBS survivors experienced increased mild emotional behavioral problems that may affect children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioral assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.
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Affiliation(s)
- Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wan-Hsin Liu
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Division of General Paediatrics, Department of Paediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Azucena Bardaji
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
| | - Charles R Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | | | | | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children’s Research Institute 2, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Daniels JP, Dixon E, Gill A, Bishop J, Wilks M, Millar M, Gray J, Roberts TE, Plumb J, Deeks JJ, Hemming K, Khan KS, Thangaratinam S. Rapid intrapartum test for maternal group B streptococcal colonisation and its effect on antibiotic use in labouring women with risk factors for early-onset neonatal infection (GBS2): cluster randomised trial with nested test accuracy study. BMC Med 2022; 20:9. [PMID: 35027057 PMCID: PMC8759240 DOI: 10.1186/s12916-021-02202-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mother-to-baby transmission of group B Streptococcus (GBS) is the main cause of early-onset infection. We evaluated whether, in women with clinical risk factors for early neonatal infection, the use of point-of-care rapid intrapartum test to detect maternal GBS colonisation reduces maternal antibiotic exposure compared with usual care, where antibiotics are administered due to those risk factors. We assessed the accuracy of the rapid test in diagnosing maternal GBS colonisation, against the reference standard of selective enrichment culture. METHODS We undertook a parallel-group cluster randomised trial, with nested test accuracy study and microbiological sub-study. UK maternity units were randomised to a strategy of rapid test (GeneXpert GBS system, Cepheid) or usual care. Within units assigned to rapid testing, vaginal-rectal swabs were taken from women with risk factors for vertical GBS transmission in established term labour. The trial primary outcome was the proportion of women receiving intrapartum antibiotics to prevent neonatal early-onset GBS infection. The accuracy of the rapid test was compared against the standard of selective enrichment culture in diagnosing maternal GBS colonisation. Antibiotic resistance profiles were determined in paired maternal and infant samples. RESULTS Twenty-two maternity units were randomised and 20 were recruited. A total of 722 mothers (749 babies) participated in rapid test units; 906 mothers (951 babies) were in usual care units. There was no evidence of a difference in the rates of intrapartum antibiotic prophylaxis (relative risk 1.16, 95% CI 0.83 to 1.64) between the rapid test (41%, 297/716) and usual care (36%, 328/906) units. No serious adverse events were reported. The sensitivity and specificity measures of the rapid test were 86% (95% CI 81 to 91%) and 89% (95% CI 85 to 92%), respectively. Babies born to mothers who carried antibiotic-resistant Escherichia coli were more likely to be colonised with antibiotic-resistant strains than those born to mothers with antibiotic-susceptible E. coli. CONCLUSION The use of intrapartum rapid test to diagnose maternal GBS colonisation did not reduce the rates of antibiotics administered for preventing neonatal early-onset GBS infection than usual care, although with considerable uncertainty. The accuracy of the rapid test is within acceptable limits. TRIAL REGISTRATION ISRCTN74746075 . Prospectively registered on 16 April 2015.
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Affiliation(s)
- Jane P Daniels
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Emily Dixon
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alicia Gill
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mark Wilks
- Barts Health NHS Trust, London, UK.,Queen Mary University of London, London, UK
| | | | - Jim Gray
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Tracy E Roberts
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Plumb
- Group B Strep Support, JYW House, Bridge Road, Haywards Heath, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Shakila Thangaratinam
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and System Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Arias B, Kovacec V, Vigliarolo L, Suárez M, Tersigni C, Lopardo H, Mollerach M, Bonofiglio L. Epidemiology of Invasive Infections Caused by Streptococcus agalactiae in Argentina. Microb Drug Resist 2022; 28:322-329. [PMID: 35007436 DOI: 10.1089/mdr.2021.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In recent years, an increase in the number of cases of invasive infections due to Streptococcus agalactiae (group B Streptococcus [GBS]) in adults has been reported. During 2014 and 2015, a multicentric, observational, and prospective study, including 40 health centers, was developed to describe the phenotypic and genotypic characteristics of GBS isolates circulating in Argentina and to analyze the clinical and demographic characteristics of patients with invasive infections. We recovered 162 invasive (GBSi) isolates from adult patients (n = 130, 80.2%), neonates (n = 24, 15%), and children below 18 years of age (n = 8, 4.8%), and colonizing (GBSc) isolates were recovered in prenatal GBS screening. GBS infection in adults was associated with underlying diseases, mainly diabetes mellitus. All isolates were penicillin susceptible. Resistance rates to erythromycin (25%) and clindamycin (26%) among the GBSc isolates were significantly higher than those from GBSi strains (17.3% and 16.1%, respectively); by contrast, levofloxacin resistance was significantly higher in GBSi isolates (14.8% vs. 7%). Serotype Ia was the most frequent in neonates and Ib was most frequent in adults. Serotypes Ia and III were prevalent in GBSc isolates. The increase of levofloxacin resistance was associated with the presence of a serotype Ib clone. This work emphasizes the need for GBS infection surveillance studies to implement correct treatments and adequate prevention strategies.
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Affiliation(s)
- Bárbara Arias
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Verónica Kovacec
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Laura Vigliarolo
- Cátedra de Microbiología Clínica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Mariana Suárez
- Cátedra de Microbiología Clínica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Carina Tersigni
- Cátedra de Microbiología Clínica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Horacio Lopardo
- Cátedra de Microbiología Clínica, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Marta Mollerach
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET. Buenos Aires, Argentina
| | - Laura Bonofiglio
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET. Buenos Aires, Argentina
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118
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Barros RR, Alves KB, Luiz FBO, Ferreira DG. Prevalence of Streptococcus agalactiae capsular types among pregnant women in Rio de Janeiro and the impact of a capsular based vaccine. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-979020222e20633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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119
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Awwad E, Srour M, Hasan S, Khatib S. Molecular determination, serotyping, antibiotic profile and virulence factors of group B Streptococcus isolated from invasive patients at Arabcare Hospital Laboratory, Palestine. Am J Infect Control 2021; 50:934-940. [PMID: 34963647 DOI: 10.1016/j.ajic.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Streptococcus agalactiae (group B Streptococcus) is beta-hemolytic, catalase negative, gram-positive cocci, recognized as main bacterial pathogen causing infections in newborns, infants, adults, and elderly people around the world. The aim of this study is to investigate group B Streptococcus samples recovered from invasive patients and determine serotype, virulent genes, and antibiotic-resistant profile of Streptococcus agalactiae in Palestine. METHODS A total of 95 group B Streptococcus strains were isolated from neonates, infants, pregnant and non-pregnant women and males at Arabcare Hospital Laboratory, Palestine, between the period of June 2018 and September 2020. Species identification was carried out through cultivation and conventional biochemical tests. A conventional Polymerase Chain Reaction (cPCR) was used to determine the 5 serotypes and virulent genes of the Streptococcus agalactiae strains. The antibiotic resistance test of group B Streptococcus was evaluated using Kirby-Bauer disk susceptibility. Sequencing and BLAST analysis were used to determine the relationship of the isolates in this study to worldwide isolates. RESULTS Serotype III (35%) was the major group B Streptococcus strains serotype causing invasive infections in neonates, infants, pregnant and nonpregnant women, and males, followed by serotypes V (19%), Ia, and II (15%), Ib (6%), respectively. All our isolates encoding for surface protein virulent factors, including a highly virulent gene (HvgA) were mostly found in strains isolated from pregnant women (12%). These group B Streptococcus strains exhibited a high rate of resistance to clindamycin (26%). The overall percentage of levofloxacin resistance was 11%, while vancomycin and ampicillin showed higher resistance, at 14.7 and 16% respectively. In addition, the phylogenetic relationship dendrogram illustrates that Streptococcus agalactiae isolated from an invasive patient (newborn) in Palestine was similar to strains found in China and Japan. CONCLUSIONS The outcomes of this study demonstrate that resistant group B Streptococcus strains are common in Palestine, therefore, evidence-based infection prevention and antibiotic stewardship efforts are necessary.
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Affiliation(s)
| | - Mahmoud Srour
- Biology and Biochemistry Department, Faculty of Science, Birzeit University, Palestine
| | - Shadi Hasan
- Biology and Biochemistry Department, Faculty of Science, Birzeit University, Palestine
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Prevalence and Risk Factors of Group B Streptococcus Colonization in Pregnant Women: A Pilot Study in Palestine. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2021; 2021:8686550. [PMID: 34938378 PMCID: PMC8687845 DOI: 10.1155/2021/8686550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 01/31/2023]
Abstract
Background Maternal Streptococcus agalactiae (Group B Streptococcus (GBS)) colonization is an important cause of complications in mothers and neonates during gestation and after delivery. The data regarding GBS colonization among pregnant women in Palestine is scarce. The aim of this study is to determine the prevalence of GBS colonization, its associated risk factors, and the antibiotic sensitivity patterns in Nablus, West Bank, Palestine. Methods A cross-sectional, single center study conducted at Rafidia Governmental Hospital in Nablus, West Bank, Palestine. Samples were collected between November 2019 and January 2020. Vaginal swabs from 200 pregnant women (≥35 weeks of gestation) attending the labor and delivery department were plated directly on CHROMagarTM StrepB (CHROM agar, France) and placed in an incubator at 35–37°C. After 24 and 48 hours, the plates were checked for growth and classified into three categories: growth of GBS with mauve colonies on chromogenic media, no growth, or other growth. The identification of the mauve colonies was confirmed by the CAMP test. Identified GBS isolates were tested for susceptibility to vancomycin, ampicillin, clindamycin, cefotaxime, erythromycin, and levofloxacin using the disc diffusion method. Clinical and demographic information were collected using a questionnaire. Result The overall prevalence of GBS colonization was 12%. The median age of the study population was 27 years. GBS colonization was significantly associated with age (p=0.013), history of previous preterm delivery (p=0.013), and parity (p=0.015). No association was noted with smoking, previous abortion, previous history of fetal demise, vaginitis, or urinary tract infection. Resistance to ampicillin, vancomycin, cefotaxime, erythromycin, clindamycin, and levofloxacin was found to be 91.7%, 54.2%, 45.8%, 29.2%, 25%, and 8.3%, respectively. Conclusion The prevalence of vaginal GBS in this study was 12% from Nablus, West Bank. Further research is needed to determine the GBS serotypes common in West Bank and the burden they cause on the health system. Moreover, this study also highlights the need to establish a screening program suited to a developing country with low control on the antibiotic's prescription protocols.
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Abstract
Group B Streptococcus (GBS) is a leading cause of invasive neonatal disease. Epidemiological surveillance of GBS is important to determine cumulative incidence, antimicrobial resistance rates, and maternal and neonatal disease prevention. In this study, we present an update on GBS epidemiology in Alberta, Canada, from 2014 to 2020. Over the 7-year period, 1,556 GBS isolates were submitted to the Alberta Public Health Laboratory for capsular polysaccharide (CPS) typing and antimicrobial susceptibility testing. We analyzed the distribution of CPS types in Alberta and found CPS types III (23.6%), Ia (16.0%), Ib (14.8%), II (13.3%), V (12.7%), IV (12.5%), and VI (2.38%) to be the most prevalent. Less than 1% each of CPS types VII, VIII, and IX were identified. In agreement with historical data, the presence of CPS type IV continued to rise across Alberta, particularly in cases of adult infection, where a 2-fold increase was observed. Cumulative incidences of GBS cases per 100,000 population and late-onset disease per 1,000 live births increased from 4.43 to 5.36 and 0.38 to 0.41, respectively, from 2014 to 2020. However, the incidence of early-onset disease decreased during the 7-year period from 0.2 to 0.07, suggestive of successful intrapartum chemoprophylaxis treatment programs. All GBS isolates were susceptible to penicillin and vancomycin. However, nonsusceptibility to erythromycin increased significantly, from 36.85% to 50.8%, from 2014 to 2020. Similarly, nonsusceptibility to clindamycin also increased significantly, from 21.0% to 45.8%. In comparison to historical data, the overall rates of GBS infection and antimicrobial resistance have increased and the predominant CPS types have changed. IMPORTANCE This work describes the epidemiology of invasive infections caused by the bacterium group B Streptococcus (GBS) in Alberta, Canada. We show that rates of invasive GBS disease have increased from 2014 to 2020 for both adult disease and late-onset disease in neonates, whereas the rate of early onset disease in neonates has decreased. We also show that the rate of resistance to erythromycin (an antibiotic used to treat GBS) has also increased in this time.
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MESH Headings
- Adolescent
- Adult
- Alberta/epidemiology
- Anti-Bacterial Agents/therapeutic use
- Bacterial Typing Techniques
- Blood Culture
- Canada/epidemiology
- Child
- Child, Preschool
- Clindamycin/therapeutic use
- Drug Resistance, Multiple, Bacterial/genetics
- Erythromycin/therapeutic use
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/microbiology
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Polysaccharides, Bacterial/analysis
- Streptococcal Infections/drug therapy
- Streptococcal Infections/epidemiology
- Streptococcus agalactiae/classification
- Streptococcus agalactiae/drug effects
- Streptococcus agalactiae/isolation & purification
- Young Adult
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Affiliation(s)
- Angela Ma
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Albertagrid.17089.37, Edmonton, Canada
| | - L Alexa Thompson
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Albertagrid.17089.37, Edmonton, Canada
| | - Thomas Corsiatto
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Albertagrid.17089.37, Edmonton, Canada
| | - Donna Hurteau
- Alberta Precision Laboratories-Provincial Laboratory for Public Health, Edmonton, Canada
| | - Gregory J Tyrrell
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Albertagrid.17089.37, Edmonton, Canada
- Alberta Precision Laboratories-Provincial Laboratory for Public Health, Edmonton, Canada
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122
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Epidemiological Characterization of Group B Streptococcus Infections in Alberta, Canada: An Update from 2014 to 2020. Microbiol Spectr 2021; 9:e0128321. [PMID: 34762517 PMCID: PMC8585492 DOI: 10.1128/spectrum.01283-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Group B Streptococcus (GBS) is a leading cause of invasive neonatal disease. Epidemiological surveillance of GBS is important to determine cumulative incidence, antimicrobial resistance rates, and maternal and neonatal disease prevention. In this study, we present an update on GBS epidemiology in Alberta, Canada, from 2014 to 2020. Over the 7-year period, 1,556 GBS isolates were submitted to the Alberta Public Health Laboratory for capsular polysaccharide (CPS) typing and antimicrobial susceptibility testing. We analyzed the distribution of CPS types in Alberta and found CPS types III (23.6%), Ia (16.0%), Ib (14.8%), II (13.3%), V (12.7%), IV (12.5%), and VI (2.38%) to be the most prevalent. Less than 1% each of CPS types VII, VIII, and IX were identified. In agreement with historical data, the presence of CPS type IV continued to rise across Alberta, particularly in cases of adult infection, where a 2-fold increase was observed. Cumulative incidences of GBS cases per 100,000 population and late-onset disease per 1,000 live births increased from 4.43 to 5.36 and 0.38 to 0.41, respectively, from 2014 to 2020. However, the incidence of early-onset disease decreased during the 7-year period from 0.2 to 0.07, suggestive of successful intrapartum chemoprophylaxis treatment programs. All GBS isolates were susceptible to penicillin and vancomycin. However, nonsusceptibility to erythromycin increased significantly, from 36.85% to 50.8%, from 2014 to 2020. Similarly, nonsusceptibility to clindamycin also increased significantly, from 21.0% to 45.8%. In comparison to historical data, the overall rates of GBS infection and antimicrobial resistance have increased and the predominant CPS types have changed. IMPORTANCE This work describes the epidemiology of invasive infections caused by the bacterium group B Streptococcus (GBS) in Alberta, Canada. We show that rates of invasive GBS disease have increased from 2014 to 2020 for both adult disease and late-onset disease in neonates, whereas the rate of early onset disease in neonates has decreased. We also show that the rate of resistance to erythromycin (an antibiotic used to treat GBS) has also increased in this time.
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Liu J, Chen F, Guan H, Yu J, Yu J, Zhao J, Liu Y, Shen L. Emerging Fatal Ib/CC12 Hypervirulent Multiresistant Streptococcus agalactiae in Young Infants With Bloodstream Infection in China. Front Microbiol 2021; 12:767803. [PMID: 34975795 PMCID: PMC8715515 DOI: 10.3389/fmicb.2021.767803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Streptococcus agalactiae [also known as group B Streptococcus (GBS)] is a tremendous threat to young infants. Eighty pediatric GBS infection cases were enrolled from a teaching hospital in Shanghai between 2009 and 2020; among them, 72.5% (58/80) were diagnosed with bloodstream infection (BSI). Sequence types (STs) and serotypes of associated GBS strains were identified, and most of the Ib/clonal complex (CC)12 (86.7%, 13/15) strains caused BSIs, which was significantly higher than that of the genetically related clone Ib/CC10 (20%, 2/10; p < 0.05). Ib/CC12 BSI (30.8%) mortality was significantly higher than that of non-Ib/CC12 BSI (2.2%; p < 0.05). Virulence genes associated with adhesion, invasion, and immune evasion were detected using polymerase chain reaction. The fbsA and gbsPC1 positive rates of Ib/CC12 strains was higher than that of non-Ib/CC12 strains, whereas cpsIaJ, cpsJ, cpsI, and cpsG positive rates were lower than those of non-Ib/CC12 (p < 0.05). In in vitro studies, the Ib/CC12 strains had strong invasiveness in RAW264.7 cells, but less invasiveness in human umbilical vein endothelial cells, human brain microvascular endothelial cells, and human mammary epithelial cells when compared to other two clones. In the in vivo model, the Ib/CC12 GBS invaded the circulation system more rapidly after intraperitoneal injection, was more difficult to eradicate by phagocytes, and caused significantly higher mortality than Ib/CC10 and III/ST17 (p < 0.05). Genome analysis showed that the Ib/CC12 strains had two clustered regularly interspaced short palindromic repeat-Cas systems and carried more antibiotic resistant genes, which conferred resistance to macrolides, clindamycin, aminoglycosides, and tetracycline. The Ib/CC12 strains had 45 unique annotated genes compared to that of Ib/CC10, including the pathogen-related toxin/antitoxin system, PezA/T. In conclusion, Ib/CC12 is an emerging hypervirulent multiresistant GBS clone that causes invasive and fatal infections in pediatric patients. The prevention and control of Ib/CC12 GBS infection should be emphasized.
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Affiliation(s)
- Jingxian Liu
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Chen
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyan Guan
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiajia Yu
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Yu
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhao
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Liu
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Lisong Shen, ; Ying Liu,
| | - Lisong Shen
- Department of Clinical Laboratory, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Faculty of Medical Laboratory Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Lisong Shen, ; Ying Liu,
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Invasive Group B Streptococcal Disease in Neonates and Infants, Italy, Years 2015-2019. Microorganisms 2021; 9:microorganisms9122579. [PMID: 34946181 PMCID: PMC8708122 DOI: 10.3390/microorganisms9122579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/31/2023] Open
Abstract
Invasive infections by group B streptococci (iGBS) are the leading cause of sepsis and meningitis in the first three months of life worldwide. The clinical and microbiological characteristics of neonatal and infant iGBS in Italy during the years 2015–2019 were investigated. Voluntary-based surveillance reported 191 cases (67 early-onset (EOD) and 124 late-onset disease (LOD)) and 89 bacterial isolates were received. The main clinical manifestations were sepsis (59.2%) followed by meningitis (21.5%), bacteremia (12.0%) and septic shock (6.3%). Hospitalized preterm babies accounted for one third of iGBS and constituted the most fragile population in terms of mortality (8.2%) and brain damage (16.4%). GBS serotype III was predominant in EOD (56%) and caused almost all LOD (95%). The rate of resistance to clindamycin reached 28.8%. Most of clindamycin-resistant GBS strains (76%) were serotype III-ST17 and possessed the genetic markers of the emerging multidrug resistant (MDR) CC-17 sub-clone. Our data revealed that iGBS is changing since it is increasingly reported as a healthcare-associated infection (22.6%), mainly caused by MDR-CC17. Continuous monitoring of the clinical and microbiological characteristics of iGBS remains of primary importance and it represents, at present, the most effective tool to support prevention strategies and the research on the developing GBS vaccine.
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Shabayek S, Ferrieri P, Spellerberg B. Group B Streptococcal Colonization in African Countries: Prevalence, Capsular Serotypes, and Molecular Sequence Types. Pathogens 2021; 10:pathogens10121606. [PMID: 34959562 PMCID: PMC8706430 DOI: 10.3390/pathogens10121606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022] Open
Abstract
Streptococcus agalactiae or group B streptococcus (GBS) is a commensal of the gastrointestinal and genitourinary tracts of healthy women and an important cause of neonatal invasive infections worldwide. Transmission of bacteria to the newborn occurs at birth and can be prevented by intrapartum antibiotic prophylaxis. However, this not available in resource limited settings in Africa, which carries a particular high burden of disease. Serotype based vaccines are in development and present a suitable alternative to prevent neonatal infections. To be able to assess vaccine efficacy, knowledge and surveillance of GBS epidemiological data are required. This review summarizes investigations about the serotype distribution and the multi-locus sequence types (MLST) found in different African countries. While most serotypes and MLST data are comparable to findings from other continents, some specific differences exist. Serotype V is predominant among colonizing maternal strains in many different African countries. Serotypes that are rarely detected in western industrialized nations, such as serotypes VI, VII and IX, are prevalent in studies from Ghana and Egypt. Moreover, some specific MLST sequence types that seem to be more or less unique to Africa have been detected. However, overall, the data confirm that a hexavalent vaccine can provide broad coverage for the African continent and that a protein vaccine could represent a promising alternative.
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Affiliation(s)
- Sarah Shabayek
- Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt;
| | - Patricia Ferrieri
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
| | - Barbara Spellerberg
- Institute of Medical Microbiology and Hygiene, University Hospital Ulm, 89081 Ulm, Germany
- Correspondence:
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Meex C, Devey A, Defêche J, Bontems S, Descy J, Hayette MP, Sacheli R, Melin P. Evaluation of the Revogene® GBS DS assay performance for the intrapartum screening of group B streptococcus in comparison with intrapartum culture. Diagn Microbiol Infect Dis 2021; 102:115616. [PMID: 34974352 DOI: 10.1016/j.diagmicrobio.2021.115616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
Prevention of perinatal Group B Streptococcus (GBS) transmission is crucial in our effort to prevent Early-onset GBS disease. Here, we established the performance of the Revogene GBS DS assay for the detection of group B streptococcus on intrapartum vaginal samples in a laboratory environment using a prospective noninterventional study design. Intrapartum vaginal swabs were enriched using a selective culture method which served as study reference method. Overall, 119 patients were enrolled with an antenatal and intrapartum Group B Streptococcus colonization prevalence of 12.9% and 11.8%, respectively. Compared to intrapartum culture, the Revogene GBS DS assay had a sensitivity of 92.9% and a specificity of 99.1%, while the antenatal culture displayed a sensitivity 78.6% of and specificity of 96.2%. The Revogene GBS DS assay displayed an acceptable performance according to the European Group B Streptococcus consensus recommendations. Complementary studies in clinical practice are needed to confirm these findings.
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Affiliation(s)
- Cécile Meex
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium; National Reference Center Streptococcus agalactiae, University Hospital of Liege, Liege, Belgium.
| | - Anaïs Devey
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
| | - Justine Defêche
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
| | - Sébastien Bontems
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
| | - Julie Descy
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
| | - Rosalie Sacheli
- National Reference Center Streptococcus agalactiae, University Hospital of Liege, Liege, Belgium
| | - Pierrette Melin
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium; National Reference Center Streptococcus agalactiae, University Hospital of Liege, Liege, Belgium
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Kam KQ, Thoon KC, Tee WSN, Ang MLT, Tan NWH, Yeo KT, Li J, Chong CY. Serotype distribution and incidence of invasive early onset and late onset group B streptococcal disease amongst infants in Singapore. BMC Infect Dis 2021; 21:1221. [PMID: 34876053 PMCID: PMC8650237 DOI: 10.1186/s12879-021-06891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The current group B streptococcal (GBS) preventive measures had reduced invasive GBS early onset disease (EOD) incidences worldwide, but the late onset disease (LOD) incidences had remained unchanged. Administration of a safe and effective GBS vaccine in addition to the current strategies were thought to be the next steps in reducing the incidences of invasive GBS infection especially LOD. In this study, we aimed to examine the causative GBS serotypes in invasive GBS disease, determine the incidences of EOD and LOD, and compare the risk factors between EOD and LOD. Methods A retrospective study of infants ≤ 90-day-old over an 8-year period (2010–2017). The incidences of EOD and LOD were obtained by using patients with EOD and LOD who were born in our institution as the numerator and the live births in our institution per year of the study period as the denominator. Available GBS isolates were serotyped by the National Public Health Laboratory using capsular serotyping methods. The risk factors of EOD and LOD were compared. Results A total of 71 infants were identified; 16 (22.5%) and 55 (77.5%) of them had EOD and LOD, respectively. Serotype III (n = 42, 71.2%) was the most common serotype amongst the 59 isolates available for serotyping. Serotypes Ia, Ib, II, III, and V accounted for 98.3% (n = 58) of the invasive GBS diseases. The overall incidence was 0.42 per 1000 live births. The mean incidences of EOD and LOD were 0.13 per 1000 live births and 0.29 per 1000 live births, respectively. On multivariate analysis, risk factors for LOD as compared to EOD were: Chinese ethnicity (OR 27.1, 95% CI 3.0–243.1, p = 0.003) and negative/unknown maternal GBS status (OR 20.0, 95% CI 2.0–250.0, p = 0.012). Prematurity and intrapartum risk factors (peripartum maternal pyrexia, prolonged rupture of membrane) of EOD were not associated with LOD. Conclusions The LOD incidence had remained higher than EOD incidence in our cohort. A GBS vaccine that covers the major causative serotypes found in our cohort can potentially reduce the overall GBS disease burden in the country.
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Affiliation(s)
- Kai-Qian Kam
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore. .,Duke-National University of Singapore Medical School, Singapore City, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Wen Sim Nancy Tee
- Department of Laboratory Medicine, National University Health System, Singapore City, Singapore
| | - Michelle Lay Teng Ang
- National Public Health Laboratory, National Centre of Infectious Diseases, Singapore City, Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Kee Thai Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.,Department of Neonatology, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Jiahui Li
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, 100 Bukit Timah, Singapore City, 229899, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Duke-National University of Singapore Medical School, Singapore City, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
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128
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Duke JA, Paschall AV, Robinson LS, Knoot CJ, Vinogradov E, Scott NE, Feldman MF, Avci FY, Harding CM. Development and Immunogenicity of a Prototype Multivalent Group B Streptococcus Bioconjugate Vaccine. ACS Infect Dis 2021; 7:3111-3123. [PMID: 34633812 PMCID: PMC8793035 DOI: 10.1021/acsinfecdis.1c00415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal infections and invasive diseases in nonpregnant adults worldwide. Developing a protective conjugate vaccine targeting the capsule of GBS has been pursued for more than 30 years; however, it has yet to yield a licensed product. In this study, we present a novel bioconjugation platform for producing a prototype multivalent GBS conjugate vaccine and its subsequent analytical and immunological characterizations. Using a glycoengineering strategy, we generated strains of Escherichia coli that recombinantly express the type Ia, type Ib, and type III GBS capsular polysaccharides. We then combined the type Ia-, Ib-, and III-capsule-expressing E. coli strains with an engineered Pseudomonas aeruginosa exotoxin A (EPA) carrier protein and the PglS oligosaccharyltransferase. Coexpression of a GBS capsule, the engineered EPA protein, and PglS enabled the covalent attachment of the target GBS capsule to an engineered serine residue on EPA, all within the periplasm of E. coli. GBS bioconjugates were purified, analytically characterized, and evaluated for immunogenicity and functional antibody responses. This proof-of-concept study signifies the first step in the development of a next-generation multivalent GBS bioconjugate vaccine, which was validated by the production of conjugates that are able to elicit functional antibodies directed against the GBS capsule.
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Affiliation(s)
- Jeremy A. Duke
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia 30602, United States
- Center for Molecular Medicine, University of Georgia, Athens, Georgia 30602, United States
| | - Amy V. Paschall
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia 30602, United States
- Center for Molecular Medicine, University of Georgia, Athens, Georgia 30602, United States
| | | | | | - Evgeny Vinogradov
- Human Health Therapeutics Centre, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Nichollas E. Scott
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Mario F. Feldman
- VaxNewMo, St. Louis, Missouri 63110, United States
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Fikri Y. Avci
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia 30602, United States
- Center for Molecular Medicine, University of Georgia, Athens, Georgia 30602, United States
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129
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Motallebirad T, Fazeli H, Azadi D, Shokri D, Moghim S, Esfahani BN. Determination of Capsular Serotypes, Antibiotic Susceptibility Pattern, and Molecular Mechanism of Erythromycin Resistance among Clinical Isolates of Group B Streptococcus in Isfahan, Iran. Adv Biomed Res 2021; 10:27. [PMID: 34760809 PMCID: PMC8531737 DOI: 10.4103/abr.abr_269_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Documented streptococcal resistance to erythromycin has recently been raised. The aim of this study is to identify the molecular mechanism of erythromycin resistance among group B Streptococcus (GBS) strains and to correlate with the clinical origin of strains. Materials and Methods: A total number of 134 colonizing (n = 36), invasive (n = 36), noninvasive (n = 46), and asymptomatic (n = 16) GBS isolates were characterized by the detection of dltS gene, capsular serotyping, antibiotic susceptibility profiles using disc diffusion method, and screening of the ermB, ermTR, and mefA resistance genes. Results: The distribution of capsular serotypes was as follow: serotype III (24.6%), Ia (21.6%), V (17.9%), Ib (14.9%), II (8.9%), IV (8.9%), VI (1.5%), and VII (1.5%). From 134 GBS isolates, 51 (38%) isolates were resistant to erythromycin. The constitutive macrolide lincosamide streptogrmin B (MLSB) was the most common resistance phenotype (62.7%), followed by inducible MLSB (27.4%) and M phenotype (9.8%). Erythromycin resistance rate was higher among asymptomatic GBS strains (13/16, 81.2%). Serotype III was the most prevalent type among resistant isolates (41.1%). The ermB gene highly distributed among resistant strains (64.7%), followed by ermTR (21.5%) and mefA (9.8%). The ermB gene was related to constitutive MLSB phenotype (84.3%, P < 0.05) and serotypes III (61.9%), Ib (87.5%), and V (83.3%). All M phenotype strains harbored mefA gene and were in association with serotype Ia (90%). Conclusion: The current study suggests that ribosomal modification with erm genes is the main mechanism of erythromycin resistance. Because of relatively high prevalence of erythromycin resistance, double disc test highly recommended for GBS disease treatment and intrapartum prophylaxis among penicillin intolerant patients in our region.
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Affiliation(s)
- Tahereh Motallebirad
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Fazeli
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Azadi
- Department of Basic and Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Dariush Shokri
- Infectious Disease and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Moghim
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Dammann AN, Chamby AB, Gonzalez FJ, Sharp ME, Flores K, Shahi I, Dongas S, Hooven TA, Ratner AJ. Group B Streptococcus capsular serotype alters vaginal colonization fitness. J Infect Dis 2021; 225:1896-1904. [PMID: 34788438 DOI: 10.1093/infdis/jiab559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) remains a leading cause of infant morbidity and mortality. A candidate vaccine targets six GBS serotypes, offering a potential alternative to intrapartum antibiotic prophylaxis to reduce disease burden. However, our understanding of the contributions of specific capsule types to GBS colonization and disease remains limited. METHODS Using allelic exchange, we generated isogenic GBS strains differing only in the serotype-determining region in two genetic backgrounds, including the hypervirulent clonal complex (CC) 17. Using a murine model of vaginal co-colonization, we evaluated the roles of the presence of capsule and of expression of specific capsular types in GBS vaginal colonization fitness independent of other genetic factors. RESULTS Encapsulated wild-type strains COH1 (CC17, serotype III) and A909 (non-CC17, serotype Ia), outcompeted isogenic acapsular mutants in murine vaginal co-colonization. COH1 wild-type outcompeted A909. Notably, expression of type Ia capsule conferred an advantage over type III capsule in both genetic backgrounds. CONCLUSIONS Specific capsule types may provide an advantage in GBS vaginal colonization in vivo. However, success of certain GBS lineages, including CC17, likely involves both capsule and non-capsule genetic elements. Capsule switching in GBS, a potential outcome of conjugate vaccine programs, may alter colonization fitness or pathogenesis.
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Affiliation(s)
- Allison N Dammann
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna B Chamby
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Francisco J Gonzalez
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Molly E Sharp
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Karina Flores
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ifrah Shahi
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sophia Dongas
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas A Hooven
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Richard King Mellon Institute for Pediatric Research, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Adam J Ratner
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.,Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
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131
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Yao Y, Cai X, Ye Y, Wang F, Chen F, Zheng C. The Role of Microbiota in Infant Health: From Early Life to Adulthood. Front Immunol 2021; 12:708472. [PMID: 34691021 PMCID: PMC8529064 DOI: 10.3389/fimmu.2021.708472] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
From early life to adulthood, the microbiota play a crucial role in the health of the infant. The microbiota in early life are not only a key regulator of infant health but also associated with long-term health. Pregnancy to early life is the golden time for the establishment of the infant microbiota, which is affected by both environmental and genetic factors. Recently, there is an explosion of the studies on the role of microbiota in human diseases, but the application to disease or health is relatively limited because many aspects of human microbiota remain controversial, especially about the infant microbiota. Therefore, a critical and conclusive review is necessary to understand fully the relationship between the microbiota and the health of infant. In this article, we introduce in detail the role of microbiota in the infant from pregnancy to early life to long-term health. The main contents of this article include the relationship between the maternal microbiota and adverse pregnancy outcomes, the establishment of the neonatal microbiota during perinatal period and early life, the composition of the infant gut microbiota, the prediction of the microbiota for long-term health, and the future study directions of microbiota.
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Affiliation(s)
- Yao Yao
- Department of Pharmacy, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Xiaoyu Cai
- Department of Clinical Pharmacology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiqing Ye
- Department of Pharmacy, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Fengmei Wang
- Department of Pharmacy, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Fengying Chen
- Department of Pharmacy, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Caihong Zheng
- Department of Pharmacy, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
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132
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Population genomics reveals distinct temporal association with the emergence of ST1 serotype V Group B Streptococcus and macrolide resistance in North America. Antimicrob Agents Chemother 2021; 66:e0071421. [PMID: 34633844 DOI: 10.1128/aac.00714-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Identified in the 1970s as the leading cause of invasive bacterial disease in neonates and young infants, Group B Streptococcus (GBS) is now also recognized as a significant cause of morbidity and mortality among adults with underlying medical conditions and the elderly. Concomitant with the increasing incidence of GBS invasive disease in adults is the rise of resistance among GBS isolates to second line antibiotics. Previous research shows that among serotype V GBS - one of the most common capsular types causing adult invasive disease - sequence type 1 (ST1) - accounts for an overwhelming majority of adult invasive disease isolates and frequently harbors macrolide resistance. In this study, using whole genome sequencing data from strains isolated in the USA and Canada over a 45-year period, we examined the association of antimicrobial resistance with the emergence of invasive serotype V ST1 GBS. Our findings show a strong temporal association between increased macrolide resistance and the emergence of serotype V ST1 GBS subpopulations that currently co-circulate to cause adult as well as young infant invasive disease. ST1 GBS subpopulations are defined, in part, by the presence of macrolide resistance genes in mobile genetic elements. Increased frequency of macrolide resistance-encoding mobile genetic elements among invasive GBS ST1 strains suggests the presence of such elements contributes to GBS virulence. Our work provides a foundation for the investigation of genetic features contributing to the increasing prevalence and pathogenesis of serotype V GBS in adult invasive disease.
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133
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John HB, Arumugam A, Priya M, Murugesan N, Rajendraprasad N, Rebekah G, Paul P, Chandna J, Lawn JE, Santhanam S. South Indian children's neurodevelopmental outcomes after Group B Streptococcus invasive disease: A case cohort study. Clin Infect Dis 2021; 74:S24-S34. [PMID: 34558605 PMCID: PMC8775645 DOI: 10.1093/cid/ciab792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background This study is part of a multicountry matched-cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI) of children exposed to invasive group B Streptococcus (iGBS). The specific objective of this paper is to compare NDI across domains of iGBS survivors with a matched non iGBS group in our population. Methods Survivors of iGBS in a South Indian hospital were identified and recruited between January 2020 and April 2021. Cases were compared with age- and gender-matched non iGBS children. Participants were assessed using Bayley Scales of Infant and Toddler Development–3rd edition (BSID-III), Wechsler Preschool and Primary Scale of Intelligence–4th edition (WPPSI-IV), Wechsler Intelligence Scale for Children–5th edition (WISC-V), Child Behavior Checklist (CBCL), and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2), depending on age. Results Our cohort comprised 35 GBS-exposed and 65 matched non iGBS children, aged 1–14 years. The iGBS-exposed group had 17 (48.6%) children with impairment in ≥1 domain compared to 25 (38%) in the non iGBS group (unadjusted OR, 1.51; 95% CI, .65–3.46), 9 (26%) children with “multi-domain impairment” compared to 10 (15.4%) in the non iGBS group (unadjusted OR, 1.90; 95% CI, .69–5.24), and 1 (2.9%) child with moderate to severe impairment compared to 3 (4.6%) in the non iGBS group (unadjusted OR, .60; 95% CI, .06–6.07). In the iGBS group, more children had motor impairments compared with the non iGBS group (unadjusted OR, 10.7; 95% CI, 1.19–95.69; P = .034). Conclusions Children with iGBS seem at higher risk of developing motor impairments compared with a non iGBS group.
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Affiliation(s)
- Hima B John
- Department of Neonatology, Christian Medical College, Vellore
| | - Asha Arumugam
- Department of Neonatology, Christian Medical College, Vellore
| | - Mohana Priya
- Department of Neonatology, Christian Medical College, Vellore
| | | | | | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Horváth-Puhó E, Snoek L, van Kassel MN, Gonçalves BP, Chandna J, Procter SR, van de Beek D, de Gier B, van der Ende A, Sørensen HT, Lawn JE, Bijlsma MW. Every Country, Every Woman, Every Child; Group B Streptococcal Disease Worldwide Prematurity modifies the risk of long-term neurodevelopmental impairments after invasive Group B Streptococcus infections during infancy in Denmark and the Netherlands. Clin Infect Dis 2021; 74:S44-S53. [PMID: 34559200 PMCID: PMC8775650 DOI: 10.1093/cid/ciab774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Preterm birth and neonatal infections are both associated with mortality and long-term neurodevelopmental impairments (NDIs). We examined whether the effect of invasive group B Streptococcus disease (iGBS) on mortality and long-term NDI differs for preterm and term infants, and whether co-occurrence of iGBS and prematurity leads to worse outcome. Methods Nationwide cohort studies of children with a history of iGBS were conducted using Danish and Dutch medical databases. Comparison cohorts of children without iGBS were matched on birth year/month, sex, and gestational age. Effects of iGBS on all-cause mortality and NDI were analyzed using Cox proportional hazards and logistic regression. Effect modification by prematurity was evaluated on additive and multiplicative scales. Results We identified 487 preterm and 1642 term children with a history of iGBS and 21 172 matched comparators. Dutch preterm children exposed to iGBS had the highest mortality rate by 3 months of age (671/1000 [95% CI, 412–929/1000] person-years). Approximately 30% of this mortality rate could be due to the common effect of iGBS and prematurity. Preterm children with iGBS had the highest NDI risk (8.8% in Denmark, 9.0% in the Netherlands). Of this NDI risk 36% (Denmark) and 60% (the Netherlands) might be due to the combined effect of iGBS and prematurity. Conclusions Prematurity is associated with iGBS development. Our study shows that it also negatively impacts outcomes of children who survive iGBS. Preterm infants would benefit from additional approaches to prevent maternal GBS colonization, as this decreases risk of both preterm birth and iGBS.
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Affiliation(s)
- Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Linde Snoek
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
| | - Merel N van Kassel
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
| | - Bronner P Gonçalves
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Simon R Procter
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Diederik van de Beek
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
| | - Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Arie van der Ende
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC/RIVM, University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Merijn W Bijlsma
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Pediatrics, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
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Lukhele ST, Kwatra G, Ismail A, Allam M, Dangor Z, Madhi SA. Investigation of Possible Nosocomial-Associated Invasive Group B Streptococcus Disease Using Whole-Genome Sequencing: A Report of 3 Cases. J Pediatric Infect Dis Soc 2021; 10:880-882. [PMID: 34129035 DOI: 10.1093/jpids/piab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022]
Abstract
We investigated possible nosocomial transmission of 3 invasive cases of Group B Streptococcus serotype III disease in newborns delivered in the same facility. All cases were of the same sequence type and clonal complex. Genomic variation was detected within the core genome and capsular region, indicating different sources of acquisition.
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Affiliation(s)
- Sindiswa T Lukhele
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.,Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Mushal Allam
- Sequencing Core Facility, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
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136
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Brokaw A, Furuta A, Dacanay M, Rajagopal L, Adams Waldorf KM. Bacterial and Host Determinants of Group B Streptococcal Vaginal Colonization and Ascending Infection in Pregnancy. Front Cell Infect Microbiol 2021; 11:720789. [PMID: 34540718 PMCID: PMC8446444 DOI: 10.3389/fcimb.2021.720789] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
Group B streptococcus (GBS) is a gram-positive bacteria that asymptomatically colonizes the vaginal tract. However, during pregnancy maternal GBS colonization greatly predisposes the mother and baby to a wide range of adverse outcomes, including preterm birth (PTB), stillbirth, and neonatal infection. Although many mechanisms involved in GBS pathogenesis are partially elucidated, there is currently no approved GBS vaccine. The development of a safe and effective vaccine that can be administered during or prior to pregnancy remains a principal objective in the field, because current antibiotic-based therapeutic strategies do not eliminate all cases of invasive GBS infections. Herein, we review our understanding of GBS disease pathogenesis at the maternal-fetal interface with a focus on the bacterial virulence factors and host defenses that modulate the outcome of infection. We follow GBS along its path from an asymptomatic colonizer of the vagina to an invasive pathogen at the maternal-fetal interface, noting factors critical for vaginal colonization, ascending infection, and vertical transmission to the fetus. Finally, at each stage of infection we emphasize important host-pathogen interactions, which, if targeted therapeutically, may help to reduce the global burden of GBS.
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Affiliation(s)
- Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Matthew Dacanay
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Kristina M Adams Waldorf
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, University of Washington and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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137
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Ghia C, Rambhad G. Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine - a narrative review. Ther Adv Infect Dis 2021; 8:20499361211045253. [PMID: 34540226 PMCID: PMC8445532 DOI: 10.1177/20499361211045253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
Streptococcus agalactiae, a Gram-positive bacterium, causes invasive infection known as Group B streptococcal disease (GBS). It is a leading cause of neonatal death and complications prior to delivery. The burden of GBS is unknown in India despite the high incidence of preterm and stillbirths. In this study, we performed a narrative review of the available literature (published in the last 10 years) on the epidemiology of GBS, using PubMed and Google Scholar, to understand its impact in India and evaluate potential strategies to prevent the disease in the high-risk population, that is, neonates. The review showed that the incidence of early- and late-onset GBS in neonates (per 1000 live births) was in the ranges of 0.090-0.68 and 0.0-0.07 respectively. The overall case fatality rate reported in only one study was 0.63. In pregnant women, the prevalence of GBS colonization was 2-62% and its transmission to their newborns varied from 6.7% to 11.1%. The serotype distribution of GBS is unclear, but some studies reported the distribution of types Ia, Ib, II, III, V, VII among pregnant women in India. The associated risk factors for GBS colonization in pregnant women are unclear but a few studies suggest the role of age and multigravida, while the risk factors in neonates include preterm birth, prolonged rupture of membrane (⩾18 h), maternal fever, obstetric complications, and prolonged labor >18 h. Screening of GBS is not a routine practice in India and intrapartum antibiotics prophylaxis is limited to only in risk conditions to prevent neonatal disease transmission. A few studies also suggest that high birth rate, poor detection methods, and financial constraints limit routine GBS screening in a developing country such as India. Hence, maternal vaccination is the most promising strategy to prevent neonatal GBS and Pfizer's hexavalent GBS conjugate vaccine (GBS6) is being developed for GBS neonatal disease.
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Affiliation(s)
- Canna Ghia
- Pfizer Ltd, The Capital, 1802, 18th Floor, Plot No. C-70, G Block, Bandra Kurla Complex, Bandra (East), Mumbai, Maharashtra 400051, India
| | - Gautam Rambhad
- Pfizer Ltd, The Capital, 1802, 18th Floor, Plot No. C-70, G Block, Bandra Kurla Complex, Bandra (East), Mumbai, 400051, India
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To KN, Powell O, Jamrozy D, Kopunova R, Anastasiadou K, Faal A, Secka O, Chalker V, Le Doare K, Jauneikaite E. RAPD PCR detects co-colonisation of multiple group B streptococcus genotypes: A practical molecular technique for screening multiple colonies. J Microbiol Methods 2021; 190:106322. [PMID: 34506810 PMCID: PMC9395992 DOI: 10.1016/j.mimet.2021.106322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022]
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal meningitis, pneumonia, and sepsis. The biggest contributing factor of neonatal infections is due to vertical transmission from maternal colonisation of GBS in the genitourinary tract. Multiple serotype colonisation is often not investigated in epidemiological studies, but it is an important consideration for serotype-based vaccine development and implementation to ensure less abundant serotypes are not under-represented. In this study, we show that RAPD PCR is a quick tool useful in screening the presence of genetically different strains using multiple colony picks from a single patient swab. We observed a maximum of five different GBS strains colonising a single patient at a specific time. Co-colonisation of GBS strains is present in pregnant women and infants. GBS serotype acquisition and loss is a common occurrence during colonisation. RAPD PCR can be used as a screening tool to identify genetically distinct strains. Assay may be useful to complement serotyping before sending GBS isolates for further characterisations.
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Affiliation(s)
- Ka-Ning To
- Department of Infectious Disease, Imperial College London, Norfolk Place, London W2 1PG, UK; Institute of Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Oliver Powell
- MRC Centre for Molecular Bacteriology and Infection, Department of Infectious Disease, Imperial College London, 14 Armstrong Road, London SW7 2DD, UK.
| | - Dorota Jamrozy
- Wellcome Sanger Institute, Hinxton, Cambridge CB10 1SA, UK.
| | - Rachel Kopunova
- Department of Medicine, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | - Kyriaki Anastasiadou
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Amadou Faal
- Microbiology Laboratories, MRC Unit The Gambia at LSHTM, Fajara, P. O. Box 273, The Gambia.
| | - Ousman Secka
- Microbiology Laboratories, MRC Unit The Gambia at LSHTM, Fajara, P. O. Box 273, The Gambia.
| | - Victoria Chalker
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, 61 Colindale, London NW9 5EQ, UK.
| | - Kirsty Le Doare
- Department of Infectious Disease, Imperial College London, Norfolk Place, London W2 1PG, UK; Institute of Infection and Immunity, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Elita Jauneikaite
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; NHIR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, Hammersmith Campus, Commonwealth Building, London, W12 0NN, UK.
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Baeringsdottir B, Erlendsdottir H, Bjornsdottir ES, Martins ER, Ramirez M, Haraldsson A, Thorkelsson T. Group B streptococcal infections in infants in Iceland: clinical and microbiological factors. J Med Microbiol 2021; 70:001426. [PMID: 34554080 PMCID: PMC8697508 DOI: 10.1099/jmm.0.001426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/19/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction. Group B streptococcus (GBS) is a leading cause of invasive neonatal infections. These have been divided into early-onset disease (EOD; <7 days) and late-onset disease (LOD; 7-89 days), with different GBS clonal complexes (CCs) associated with different disease presentations.Hypothesis. Different GBS CCs are associated with timing of infection (EOD or LOD) and clinical presentation (sepsis, meningitis or pneumonia).Aim. To study infant GBS infections in Iceland from 1975 to 2019. Are specific GBS CCs related to disease presentation? Is CC17 overrepresented in infant GBS infections in Iceland?Methodology. All culture-confirmed invasive GBS infections in infants (<90 days) in Iceland from 1975 to 2019 were included. Clinical information was gathered from medical records.Results. A total of 127 invasive GBS infections in infants were diagnosed, but 105 infants were included in the study. Of these, 56 had EOD and 49 had LOD. The incidence of GBS infections declined from 2000 onwards but increased again at the end of the study period. Furthermore, there was a significant increase in LOD over the study period (P=0.0001). The most common presenting symptoms were respiratory difficulties and fever and the most common presentation was sepsis alone. Approximately one-third of the cases were caused by GBS CC17 of serotype III with surface protein RIB and pili PI-1+PI-2b or PI-2b. CC17 was significantly associated with LOD (P<0.001).Conclusion. CC17 is a major cause of GBS infection in infants in Iceland. This clone is associated with LOD, which has been increasing in incidence. Because intrapartum antibiotic prophylaxis only prevents EOD, it is important to continue the development of a GBS vaccine in order to prevent LOD infections.
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Affiliation(s)
| | - Helga Erlendsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Elisabete R. Martins
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Asgeir Haraldsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Thordur Thorkelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- The Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland
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Berardi A, Trevisani V, Di Caprio A, Bua J, China M, Perrone B, Pagano R, Lucaccioni L, Fanaro S, Iughetti L, Lugli L, Creti R. Understanding Factors in Group B Streptococcus Late-Onset Disease. Infect Drug Resist 2021; 14:3207-3218. [PMID: 34429620 PMCID: PMC8380284 DOI: 10.2147/idr.s291511] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
Group B streptococcus (GBS) infection remains a leading cause of sepsis, pneumonia, and meningitis in infants. Rates of GBS early onset disease have declined following the widcespread use of intrapartum antibiotic prophylaxis; hence, late-onset infections (LOGBS) are currently a common presentation of neonatal GBS dicsease. The pathogenesis, mode of transmission, and risk factors associated with LOGBS are unclear, which interfere with effective prevention efforts. GBS may be transmitted from the mother to the infant at the time of delivery or during the postpartum period via contaminated breast milk, or as nosocomial or community-acquired infection. Maternal GBS colonization, prematurity, young maternal age, HIV exposure, and ethnicity (Black) are identified as risk factors for LOGBS disease; however, further studies are necessary to confirm additional risk factors, if any, for the implementation of effective prevention strategies. This narrative review discusses current and previous studies that have reported LOGBS. Few well-designed studies have described this condition; therefore, reliable assessment of maternal GBS colonization, breastfeeding, and twin delivery as risk factors for LOGBS remains limited.
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Affiliation(s)
- Alberto Berardi
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Viola Trevisani
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy
| | - Antonella Di Caprio
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy
| | - Jenny Bua
- Terapia Intensiva Neonatale, IRCCS Azienda Ospedaliero Universitaria "Burlo Garofalo", Trieste, Italy
| | | | - Barbara Perrone
- Terapia Intensiva Neonatale, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Rossella Pagano
- Unità Operativa di Pediatria, Civile Sassuolo, Sassuolo, Italy
| | - Laura Lucaccioni
- Unità Operativa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Silvia Fanaro
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Lorenzo Iughetti
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy.,Unità Operativa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Licia Lugli
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Roberta Creti
- Reparto di Antibiotico Resistenza e Patogeni Speciali (AR-PS), Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
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Berardi A, Spada C, Creti R, Auriti C, Gambini L, Rizzo V, Capretti M, Laforgia N, Papa I, Tarocco A, Lanzoni A, Biasucci G, Piccinini G, Nardella G, Latorre G, Merazzi D, Travan L, Reggiani MLB, Baroni L, Ciccia M, Lucaccioni L, Iughetti L, Lugli L. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerg Infect Dis 2021; 27:2279-2287. [PMID: 34423765 PMCID: PMC8386770 DOI: 10.3201/eid2709.210049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
At the time of late-onset disease, mothers often have positive breast milk culture or group B Streptococcus bacteriuria, suggesting heavy maternal colonization. We retrospectively investigated mother-to-infant transmission of group B Streptococcus (GBS) in 98 cases of late-onset disease reported during 2007–2018 by a network in Italy. Mothers with full assessment of vaginal/rectal carriage tested at prenatal screening and at time of late onset (ATLO) were included. Thirty-three mothers (33.7%) were never GBS colonized; 65 (66.3%) were vaginal/rectal colonized, of which 36 (36.7%) were persistently colonized. Mothers with vaginal/rectal colonization ATLO had high rates of GBS bacteriuria (33.9%) and positive breast milk culture (27.5%). GBS strains from mother–infant pairs were serotype III and possessed the surface protein antigen Rib. All but 1 strain belonged to clonal complex 17. GBS strains from 4 mother–infant pairs were indistinguishable through pulsed-field gel electrophoresis. At least two thirds of late-onset cases are transmitted from mothers, who often have vaginal/rectal carriage, positive breast milk culture, or GBS bacteriuria, which suggests heavy maternal colonization.
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Li M, Brokaw A, Furuta AM, Coler B, Obregon-Perko V, Chahroudi A, Wang HY, Permar SR, Hotchkiss CE, Golos TG, Rajagopal L, Adams Waldorf KM. Non-human Primate Models to Investigate Mechanisms of Infection-Associated Fetal and Pediatric Injury, Teratogenesis and Stillbirth. Front Genet 2021; 12:680342. [PMID: 34290739 PMCID: PMC8287178 DOI: 10.3389/fgene.2021.680342] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 12/25/2022] Open
Abstract
A wide array of pathogens has the potential to injure the fetus and induce teratogenesis, the process by which mutations in fetal somatic cells lead to congenital malformations. Rubella virus was the first infectious disease to be linked to congenital malformations due to an infection in pregnancy, which can include congenital cataracts, microcephaly, hearing impairment and congenital heart disease. Currently, human cytomegalovirus (HCMV) is the leading infectious cause of congenital malformations globally, affecting 1 in every 200 infants. However, our knowledge of teratogenic viruses and pathogens is far from complete. New emerging infectious diseases may induce teratogenesis, similar to Zika virus (ZIKV) that caused a global pandemic in 2016-2017; thousands of neonates were born with congenital microcephaly due to ZIKV exposure in utero, which also included a spectrum of injuries to the brain, eyes and spinal cord. In addition to congenital anomalies, permanent injury to fetal and neonatal organs, preterm birth, stillbirth and spontaneous abortion are known consequences of a broader group of infectious diseases including group B streptococcus (GBS), Listeria monocytogenes, Influenza A virus (IAV), and Human Immunodeficiency Virus (HIV). Animal models are crucial for determining the mechanism of how these various infectious diseases induce teratogenesis or organ injury, as well as testing novel therapeutics for fetal or neonatal protection. Other mammalian models differ in many respects from human pregnancy including placentation, labor physiology, reproductive tract anatomy, timeline of fetal development and reproductive toxicology. In contrast, non-human primates (NHP) most closely resemble human pregnancy and exhibit key similarities that make them ideal for research to discover the mechanisms of injury and for testing vaccines and therapeutics to prevent teratogenesis, fetal and neonatal injury and adverse pregnancy outcomes (e.g., stillbirth or spontaneous abortion). In this review, we emphasize key contributions of the NHP model pre-clinical research for ZIKV, HCMV, HIV, IAV, L. monocytogenes, Ureaplasma species, and GBS. This work represents the foundation for development and testing of preventative and therapeutic strategies to inhibit infectious injury of human fetuses and neonates.
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Affiliation(s)
- Miranda Li
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- Department of Biological Sciences, Columbia University, New York, NY, United States
| | - Alyssa Brokaw
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anna M. Furuta
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Veronica Obregon-Perko
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Hsuan-Yuan Wang
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Sallie R. Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Charlotte E. Hotchkiss
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
| | - Thaddeus G. Golos
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Lakshmi Rajagopal
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Kristina M. Adams Waldorf
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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143
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Shibata M, Morozumi M, Maeda N, Komiyama O, Shiro H, Iwata S, Ubukata K. Relationship between intrapartum antibiotic prophylaxis and group B streptococcal colonization dynamics in Japanese mother-neonate pairs. J Infect Chemother 2021; 27:977-983. [PMID: 33610482 DOI: 10.1016/j.jiac.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In Japan, universal screening for group B streptococcal (GBS) colonization in pregnant women and intrapartum antibiotic prophylaxis (IAP) are recommended to prevent neonatal GBS infection. However, the dynamics of GBS colonization in Japanese mother/neonate pairs have not been adequately studied. METHODS A prospective cohort study was conducted from July 2018 to March 2019. Rectovaginal samples were collected from pregnant women (33-37 gestation weeks) once. In neonates, nasopharyngeal and rectal samples were collected at three time points: after birth, 1 week after birth, and 1 month after birth. All samples were analyzed for GBS using real-time PCR testing and culture methods. Capsular typing was performed for all GBS isolates and GBS-positive samples using real-time PCR testing. RESULTS The overall maternal and neonatal GBS-positivity rates were 22.7% (57/251) and 8.8% (22/251), respectively. IAP for GBS-positive mothers (96.5%) was highly administered. Eleven (19.3%) neonates born to GBS-positive mothers were GBS-positive, which was significantly higher than the 11 (5.7%) neonates born to GBS-negative mothers. The rate of GBS-positivity in neonates increased with an increased number of GBS colonies in mothers. More neonates were GBS-positive 1 month after birth than 1 week after birth, and there was a higher rate of GBS-positive rectal swabs than nasopharyngeal swabs. Capsular types of GBS that were isolated from each mother and neonate pair were the same, namely, Ib, III, V, and VI. CONCLUSIONS These findings indicate that the efficacy of IAP in preventing GBS transmission to neonates might be limited to within a few weeks after birth.
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Affiliation(s)
- Meiwa Shibata
- Department of Pediatrics, Yokohama Rosai Hospital, Japan; Department of Infectious Diseases, Keio University School of Medicine, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Japan
| | - Osamu Komiyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroyuki Shiro
- Department of Pediatrics, Yokohama Rosai Hospital, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, Keio University School of Medicine, Japan; Department of Infectious Diseases, National Cancer Center Hospital, Japan
| | - Kimiko Ubukata
- Department of Infectious Diseases, Keio University School of Medicine, Japan; Department of General Medicine, Keio University School of Medicine, Japan.
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144
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Moon CJ, Kwon TH, Lee KS, Lee HS. Recurrent neonatal sepsis and progressive white matter injury in a premature newborn culture-positive for group B Streptococcus: A case report. Medicine (Baltimore) 2021; 100:e26387. [PMID: 34160417 PMCID: PMC8238304 DOI: 10.1097/md.0000000000026387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Group B Streptococcus (GBS) remains a principal pathogen causing neonatal sepsis and meningitis, particularly in premature infants with relatively insufficient immunity. Recurrence may occur uncommonly, largely associated with subclinical mucosal persistence or repetitive exposure to exogenous sources. White matter injury (WMI) including cystic periventricular leukomalacia (PVL) has been associated with intrauterine infection/inflammation, and neonatal infection as a more significant predictor including postnatal sepsis and recurrent infection, even without microbial neuroinvasion. Furthermore, clinical and experimental evidence of WMI by some bacteria other than GBS without central nervous system invasion has been reported. However, there is little evidence of WMI associated with neonatal GBS sepsis in the absence of meningitis in the literature. PATIENT CONCERNS A newborn at 30+4 weeks' gestation with low birthweight presented with 2 episodes (with a 13-day interval with no antibiotic therapy) of neonatal sepsis culture-proven for GBS with early-onset presentation after clinical chorioamnionitis via vertical GBS transmission and the associated conditions including prematurity-related neonatal immunodeficiency and persistent mucosal GBS carriage after the first antibiotic treatment. The perinatal GBS infection was complicated by progressive WMI presenting with ventriculomegaly and cystic PVL without a definite evidence of meningitis, intraventricular hemorrhage, and documented cerebral hypoxia or hypoperfusion conditions including septic shock. DIAGNOSES Recurrent group B streptococcal sepsis and cystic PVL with ventriculomegaly. INTERVENTIONS Two episodes of GBS sepsis were treated with 15-day parenteral antibiotic therapy, respectively. OUTCOMES Resolution of the recurrent GBS sepsis without further relapses, however, complicated by WMI and subsequent about 6 months delay in motor development at 12 months' corrected age. LESSONS This case suggests WMI associated with GBS bacteremia without central nervous system entry by viable GBS and also shows that in premature infants, intrauterine GBS infection with no interventions may lead to extensive and persistent GBS colonization, early-onset and recurrent GBS disease, and WMI. Postnatal as well as intrauterine infection/inflammation controls with maternal prophylaxis may be pivotal for prevention and limiting the magnitude of neurologic injury.
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MESH Headings
- Administration, Intravenous
- Anti-Bacterial Agents/administration & dosage
- Chorioamnionitis/diagnosis
- Chorioamnionitis/microbiology
- Developmental Disabilities/diagnosis
- Developmental Disabilities/microbiology
- Drug Therapy, Combination/methods
- Female
- Humans
- Hydrocephalus/diagnosis
- Hydrocephalus/microbiology
- Infant
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infectious Disease Transmission, Vertical
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/microbiology
- Leukomalacia, Periventricular/pathology
- Magnetic Resonance Imaging
- Male
- Maternal Age
- Neonatal Sepsis/diagnosis
- Neonatal Sepsis/microbiology
- Neonatal Sepsis/therapy
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/microbiology
- Recurrence
- Streptococcal Infections/complications
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcal Infections/transmission
- Streptococcus agalactiae/isolation & purification
- White Matter/diagnostic imaging
- White Matter/microbiology
- White Matter/pathology
- Young Adult
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Affiliation(s)
- Cheong-Jun Moon
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Tae Hee Kwon
- Department of Radiology, Cha Gangnam Medical Center, Cha University School of Medicine
| | - Kyung Sang Lee
- Department of Radiology, Cha Gangnam Medical Center, Cha University School of Medicine
| | - Hyun-Seung Lee
- Department of Pediatrics, Incheon Worker‘s Compensation Hospital, Incheon
- Department of Pediatrics, Cha Gangnam Medical Center, Cha University School of Medicine, Seoul, Republic of Korea
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145
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Ding Y, Wang Y, Hsia Y, Russell N, Heath PT. Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China. Emerg Infect Dis 2021; 26:2651-2659. [PMID: 33079042 PMCID: PMC7588546 DOI: 10.3201/eid2611.181414] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We performed a systematic review and meta-analysis of the incidence, case-fatality rate (CFR), isolate antimicrobial resistance patterns, and serotype and sequence type distributions for invasive group B Streptococcus (GBS) disease in infants <1–89 days of age in China. We searched the PubMed/Medline, Embase, Wanfang, and China National Knowledge Infrastructure databases for research published during January 1, 2000–March 16, 2018, and identified 64 studies. Quality of included studies was assessed by using Cochrane tools. Incidence and CFR were estimated by using random-effects meta-analyses. Overall incidence was 0.55 (95% CI 0.35–0.74) cases/1,000 live births, and the CFR was 5% (95% CI 3%–6%). Incidence of GBS in young infants in China was higher than the estimated global incidence (0.49 cases/1,000 live births) and higher than previous estimates for Asia (0.3 cases/1,000 live births). Our findings suggest that implementation of additional GBS prevention efforts in China, including maternal vaccination, could be beneficial.
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146
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Plainvert C, Hays C, Touak G, Joubrel-Guyot C, Dmytruk N, Frigo A, Poyart C, Tazi A. Multidrug-Resistant Hypervirulent Group B Streptococcus in Neonatal Invasive Infections, France, 2007-2019. Emerg Infect Dis 2021; 26:2721-2724. [PMID: 33079049 PMCID: PMC7588536 DOI: 10.3201/eid2611.201669] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We analyzed group B Streptococcus (GBS) neonatal invasive infections reported during 2007–2019 in France. The hypervirulent clonal complex (CC) 17 GBS was responsible for 66% (827/1,262) of cases. The role of CC17 GBS increased over time (p for trend = 0.0001), together with the emergence of a multidrug-resistant CC17 GBS sublineage.
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147
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Abstract
Neonatal sepsis (NS) kills 750,000 infants every year. Effectively treating NS requires timely diagnosis and antimicrobial therapy matched to the causative pathogens, but most blood cultures for suspected NS do not recover a causative pathogen. We refer to these suspected but unidentified pathogens as microbial dark matter. Given these low culture recovery rates, many non–culture-based technologies are being explored to diagnose NS, including PCR, 16S amplicon sequencing, and whole metagenomic sequencing. However, few of these newer technologies are scalable or sustainable globally. To reduce worldwide deaths from NS, one possibility may be performing population-wide pathogen discovery. Because pathogen transmission patterns can vary across space and time, computational models can be built to predict the pathogens responsible for NS by region and season. This approach could help to optimally treat patients, decreasing deaths from NS and increasing antimicrobial stewardship until effective diagnostics that are scalable become available globally.
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148
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Gonçalves BP, Procter SR, Clifford S, Koukounari A, Paul P, Lewin A, Jit M, Lawn J. Estimation of country-level incidence of early-onset invasive Group B Streptococcus disease in infants using Bayesian methods. PLoS Comput Biol 2021; 17:e1009001. [PMID: 34125829 PMCID: PMC8202927 DOI: 10.1371/journal.pcbi.1009001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/25/2021] [Indexed: 01/30/2023] Open
Abstract
Neonatal invasive disease caused by Group B Streptococcus (GBS) is responsible for much acute mortality and long-term morbidity. To guide development of better prevention strategies, including maternal vaccines that protect neonates against GBS, it is necessary to estimate the burden of this condition globally and in different regions. Here, we present a Bayesian model that estimates country-specific invasive GBS (iGBS) disease incidence in children aged 0 to 6 days. The model combines different types of epidemiological data, each of which has its own limitations: GBS colonization prevalence in pregnant women, risk of iGBS disease in children born to GBS-colonized mothers and direct estimates of iGBS disease incidence where available. In our analysis, we present country-specific maternal GBS colonization prevalence after adjustment for GBS detection assay used in epidemiological studies. We then integrate these results with other epidemiological data and estimate country-level incidence of iGBS disease including in countries with no studies that directly estimate incidence. We are able to simultaneously estimate two key epidemiological quantities: the country-specific incidence of early-onset iGBS disease, and the risk of iGBS disease in babies born to GBS-colonized women. Overall, we believe our method will contribute to a more comprehensive quantification of the global burden of this disease, inform cost-effectiveness assessments of potential maternal GBS vaccines and identify key areas where data are necessary. Invasive disease caused by Group B Streptococcus (GBS) in young infants continues to be a major public health problem in both developed and developing countries. However, data on the incidence of this infection during the first week of life are only available for a small number of countries, which has complicated the quantification of the burden of this disease globally. In this paper, we develop a Bayesian framework to estimate the incidence of invasive GBS infection that combines data from multiple types of epidemiological studies, with adjustment for relevant factors such as diagnostic methods used in the studies. We present estimates from a series of models, and our results highlight the potential weaknesses of different types of studies and the importance to consider the entire evidence when estimating global burden of invasive neonatal infections. We believe this model is a step toward better quantification of the number of cases in different regions.
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Affiliation(s)
- Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sam Clifford
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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149
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Garcia VR. Impact of Intrapartum Antibiotic Prophylaxis for Group B Streptococcus on the Term Infant Gut Microbiome: A State of the Science Review. J Midwifery Womens Health 2021; 66:351-359. [PMID: 34114318 DOI: 10.1111/jmwh.13245] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 01/15/2023]
Abstract
Since the implementation of screening and prophylaxis guidelines for group B streptococcus (GBS) in the early 1990s there has been considerable advancement in scientific knowledge about the gut microbiome and its role in both health and disease processes. Research assessing early influences during the development of the infant gut microbiome has advanced considerably in the last 15 years. It is now widely accepted that early introduction of antibiotics in infancy is associated with increased risk for illness later in life. Research on antibiotic administration to pregnant individuals during labor for GBS colonization and its potential impact on the developing gut microbiome of term infants is now emerging. Despite the growing body of evidence of the negative impact of antibiotics on the gut microbiome, the guidelines for GBS prophylaxis among pregnant individuals have not changed significantly since their inception in the 1990s. This state of the science review examines the association between intrapartum antibiotic administration and alterations in the gut microbiome of term infants born vaginally, specifically in relation to microbial composition; the occurrence of and effect on antibiotic resistance genes in the infant gut; and the factors that may compound or mitigate these effects.
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Yuan XY, Liu HZ, Liu JF, Sun Y, Song Y. Pathogenic mechanism, detection methods and clinical significance of group B Streptococcus. Future Microbiol 2021; 16:671-685. [PMID: 34098731 DOI: 10.2217/fmb-2020-0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Group B Streptococcus (GBS) is the main pathogen of perinatal infection. It can lead to adverse pregnancy, maternal infection, premature delivery, abortion, stillbirth and a series of adverse maternal and infant outcomes such as neonatal sepsis, meningitis or pneumonia during delivery. In order to reduce the infection of perinatal pregnant and the adverse pregnancy outcome, more attention should be paid in the clinical practice, screening efforts, universal detection of GBS infection for pregnant women and preventive treatment for the possible mother infant infection. In this study, the biological characteristics, immunophenotype, major pathogenic mechanism, laboratory test methods and clinical significance of GBS are summarized.
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Affiliation(s)
- Xiao-Yan Yuan
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
| | - Hai-Zhu Liu
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
| | - Jia-Fei Liu
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China.,Department of Medical Laboratory Sciences, Weifang Medical University, Weifang, Shandong, 261000, PR China
| | - Yong Sun
- Department of Clinical Lab, Yantai Laiyang Central Hospital, Yantai, Shandong, 264200, PR China
| | - Yu Song
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
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