201
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Plainvert C, Anselem O, Joubrel C, Marcou V, Falloukh A, Frigo A, Magdoud El Alaoui F, Ancel PY, Jarreau PH, Mandelbrot L, Goffinet F, Poyart C, Tazi A. Persistence of group B Streptococcus vaginal colonization and prevalence of hypervirulent CC-17 clone correlate with the country of birth: a prospective 3-month follow-up cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:133-140. [PMID: 32812077 DOI: 10.1007/s10096-020-04011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023]
Abstract
To identify factors associated with vaginal colonization and persistence by group B Streptococcus (GBS) and by the hypervirulent neonatal CC-17 clone in late pregnancy and after delivery, a multicentre prospective observational cohort with 3-month follow-up was established in two university hospitals, Paris area, France. Pregnant women were recruited when antenatal screening for GBS vaginal colonization at 34-38 weeks of gestational age was positive. Vaginal samples were analysed by conventional culture methods at antenatal screening, delivery, and 21 and 60 days following delivery. Identification of the hypervirulent neonatal GBS CC-17 was performed. Colonization was defined as persistent when all vaginal samples were positive for GBS. A total of 754 women were included. GBS vaginal colonization was persistent in 63% of the cases (95% CI 59%-67%). Persistent colonization was more likely in women born in Sub-Saharan Africa compared with women born in France (OR = 1.88, 95% CI 1.05-3.52), and GBS CC-17 was overrepresented in women born in Sub-Saharan Africa (OR = 2.09, 95% CI 1.20-3.57). Women born in Sub-Saharan Africa are at higher risk for GBS vaginal persistence than women born in France. This observation correlates with an increased prevalence of the hypervirulent GBS CC-17 in the former group, which likely reflect variations linked to ethnicity and vaginal community-state types and might account for the increased susceptibility of black neonates to GBS infections.
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Affiliation(s)
- Céline Plainvert
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Olivia Anselem
- FHU Prema, Paris, France
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Caroline Joubrel
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Valérie Marcou
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Amiel Falloukh
- Department of Neonatal Medicine, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Amandine Frigo
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Fatma Magdoud El Alaoui
- Department of Microbiology, Louis Mourier Hospital, AP-HP, Colombes, France
- Université de Paris, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
- URC-CIC P1419, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Pierre Henri Jarreau
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Laurent Mandelbrot
- FHU Prema, Paris, France
- Université de Paris, Paris, France
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, AP-HP, Colombes, France
| | - François Goffinet
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
| | - Claire Poyart
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
- Université de Paris, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France.
- FHU Prema, Paris, France.
- Université de Paris, Paris, France.
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202
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Stewart AG, Burnard D, Sowden D, McMillan D. Whole genome sequencing for antimicrobial resistance mechanisms, virulence factors and clonality in invasive Streptococcus agalactiae blood culture isolates recovered in Australia. Pathology 2020; 52:694-699. [PMID: 32800332 DOI: 10.1016/j.pathol.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 02/04/2023]
Abstract
Invasive Streptococcus agalactiae (Group B streptococci, GBS) infections result in a large burden of disease globally. Changes in clinical and molecular epidemiology, as well as antibiotic resistance patterns, are being described globally amongst GBS isolates. Very little is known about the characteristics of invasive GBS disease in the Australian setting. Therefore, this study aimed to define the clinical and genomic characteristics of invasive GBS isolates from the Sunshine Coast region in Australia. Thirty-two isolates were identified over a 3-year period. Known risk factors for disease were present in 71.9% and the leading site of disease was the skin and soft tissue (40.6%). Sequence types (ST) 1, 17 and 23 made up 50% with ST17 making up 56.2% of the total. Serotype Ia was the most prevalent (9/32, 28.1%). Clindamycin and erythromycin resistance was seen in 12.5% and 25%, respectively. Active surveillance and local knowledge of GBS epidemiology and antibiotic resistance has both patient and public health importance. Vaccine candidates are currently in their clinical phase of development.
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Affiliation(s)
- Adam G Stewart
- University of Queensland Centre for Clinical Research, School of Medicine, University of Queensland, Qld, Australia.
| | - Delaney Burnard
- University of Queensland Centre for Clinical Research, School of Medicine, University of Queensland, Qld, Australia; Sunshine Coast Health Institute, Sunshine Coast Health Institute, Birtinya, Qld, Australia; Sunshine Coast University, Qld, Australia
| | - David Sowden
- Department of Infectious Diseases, Sunshine Coast University Hospital, Qld, Australia
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203
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Dos Santos NFB, da Silva LR, Costa FJMD, de Mattos DM, de Carvalho E, Ferreira LCDS, Ferreira RDCC. Immunization with a recombinant BibA surface protein confers immunity and protects mice against group B Streptococcus (GBS) vaginal colonization. Vaccine 2020; 38:5286-5296. [PMID: 32571719 DOI: 10.1016/j.vaccine.2020.05.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
Streptococcus agalactiae or group B Streptococcus (GBS) is a Gram-positive bacterium divided into ten distinct serotypes that colonizes the vaginal and rectal tracts of approximately 30% of women worldwide. GBS is the leading cause of invasive infection in newborns, causing sepsis, pneumoniae and meningitis. The main strategy to prevent GSB infection in newborns includes the use of intrapartum antibiotic therapy, which does not prevent late-onset diseases and may select resistant bacterial strains. We still do not have a vaccine formulation specific for this pathogen approved for human use. Conserved surface proteins are potential antigens that could be targets for recognition by antibodies and activation of cell opsonization. We used a serotype V GBS (GBS-V)-derived recombinant surface protein, rBibA, and evaluated the potential protective role of the induced antigen-specific antibodies after parenteral or mucosal immunizations in C57BL/6 mice. In vitro and in vivo assays demonstrated that vaccine formulations containing BibA combined with different adjuvants induced serum IgG and/or secreted IgA antibodies, leading to enhanced opsonophagocytosis of GBS-V cells and reduced invasion of epithelial cells. One BibA-based vaccine formulation adjuvanted with a nontoxic derivative of the heat-labile toxin produced by enterotoxigenic Escherichia coli (ETEC) strains was capable of inducing protection against vaginal colonization and lethal parenteral challenge with GBS-V. Serum collected from vaccinated mice conferred passive protection against vaginal colonization in naïve mice challenged with GBS-V. Taken together, the present data demonstrate that the BibA protein is a promising antigen for development of a vaccine to protect against GBS infection.
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Affiliation(s)
- Nayara Fernanda Barros Dos Santos
- Laboratory of Vaccine Development, Department of Microbiology, Biomedical Science Institute, University of São Paulo, 1374 Prof. Lineu Prestes Avenue, São Paulo, SP 05508-000, Brazil.
| | - Lukas Raposo da Silva
- Laboratory of Vaccine Development, Department of Microbiology, Biomedical Science Institute, University of São Paulo, 1374 Prof. Lineu Prestes Avenue, São Paulo, SP 05508-000, Brazil.
| | - Fagner James Martins Dantas Costa
- Laboratory of Vaccine Development, Department of Microbiology, Biomedical Science Institute, University of São Paulo, 1374 Prof. Lineu Prestes Avenue, São Paulo, SP 05508-000, Brazil.
| | - Daniely Maranhão de Mattos
- Laboratory of Vaccine Development, Department of Microbiology, Biomedical Science Institute, University of São Paulo, 1374 Prof. Lineu Prestes Avenue, São Paulo, SP 05508-000, Brazil.
| | - Enéas de Carvalho
- Laboratory of Molecular Biotechnology I, Biotechnology Center, Butantan Institute, 1500 Vital Brasil Avenue, São Paulo, SP 03178-200, Brazil.
| | - Luís Carlos de Souza Ferreira
- Laboratory of Vaccine Development, Department of Microbiology, Biomedical Science Institute, University of São Paulo, 1374 Prof. Lineu Prestes Avenue, São Paulo, SP 05508-000, Brazil.
| | - Rita de Cássia Café Ferreira
- Laboratory of Vaccine Development, Department of Microbiology, Biomedical Science Institute, University of São Paulo, 1374 Prof. Lineu Prestes Avenue, São Paulo, SP 05508-000, Brazil.
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204
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Lu J, Francis J, Doster RS, Haley KP, Craft KM, Moore RE, Chambers SA, Aronoff DM, Osteen K, Damo SM, Manning S, Townsend SD, Gaddy JA. Lactoferrin: A Critical Mediator of Both Host Immune Response and Antimicrobial Activity in Response to Streptococcal Infections. ACS Infect Dis 2020; 6:1615-1623. [PMID: 32329605 DOI: 10.1021/acsinfecdis.0c00050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Streptococcal species are Gram-positive bacteria responsible for a variety of disease outcomes including pneumonia, meningitis, endocarditis, erysipelas, necrotizing fasciitis, periodontitis, skin and soft tissue infections, chorioamnionitis, premature rupture of membranes, preterm birth, and neonatal sepsis. In response to streptococcal infections, the host innate immune system deploys a repertoire of antimicrobial and immune modulating molecules. One important molecule that is produced in response to streptococcal infections is lactoferrin. Lactoferrin has antimicrobial properties including the ability to bind iron with high affinity and sequester this important nutrient from an invading pathogen. Additionally, lactoferrin has the capacity to alter the host inflammatory response and contribute to disease outcome. This Review presents the most recent published work that studies the interaction between the host innate immune protein lactoferrin and the invading pathogen, Streptococcus.
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Affiliation(s)
- Jacky Lu
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Jamisha Francis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Ryan S. Doster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Kathryn P. Haley
- Department of Biomedical Sciences, Grand Valley State University, Allendale, Michigan 49401, United States
| | - Kelly M. Craft
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Rebecca E. Moore
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Schuyler A. Chambers
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - David M. Aronoff
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Kevin Osteen
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Veterans Affairs, Tennessee Valley Healthcare Systems, Nashville, Tennessee 37212, United States
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Steven M. Damo
- Department of Chemistry, Fisk University, Nashville, Tennessee 37208, United States
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Shannon Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48824, United States
| | - Steven D. Townsend
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Jennifer A. Gaddy
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Veterans Affairs, Tennessee Valley Healthcare Systems, Nashville, Tennessee 37212, United States
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205
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Anwer S, Ades A, Dias S. Joint synthesis of conditionally related multiple outcomes makes better use of data than separate meta-analyses. Res Synth Methods 2020; 11:496-506. [PMID: 31680481 PMCID: PMC7383979 DOI: 10.1002/jrsm.1380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/20/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND When there are structural relationships between outcomes reported in different trials, separate analyses of each outcome do not provide a single coherent analysis, which is required for decision-making. For example, trials of intrapartum anti-bacterial prophylaxis (IAP) to prevent early onset group B streptococcal (EOGBS) disease can report three treatment effects: the effect on bacterial colonisation of the newborn, the effect on EOGBS, and the effect on EOGBS conditional on newborn colonisation. These outcomes are conditionally related, or nested, in a multi-state model. This paper shows how to exploit these structural relationships, providing a single coherent synthesis of all the available data, while checking to ensure that different sources of evidence are consistent. RESULTS Overall, the use of IAP reduces the risk of EOGBS (RR: 0.03; 95% Credible Interval (CrI): 0.002-0.13). Most of the treatment effect is due to the prevention of colonisation in newborns of colonised mothers (RR: 0.08, 95% CrI: 0.04-0.14). Node-splitting demonstrated that the treatment effect calculated using only direct evidence was consistent with that predicted from the remaining evidence (p = 0.15). The findings accorded with previously published separate meta-analyses of the different outcomes, once these are re-analysed correctly accounting for zero cells. CONCLUSION Multiple outcomes should be synthesised together where possible, taking account of their structural relationships. This generates an internally coherent analysis, suitable for decision making, in which estimates of each of the treatment effects are based on all available evidence (direct and indirect). Separate meta-analyses of each outcome have none of these properties.
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Affiliation(s)
- Sumayya Anwer
- Centre for Reviews and DisseminationUniversity of YorkYO10 5DDUK
- Bristol Medical School, University of BristolCanynge Hall, 39 Whatley Road, BS8 2PSUK
| | - A.E. Ades
- Bristol Medical School, University of BristolCanynge Hall, 39 Whatley Road, BS8 2PSUK
| | - Sofia Dias
- Centre for Reviews and DisseminationUniversity of YorkYO10 5DDUK
- Bristol Medical School, University of BristolCanynge Hall, 39 Whatley Road, BS8 2PSUK
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206
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Increasing Resistance and Changes in Distribution of Serotypes of Streptococcus agalactiae in Poland. Pathogens 2020; 9:pathogens9070526. [PMID: 32610654 PMCID: PMC7400139 DOI: 10.3390/pathogens9070526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Streptococcus agalactiae is responsible for serious infections in newborn babies, pregnant women, and other patients. The aim of this study was to evaluate antimicrobial susceptibility, serotype distribution, and virulence determinants of the S. agalactiae isolates derived from clinical specimens considering the global increase of both antibiotic resistance and virulence. A total of 165 isolates were identified and serotyped by PCR techniques. Antimicrobial susceptibility was assessed by disk diffusion method, gradient diffusion method and VITEK® System. Virulence associated genes were investigated by PCR; ability to form biofilm was assessed using a microtiter plate assay. The highest observed MIC value for penicillin G was 0.12 µg/mL, seen in 8.5% of isolates. Resistance to erythromycin and clindamycin were found in 30.38% and 24.8% of the strains, respectively. The serotype III (32.73%), V (25.45%), and Ia (18.18%) were found as the most frequently represented. Previously unidentified strains in Poland, belonging to serotypes VI (three strains) and VII (one strain) were recognized. The presence of genes encoding various virulence factors as well as diverse ability to form biofilm were found. In conclusion, macrolide-resistance and decreased susceptibility to penicillin G were revealed signifying the increasing resistance among group B streptococci. Moreover, the presence of genes encoding various virulence factors and the ability to form biofilm were confirmed indicating their role in the pathomechanisms of the evaluated GBS infections.
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207
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Furfaro LL, Payne MS, Chang BJ. Host range, morphological and genomic characterisation of bacteriophages with activity against clinical Streptococcus agalactiae isolates. PLoS One 2020; 15:e0235002. [PMID: 32574197 PMCID: PMC7310703 DOI: 10.1371/journal.pone.0235002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/06/2020] [Indexed: 01/21/2023] Open
Abstract
Streptococcus agalactiae or Group B Streptococcus (GBS) is a leading cause of sepsis in neonates. As a preventative measure prophylactic antibiotic administration is common in pregnant women colonised with GBS, but antibiotic-resistance and adverse effects on neonatal microbiomes may result. Use of bacteriophages (phages) is one option for targeted therapy. To this end, four phages (LF1 –LF4) were isolated from wastewater. They displayed lytic activity in vitro against S. agalactiae isolates collected from pregnant women and neonates, with 190/246 isolates (77.2%) and 10/10 (100%) isolates susceptible to at least one phage, respectively. Phage genomes ranged from 32,205–44,768 bp and all phages were members of the Siphoviridae family. High nucleotide identity (99.9%) was observed between LF1 and LF4, which were closely related to a putative prophage of S. agalactiae. The genome organisation of LF2 differed, and it showed similarity to a different S. agalactiae prophage, while LF3 was more closely related to a Streptococcus pyogenes phage. Lysogenic gene presence (integrase, repressor and regulatory modules), was suggestive of temperate phages. In a therapeutic context, temperate phages are not ideal candidates, however, the broad host range activity of these phages observed on clinical isolates in vitro is promising for future therapeutic approaches including bioengineered phage or lysin applications.
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Affiliation(s)
- Lucy L. Furfaro
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Crawley, Australia
- * E-mail:
| | - Matthew S. Payne
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Crawley, Australia
| | - Barbara J. Chang
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Crawley, Australia
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208
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Le Doare K, Heath PT, Plumb J, Owen NA, Brocklehurst P, Chappell LC. Uncertainties in Screening and Prevention of Group B Streptococcus Disease. Clin Infect Dis 2020; 69:720-725. [PMID: 30561556 PMCID: PMC6669315 DOI: 10.1093/cid/ciy1069] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/11/2018] [Indexed: 01/29/2023] Open
Abstract
In autumn 2016, the UK Department of Health (now Department of Health and Social Care) convened 2 meetings to discuss how to address research evidence gaps in order to minimize the impact of infant group B streptococcus (GBS) disease in the United Kingdom. At that meeting, a number of research priorities were highlighted, including improving the screening for GBS colonization in pregnant women, offering intrapartum antibiotic prophylaxis and point-of-care testing, and understanding the effect of widespread intrapartum antibiotic use on long-term infant health. Further discussions involved investigating the feasibility of a large prospective study of pregnant women and their infants in order to understand the role of antibodies in the protection against GBS disease in infancy following maternal exposure to GBS colonization. Here, we summarize the research uncertainties identified at that meeting.
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Affiliation(s)
- Kirsty Le Doare
- Paediatric Infectious Disease Research Group & Vaccine Institute, St George's University of London, London, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Disease Research Group & Vaccine Institute, St George's University of London, London, United Kingdom
| | - Jane Plumb
- Group B Strep Support, London, United Kingdom
| | - Natalie A Owen
- Science, Research and Evidence, Department of Health and Social Care, London, United Kingdom
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, London, United Kingdom
| | - Lucy C Chappell
- Department of Obstetrics, King's College London, London, United Kingdom
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209
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Escobar DF, Diaz-Dinamarca DA, Hernández CF, Soto DA, Manzo RA, Alarcón PI, Pinto CH, Bastias DN, Oberg-Bravo CN, Rojas R, Illanes SE, Kalergis AM, Vasquez AE. Development and analytical validation of real-time PCR for the detection of Streptococcus agalactiae in pregnant women. BMC Pregnancy Childbirth 2020; 20:352. [PMID: 32517670 PMCID: PMC7285471 DOI: 10.1186/s12884-020-03038-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal infection. In this study, we aimed to evaluate the analytical validation of qualitative real-time polymerase chain reaction (qPCR) as a means to detect GBS. Methods Genomic DNA (gDNA) was purified from 12 ATCC bacterial strains, two belonging to GBS and the remainder acting as negative controls. Additionally, gDNA was isolated from 21 strains of GBS from various serotypes (Ia, Ib and II-VIII). All gDNA was used to evaluate the analytical validation of the qPCR method employing a specific Taqman probe. Inclusivity, exclusivity, anticipated reportable range, the limit of detection and robustness were evaluated. The methods used are described in international guidelines and other existing reports. The performance of this qPCR method for detecting GBS was compared to other microbiological methods used with vaginal-rectal samples from pregnant women. Results Our qPCR method for detecting GBS was analytically validated. It has a limit of detection of 0.7 GE/μL and 100% analytical specificity. It detects all strains of GBS with the same level of performance as microbiological methods. Conclusion Data suggest that this qPCR method performs adequately as a means to detect GBS in vaginal-rectal swabs from pregnant women.
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Affiliation(s)
- Daniel F Escobar
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego A Diaz-Dinamarca
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos F Hernández
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, 8380494, Santiago, Chile
| | - Daniel A Soto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Ricardo A Manzo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pedro I Alarcón
- Sección Bacteriología del Departamento Biomédico, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Camila H Pinto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego N Bastias
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile
| | - Carolayn N Oberg-Bravo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile
| | - Robert Rojas
- Centro de Genómica y Bioinformática, Universidad Mayor, Santiago, Chile
| | - Sebastián E Illanes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile.,Department of Obstetrics and Gynecology, Clínica Dávila, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Abel E Vasquez
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile. .,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile. .,Facultad de Medicina y Ciencia, Universidad San Sebastián, Providencia, Santiago, Chile. .,Present address. Instituto de Salud Pública de Chile, Av. Marathon, Ñuñoa, 1000, Santiago, Chile.
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210
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Pan-GWAS of Streptococcus agalactiae Highlights Lineage-Specific Genes Associated with Virulence and Niche Adaptation. mBio 2020; 11:mBio.00728-20. [PMID: 32518186 PMCID: PMC7373188 DOI: 10.1128/mbio.00728-20] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
GBS is a leading cause of mortality in newborn babies in high- and low-income countries worldwide. Different strains of GBS are characterized by different degrees of virulence, where some are harmlessly carried by humans or animals and others are much more likely to cause disease.
The genome sequences of almost 2,000 GBS samples isolated from both animals and humans in high- and low- income countries were analyzed using a pan-genome-wide association study approach. This allowed us to identify 279 genes which are associated with different lineages of GBS, characterized by a different virulence and preferred host. Additionally, we propose that the GBS now carried in humans may have first evolved in animals before expanding clonally once adapted to the human host.
These findings are essential to help understand what is causing GBS disease and how the bacteria have evolved and are transmitted. Streptococcus agalactiae (group B streptococcus; GBS) is a colonizer of the gastrointestinal and urogenital tracts, and an opportunistic pathogen of infants and adults. The worldwide population of GBS is characterized by clonal complexes (CCs) with different invasive potentials. CC17, for example, is a hypervirulent lineage commonly associated with neonatal sepsis and meningitis, while CC1 is less invasive in neonates and more commonly causes invasive disease in adults with comorbidities. The genetic basis of GBS virulence and the extent to which different CCs have adapted to different host environments remain uncertain. We have therefore applied a pan-genome-wide association study (GWAS) approach to 1,988 GBS strains isolated from different hosts and countries. Our analysis identified 279 CC-specific genes associated with virulence, disease, metabolism, and regulation of cellular mechanisms that may explain the differential virulence potential of particular CCs. In CC17 and CC23, for example, we have identified genes encoding pilus, quorum-sensing proteins, and proteins for the uptake of ions and micronutrients which are absent in less invasive lineages. Moreover, in CC17, carriage and disease strains were distinguished by the allelic variants of 21 of these CC-specific genes. Together our data highlight the lineage-specific basis of GBS niche adaptation and virulence. The genome sequences of almost 2,000 GBS samples isolated from both animals and humans in high- and low- income countries were analyzed using a pan-genome-wide association study approach. This allowed us to identify 279 genes which are associated with different lineages of GBS, characterized by a different virulence and preferred host. Additionally, we propose that the GBS now carried in humans may have first evolved in animals before expanding clonally once adapted to the human host. These findings are essential to help understand what is causing GBS disease and how the bacteria have evolved and are transmitted.
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Group B Streptococcus colonization rate and serotype distribution among pregnant women and their newborns at Adama Hospital Medical College, Ethiopia. Sci Rep 2020; 10:9301. [PMID: 32518331 PMCID: PMC7283305 DOI: 10.1038/s41598-020-66474-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/22/2020] [Indexed: 11/08/2022] Open
Abstract
Rectovaginal area of pregnant women can be colonized transiently with group B Streptococcus (GBS) without causing disease. The bacteria can be transmitted to the newborn before and during birth and cause early-onset neonatal disease. In this study, we aimed to determine the GBS colonization rate among pregnant women before delivery and their newborns and serotypes distribution of GBS. Two hundred-eighty pregnant women along with their newborns were screened for GBS colonization from June 2014 to October 2014 at Adama Hospital Medical College. Rectovaginal swabs from pregnant women before delivery and specimen from nasal area, external ear, umbilical cord and throat of newborns were collected and cultured. The serotyping of GBS was performed by using serotype-specific antisera. To collect sociodemographic and clinical data we employed a structured questionnaire. GBS colonization among pregnant women and their newborns were 13.2% 95% CI (8.9-17.5) and 7.4% 95% CI (4.6-10.6). Out of 37 GBS strains recovered from pregnant women, the prevalent serotypes were Ia 6(16.2%), Ib 8(21.6%), II 10(27%), III 3(8.1%), and V 8(21.6%). Out of 21 GBS strains recovered from newborns, prevalent serotypes were Ia 3(14.3%), Ib 6(28.6%), II 6(28.6%), III 4(19%), and V 1(4.8%). This study indicated the existence of primary risk factors for neonatal disease in Adama area. Serotype II was the common serotype detected in this study which is followed by serotype Ib, Ia, and V. As colonizing GBS serotypes could cause invasive disease among newborns, vaccine formulation which includes serotype II, Ia, V, Ib, and III can prevent of invasive disease caused by GBS in the study area.
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Venkatesh KK, Vladutiu CJ, Strauss RA, Thorp JM, Stringer JSA, Stamilio DM, Hughes BL, Dotters-Katz S. Association Between Maternal Obesity and Group B Streptococcus Colonization in a National U.S. Cohort. J Womens Health (Larchmt) 2020; 29:1507-1512. [PMID: 32364822 DOI: 10.1089/jwh.2019.8139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the association between maternal obesity as measured by prepregnancy body mass index (BMI) and group B streptococcus (GBS) colonization. Methods: We conducted a secondary analysis from the Consortium on Safe Labor Study (CSL) in the United States cohort study (2002-2008). Pregnant women with deliveries at ≥37 weeks of gestation who attempted labor were included (115,070 assessed deliveries). The association between maternal prepregnancy BMI, categorized as normal weight or below (<25 kg/m2), overweight (25 to <30 kg/m2), class I obesity (30 to <35 kg/m2), class II obesity (35 to <40 kg/m2), and class III obesity (≥40 kg/m2), and GBS colonization was modeled using logistic regression with generalized estimating equations. Models adjusted for maternal age, parity, race, pregestational diabetes, insurance status, study site/region, and year of delivery. Results: The overall prevalence of GBS colonization was 20.5% (23,625/115,070), which increased with rising maternal BMI, normal weight 19.3% (13,543/70,098), overweight 20.8% (5,353/25,733), class I obesity 23.0% (2,596/11,275), class II obesity 26.1% (1,270/4,850), and class III obesity 27.7% (863/3,114). In multivariable analysis, increasing maternal obesity severity was associated with higher odds of GBS colonization, namely overweight (adjusted odds ratio [AOR]: 1.09, 95% confidence interval [CI]: 1.05-1.13), class I obesity (AOR: 1.20, 95% CI: 1.15-1.26), class II obesity (AOR: 1.42, 95% CI: 1.33-1.51), and class III obesity (AOR: 1.50; 95% CI: 1.38-1.62) compared with normal weight. In secondary analyses, these associations persisted when stratified by maternal race. Conclusions: In a national U.S. sample, increasing maternal obesity severity as assessed by prepregnancy BMI was associated with a higher likelihood of maternal GBS colonization during pregnancy.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert A Strauss
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John M Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeffrey S A Stringer
- Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David M Stamilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brenna L Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Sarah Dotters-Katz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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Hayes K, O'Halloran F, Cotter L. A review of antibiotic resistance in Group B Streptococcus: the story so far. Crit Rev Microbiol 2020; 46:253-269. [PMID: 32363979 DOI: 10.1080/1040841x.2020.1758626] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Group B Streptococcus (GBS) is the leading cause of neonatal disease worldwide, and invasive disease in adults is becoming more prevalent. Currently, some countries adopt an intrapartum antibiotic prophylaxis regime to help prevent the transmission of GBS from mother to neonate during delivery. This precaution has reduced the incidence of GBS-associated early-onset disease; however, rates of late-onset disease and stillbirths associated with GBS infections remain unchanged. GBS is still recognized as being universally susceptible to beta-lactam antibiotics; however, there have been reports of reduced susceptibility to beta-lactams, including penicillin, in some countries. Resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst GBS, with several countries noting increased resistance rates in recent years. Moreover, resistance to other antibiotic classes, such as fluoroquinolones and aminoglycosides, also continues to rise. In instances where patients are allergic to penicillin and second-line antibiotics are ineffective, vancomycin is administered. While vancomycin, a last resort antibiotic, still remains largely effective, there have been two documented cases of vancomycin resistance in GBS. This review provides a comprehensive analysis of the prevalence of antibiotic resistance in GBS and outlines the specific resistance mechanisms identified in GBS isolates to date.
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Paveenkittiporn W, Ungcharoen R, Kerdsin A. Streptococcus agalactiae infections and clinical relevance in adults, Thailand. Diagn Microbiol Infect Dis 2020; 97:115005. [DOI: 10.1016/j.diagmicrobio.2020.115005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/02/2020] [Accepted: 01/26/2020] [Indexed: 01/13/2023]
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Hasperhoven GF, Al‐Nasiry S, Bekker V, Villamor E, Kramer BWW. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis. BJOG 2020; 127:680-691. [PMID: 31913562 PMCID: PMC7187465 DOI: 10.1111/1471-0528.16085] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), whereas others employ risk-based protocols. OBJECTIVES To compare the effectiveness of screening-based versus risk-based protocols in preventing EOGBS disease. SEARCH STRATEGY Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based. SELECTION CRITERIA Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk-based protocols with each other or with controls. DATA COLLECTION AND ANALYSIS Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects. MAIN RESULTS Seventeen eligible studies were included. In this meta-analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk-based protocols (ten studies, RR 0.43, 95% CI 0.32-0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). CONCLUSIONS Screening-based protocols were associated with lower incidences of EOGBS disease compared with risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. TWEETABLE ABSTRACT Meta-analysis: general screening is associated with lower rates of early-onset group B strep. neonatal sepsis compared with risk-based protocols.
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Affiliation(s)
- GF Hasperhoven
- Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - S Al‐Nasiry
- Department of Gyneacology and ObstetricsMaastricht University Medical CentreMaastrichtthe Netherlands
| | - V Bekker
- Department of PaediatricsLeiden University Medical CentreLeidenthe Netherlands
| | - E Villamor
- Department of PaediatricsMaastricht University Medical CentreMaastrichtthe Netherlands
| | - BWW Kramer
- Department of PaediatricsMaastricht University Medical CentreMaastrichtthe Netherlands
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Carreras-Abad C, Ramkhelawon L, Heath PT, Le Doare K. A Vaccine Against Group B Streptococcus: Recent Advances. Infect Drug Resist 2020; 13:1263-1272. [PMID: 32425562 PMCID: PMC7196769 DOI: 10.2147/idr.s203454] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
Group B streptococcus (GBS) causes a high burden of neonatal and infant disease globally. Implementing a vaccine for pregnant women is a promising strategy to prevent neonatal and infant GBS disease and has been identified as a priority by the World Health Organisation (WHO). GBS serotype-specific polysaccharide – protein conjugate vaccines are at advanced stages of development, but a large number of participants would be required to undertake Phase III clinical efficacy trials. Efforts are therefore currently focused on establishing serocorrelates of protection in natural immunity studies as an alternative pathway for licensure of a GBS vaccine, followed by Phase IV studies to evaluate safety and effectiveness. Protein vaccines are in earlier stages of development but are highly promising as they might confer protection irrespective of serotype. Further epidemiological, immunological and health economic studies are required to enable the vaccine to reach its target population as soon as possible.
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Affiliation(s)
- Clara Carreras-Abad
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK.,Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laxmee Ramkhelawon
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK.,Pathogen Immunity Group, Public Health England, Porton Down,UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
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Patras KA, Coady A, Babu P, Shing SR, Ha AD, Rooholfada E, Brandt SL, Geriak M, Gallo RL, Nizet V. Host Cathelicidin Exacerbates Group B Streptococcus Urinary Tract Infection. mSphere 2020; 5:e00932-19. [PMID: 32321824 PMCID: PMC7178553 DOI: 10.1128/msphere.00932-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS) causes frequent urinary tract infection (UTI) in susceptible populations, including individuals with type 2 diabetes and pregnant women; however, specific host factors responsible for increased GBS susceptibility in these populations are not well characterized. Here, we investigate cathelicidin, a cationic antimicrobial peptide, known to be critical for defense during UTI with uropathogenic Escherichia coli (UPEC). We observed a loss of antimicrobial activity of human and mouse cathelicidins against GBS and UPEC in synthetic urine and no evidence for increased cathelicidin resistance in GBS urinary isolates. Furthermore, we found that GBS degrades cathelicidin in a protease-dependent manner. Surprisingly, in a UTI model, cathelicidin-deficient (Camp-/-) mice showed decreased GBS burdens and mast cell recruitment in the bladder compared to levels in wild-type (WT) mice. Pharmacologic inhibition of mast cells reduced GBS burdens and histamine release in WT but not Camp-/- mice. Streptozotocin-induced diabetic mice had increased bladder cathelicidin production and mast cell recruitment at 24 h postinfection with GBS compared to levels in nondiabetic controls. We propose that cathelicidin is an important immune regulator but ineffective antimicrobial peptide against GBS in urine. Combined, our findings may in part explain the increased frequency of GBS UTI in diabetic and pregnant individuals.IMPORTANCE Certain populations such as diabetic individuals are at increased risk for developing urinary tract infections (UTI), although the underlying reasons for this susceptibility are not fully known. Additionally, diabetics are more likely to become infected with certain types of bacteria, such as group B Streptococcus (GBS). In this study, we find that an antimicrobial peptide called cathelicidin, which is thought to protect the bladder from infection, is ineffective in controlling GBS and alters the type of immune cells that migrate to the bladder during infection. Using a mouse model of diabetes, we observe that diabetic mice are more susceptible to GBS infection even though they also have more infiltrating immune cells and increased production of cathelicidin. Taken together, our findings identify this antimicrobial peptide as a potential contributor to increased susceptibility of diabetic individuals to GBS UTI.
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Affiliation(s)
- Kathryn A Patras
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Alison Coady
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Priyanka Babu
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Samuel R Shing
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Albert D Ha
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Emma Rooholfada
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Stephanie L Brandt
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | | | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, La Jolla, California, USA
| | - Victor Nizet
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
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218
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Wang M, Keighley C, Watts M, Plymoth M, McGee TM. Preventing Early-Onset Group B Streptococcus neonatal infection and reducing antibiotic exposure using a rapid PCR test in term prelabour rupture of membranes. Aust N Z J Obstet Gynaecol 2020; 60:753-759. [PMID: 32291755 DOI: 10.1111/ajo.13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/07/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND How best to target intrapartum antibiotic prophylaxis (IAP) to minimise both Early-Onset Group B Streptococcus (EOGBS) neonatal infection and maternal/fetal antibiotic exposure is uncertain, with both routine-screening and risk-factor approaches available. AIMS This retrospective cohort study was undertaken to examine the outcomes of a hybrid risk-and-screen approach to EOGBS prevention using GBS polymerase chain reaction (PCR). The target population was women with term prelabour rupture of membranes (TermPROM) having the risk factor of prolonged rupture of membranes (ROM) ≥18 h. MATERIALS AND METHODS Non-labouring TermPROM women had rapid GBS PCR testing at presentation. GBS screen-positive women proceeded to induction of labour and received IAP. GBS screen-negative women were allowed home to await spontaneous labour and not given IAP regardless of duration of ROM, unless other risk factors developed. For all other women, the risk-factor approach was followed. RESULTS From 2009 to 2018, there were 20 cases of culture-positive EOGBS, a rate of 0.36/1000 live births (95% CI 0.22-0.56/1000), comparable to other recent reports. Over 2010-2018 when laboratory data were available, 1120 TermPROM women with ROM ≥18 h avoided antibiotics because they were GBS PCR-negative (2.3% of all births, 3.6% of vaginal births) while 338 TermPROM women with ROM <18 h received targeted antibiotics for being GBS-positive. No cases of EOGBS occurred in TermPROM women, those with ROM ≥18 h, or due to protocol-compliance failure. CONCLUSIONS A hybrid approach involving risk-factor-based IAP and intrapartum GBS PCR screening of non-labouring TermPROM women delivers acceptably low rates of EOGBS while minimising and better targeting antibiotic exposure.
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Affiliation(s)
- Mandy Wang
- Department of Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin Keighley
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology Public Health, Institute for Clinical Pathology and Medical Research-New South Wales Health Pathology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Matthew Watts
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology Public Health, Institute for Clinical Pathology and Medical Research-New South Wales Health Pathology, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - Therese M McGee
- Department of Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Beran J, Leroux-Roels G, Van Damme P, de Hoon J, Vandermeulen C, Al-Ibrahim M, Johnson C, Peterson J, Baker S, Seidl C, Dreisbach A, Karsten A, Corsaro B, Henry O, Lattanzi M, Bebia Z. Safety and immunogenicity of fully liquid and lyophilized formulations of an investigational trivalent group B streptococcus vaccine in healthy non-pregnant women: Results from a randomized comparative phase II trial. Vaccine 2020; 38:3227-3234. [DOI: 10.1016/j.vaccine.2020.02.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 01/10/2023]
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Diaz-Dinamarca DA, Hernandez C, Escobar DF, Soto DA, Muñoz GA, Badilla JF, Manzo RA, Carrión F, Kalergis AM, Vasquez AE. Mucosal Vaccination with Lactococcus lactis-Secreting Surface Immunological Protein Induces Humoral and Cellular Immune Protection against Group B Streptococcus in a Murine Model. Vaccines (Basel) 2020; 8:vaccines8020146. [PMID: 32224855 PMCID: PMC7349291 DOI: 10.3390/vaccines8020146] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/22/2022] Open
Abstract
Group B Streptococcus (GBS) is the primary etiological agent of sepsis and meningitis in newborns and is associated with premature birth and stillbirth. The development of a licensed vaccine is one of the pending challenges for the World Health Organization. Previously, we showed that oral immunization with surface immune protein (SIP) decreases vaginal colonization of GBS and generates functional opsonizing antibodies, which was determined by opsonophagocytic assays (OPA) in vitro. We also showed that the protein has an adjuvant vaccine profile. Therefore, an oral vaccine based on SIP may be an attractive alternative to employ in the development of new vaccines against GBS. Lactococcus lactis is a highlighted oral vaccine probiotic inducer of the mucosal immune response. This bacterium could serve as an antigen-delivering vehicle for the development of an edible vaccine and has been used in clinical trials. In this study, we showed that an oral vaccine with a recombinant L. lactis strain secreting SIP from GBS (rL. lactis-SIP) can induce protective humoral and cellular immunity in an experimental model of GBS vaginal colonization in C57BL/6 mice. Mice immunized with rL. lactis-SIP were protected against clinical symptoms and bacterial colonization after GBS vaginal colonization. Our rL. lactis-SIP vaccine also induces an increase of immunoglobulin G (IgG) and immunoglobulin A (IgA) specifically against SIP. The adoptive transfer of serum from vaccinated mice to naïve mice generated protection against GBS vaginal colonization. Moreover, the rL.lactis-SIP strain induces the activation of SIP-specific T cells, which could decrease GBS vaginal colonization and generate protective antibodies when transferred to other mice. Our experimental observations strongly support the notion that rL. lactis-SIP induces protective humoral and cellular immunity and could be considered as a novel alternative in the development of vaccines for GBS.
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Affiliation(s)
- Diego A. Diaz-Dinamarca
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
| | - Carlos Hernandez
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
- Millennium Institute of Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8380453, Chile;
- Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas y Farmaceuticas, Universidad de Chile, Independencia, Santiago 8380492, Chile
| | - Daniel F. Escobar
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
| | - Daniel A. Soto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
| | - Guillermo A. Muñoz
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
- Millennium Institute of Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8380453, Chile;
| | - Jesús F. Badilla
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
- Millennium Institute of Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8380453, Chile;
- Escuela de Biotecnología, Facultad de Ciencias, Universidad Santo Tomas, Santiago 8320000, Chile
| | - Ricardo A. Manzo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
| | - Flavio Carrión
- Programa de Inmunología Traslacional, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7610315, Chile;
| | - Alexis M. Kalergis
- Millennium Institute of Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago 8380453, Chile;
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile
| | - Abel E. Vasquez
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago 780050, Chile; (D.A.D.-D.); (C.H.); (D.F.E.); (D.A.S.); (G.A.M.); (J.F.B.); (R.A.M.)
- Escuela de Biotecnología, Facultad de Ciencias, Universidad Santo Tomas, Santiago 8320000, Chile
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Providencia, Santiago 8320000, Chile
- Correspondence: ; Tel.: +562-2575-5513
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Shipitsyna E, Shalepo K, Zatsiorskaya S, Krysanova A, Razinkova M, Grigoriev A, Savicheva A. Significant shifts in the distribution of vaccine capsular polysaccharide types and rates of antimicrobial resistance of perinatal group B streptococci within the last decade in St. Petersburg, Russia. Eur J Clin Microbiol Infect Dis 2020; 39:1487-1493. [DOI: 10.1007/s10096-020-03864-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 01/31/2023]
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Dilrukshi GN, Kottahachchi J, Dissanayake DMBT, Pathiraja RP, Karunasingha J, Sampath MKA, Vidanage UA, Fernando SSN. Group B Streptococcus colonisation and their antimicrobial susceptibility among pregnant women attending antenatal clinics in tertiary care hospitals in the Western Province of Sri Lanka. J OBSTET GYNAECOL 2020; 41:1-6. [PMID: 32172646 DOI: 10.1080/01443615.2020.1716313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The proportion of Group B Streptococcus (GBS) colonisation in pregnant women >35 weeks of gestation was 18% and 49% by culture and real-time PCR respectively in selected hospitals from the Western Province of Sri Lanka. A Descriptive cross-sectional study was conducted from January to April 2019. Two low vaginal and rectal swabs were collected from 100 pregnant women. Identification of GBS was done by culture and real-time PCR. GBS isolates were found to be sensitive to penicillin, ampicillin, cefotaxime, vancomycin, while 5 and 4 isolates out of 18 were resistant to erythromycin and clindamycin, respectively. Further, there was a significant association between GBS colonisation and a history of vaginal discharge and unemployment.IMPACT STATEMENTWhat is already known on this subject? Prevalence of GBS colonisation in the vagina and rectum of pregnant women in developing countries ranges from 8.5% to 22%. The Conventional method of culture has been considered the gold standard for diagnosis, however, the culture method does not give positive results for all cases of GBS. Polymerase chain reaction (PCR) has been found to be more sensitive for the detection of GBS than culture. In Sri Lanka, ante-natal screening for GBS is not practiced as the prevalence of GBS is still unlcear due to non-availably of data. Only a few scattered studies have been conducted using culture in Sri Lanka. Thus there is an urgent need to determine the magnitude of the GBS colonisers of ante-natal women in order to set up guidelines for screening and management of GBS.What do the results of this study add? In this study, the overall GBS colonisation rate which was detected using both culture and PCR was 50% in Western Province of Sri Lanka. That was a high figure when compared to the figures which were detected previously in Sri Lanka using only conventional culture methods. The risk factors for GBS colonisation were found to have a significant relationship with the history of abnormal vaginal discharge. Further, it was found that when Candida species coexisted with GBS, the existence of GBS was enhanced. Penicillin remains the antibiotic of choice for GBS.What are the implications of these findings for clinical practice and/or further research? This study emphasises the importance of establishing national policies for screening of pregnant women of >35 weeks of gestation to reduce the risk of neonatal infection. Further, it gives an insight into the options of antibiotics that can be used for treatment of these GBS colonisers from Sri Lanka.
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Affiliation(s)
- G N Dilrukshi
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.,School of Medical Laboratory Technology, Medical Research Institute, Colombo, Sri Lanka
| | - J Kottahachchi
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - D M B T Dissanayake
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - R P Pathiraja
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | | | - M K A Sampath
- Center for Kidney Research, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - U A Vidanage
- Castle Street Hospital for Women, Colombo, Sri Lanka
| | - S S N Fernando
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
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Cost Effectiveness of Latest Recommendations for Group B Streptococci Screening in the United States. Obstet Gynecol 2020; 135:789-798. [PMID: 32168204 DOI: 10.1097/aog.0000000000003649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether group B streptococci (GBS) screening using the 2010 guideline (screening at 35 0/7-37 6/7 weeks of gestation) compared with the 2019 guideline (screening at 36 0/7-37 6/7 weeks of gestation with re-screening of women with GBS-negative results 5 weeks later) was more cost effective. METHODS We constructed a decision-analysis model to compare the outcome of GBS early-onset disease in a hypothetical cohort of 3,614,049 women at 35 0/7 weeks of gestation or greater (the number of live births in 2017 excluding births based on population frequency from 23 to 34 weeks of gestation, women with GBS bacteriuria during the current pregnancy, and those with a history of a previous neonate with GBS disease). We took both a health care and societal perspective and all costs were expressed in 2017 U.S. dollars. Effectiveness was based on neonatal quality-adjusted life years (QALYs) gained. An incremental cost-effectiveness ratio was estimated with a willingness to pay threshold set at $100,000/QALY. All model inputs were derived from the literature. One-way probability and cost sensitivity analysis were performed to investigate model assumptions. RESULTS Screening at 36 0/7-37 6/7 weeks of gestation with re-screening of women with GBS-negative results if 5 weeks passed from culture to delivery resulted in a 6% increase in neonatal QALYs gained (2,162 vs 2,037), 12% fewer cases of neonatal death (30 vs 34), and a 10% estimated reduction in total societal health care expenditures related to GBS early-onset disease ($639 million vs $707 million) when compared with the 2010 strategy of only screening at 35 0/7-37 6/7 weeks of gestation. The 2019 approach was cost effective, with an incremental cost-effectiveness ratio of $43,205 per neonatal QALY gained. CONCLUSION Screening at 36 0/7-37 6/7 weeks of gestation with a 5-week re-screening for women with GBS-negative results is more cost effective than past strategies used in the United States.
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Buurman ET, Timofeyeva Y, Gu J, Kim JH, Kodali S, Liu Y, Mininni T, Moghazeh S, Pavliakova D, Singer C, Singh S, Handke LD, Lotvin J, Prasad AK, Scully IL, Donald RGK, Jansen KU, Anderson AS. A Novel Hexavalent Capsular Polysaccharide Conjugate Vaccine (GBS6) for the Prevention of Neonatal Group B Streptococcal Infections by Maternal Immunization. J Infect Dis 2020; 220:105-115. [PMID: 30778554 PMCID: PMC6548902 DOI: 10.1093/infdis/jiz062] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/14/2019] [Indexed: 12/20/2022] Open
Abstract
Background Group B streptococcus (GBS) causes serious diseases in newborn infants, often resulting in lifelong neurologic impairments or death. Prophylactic vaccination of pregnant women prior to delivery could provide comprehensive protection, as early onset and late-onset disease and maternal complications potentially could be addressed. Methods Capsular polysaccharide conjugate vaccine GBS6 was designed using surveillance data yielded by whole-genome sequencing of a global collection of recently recovered GBS isolates responsible for invasive neonatal GBS disease. Capsular polysaccharides were isolated, oxidized using sodium periodate, and conjugated to CRM197 by reductive amination in dimethyl sulfoxide. Immune responses in mice and rhesus macaques were measured in a multiplex Luminex immunoglobulin G (IgG) assay and opsonophagocytic activity assays. Results The optimized conjugates were immunogenic, alone and in combination, in mice and rhesus macaques, inducing IgG antibodies that mediated opsonophagocytic killing. Active immunization of murine dams with GBS6 prior to mating resulted in serotype-specific protection of pups from a lethal challenge with GBS. Protection following passive administration of serotype-specific IgG monoclonal antibodies to dams demonstrated conclusively that anticapsular polysaccharide IgG alone is sufficient for protection. Conclusions The findings support the ongoing clinical evaluation of maternal GBS6 vaccination as a potential alternative method to prevent GBS disease in infants.
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Affiliation(s)
- Ed T Buurman
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | | | - Jianxin Gu
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Jin-Hwan Kim
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Srinivas Kodali
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Yongdong Liu
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Terri Mininni
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Soraya Moghazeh
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | | | | | - Suddham Singh
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Luke D Handke
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | - Jason Lotvin
- Vaccine Research and Development, Pfizer, Pearl River, New York
| | | | - Ingrid L Scully
- Vaccine Research and Development, Pfizer, Pearl River, New York
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Hanh TQ, Van Du V, Hien PT, Chinh DD, Loi CB, Dung NM, Anh DN, Anh TTK. Prevalence and capsular type distribution of group B Streptococcus isolated from vagina of pregnant women in Nghe An province, Vietnam. IRANIAN JOURNAL OF MICROBIOLOGY 2020; 12:11-17. [PMID: 32322374 PMCID: PMC7163037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Identification of GBS serotypes provides helpful information for appropriate the development of suitable vaccines; however, no reports from Vietnam have been published. This study has been performed to find the prevalence and serotypes of group B Streptococcus isolated from vagina of pregnant women in Nghe An province, Vietnam. MATERIALS AND METHODS Vaginal swabs were collected from pregnant women at 35-37 weeks of gestation at the Nghe An Obstetrics and Pediatrics Hospital, Vietnam between May 2018 and July 2019. The swabs were cultured on 5% sheep blood agar for isolation of GBS. All isolates were identified using the Gram staining, CAMP test and specific PCR. GBS strains were serotyped using the multiplex PCR assays. RESULTS The prevalence of vaginal GBS colonization was 9.20% of 750 participants. Among the isolates, serotypes III (39.13%) and V (31.89%) were the most frequent, followed by serotypes Ia (11.59%), VI (11.59%), Ib (2.90%), II (1.45%) and VII (1.45%), respectively. Serotypes IV, VIII and IX were not found. CONCLUSION The prevalence of GBS in the Nghe An province of central Vietnam was similar to reports from other parts of the world. The predominat GBS serotypes (III, V, Ia and VI) were slightly different from those previously described from other regions around the world. The high frequency of serotype VI was a notable feature of the strains from pregnant women in Vietnam.
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Affiliation(s)
- Tran Quang Hanh
- Department of Obstetrics, Nghe An Obstetrics and Pediatrics Hospital, Nghe An, Vietnam
| | - Vu Van Du
- Department of Treatment on Demand, National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam
| | - Pham Thu Hien
- Department of Treatment on Demand, National Hospital of Pediatrics, Hanoi, Vietnam
| | - Duong Dinh Chinh
- Department of Neurology, Nghe An Friendship General Hospital, Nghe An, Vietnam
| | - Cao Ba Loi
- Department of Science and Training, National Institute of Malaria Parasitology and Entomology, Hanoi, Vietnam
| | - Nguyen Manh Dung
- Department of Anesthesiology and Critical Care, 108 Military Centre Hospital, Hanoi, Vietnam
| | - Do Ngoc Anh
- Department of Medical Parasitology, Military Medical University, Hanoi, Vietnam,Corresponding author: Do Ngoc Anh, PhD, Department of Medical Parasitology, Military Medical University, Hanoi, Vietnam. Tel: +84-989255773, Fax: +84-436883994,
| | - Tran Thi Kieu Anh
- Department of Paediatric, Vinh Medical University, Nghe An, Vietnam,Corresponding author: Tran Thi Kieu Anh, PhD, Department of Paediatric, Vinh Medical University, Nghe An, Vietnam. Tel: +84-912584133, Fax: +84-2383842163,
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226
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Tumuhamye J, Steinsland H, Tumwine JK, Namugga O, Mukunya D, Bwanga F, Sommerfelt H, Nankabirwa V. Vaginal colonisation of women in labour with potentially pathogenic bacteria: a cross sectional study at three primary health care facilities in Central Uganda. BMC Infect Dis 2020; 20:98. [PMID: 32005177 PMCID: PMC6995194 DOI: 10.1186/s12879-020-4821-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Potentially pathogenic bacteria that colonise the lower genital tract of women in labour can be passed to the baby during birth. While many babies become colonised with these bacteria after delivery, a few develop neonatal infections. The lower genital tract is a reservoir for potential pathogens and a source of infection for neonates. We determined the prevalence of vaginal colonisation of potentially pathogenic bacteria among women in labour in Central Uganda and identified potential risk factors associated with this colonisation. METHODS We conducted a cross sectional study at three primary health care facilities and collected vaginal swabs from HIV-1 negative women in labour. Specimens were cultured on different selective microbiological media, and biochemical tests were used to classify bacterial isolates on the species level. Multivariable logistic regression analyses were used to estimate the association between relevant exposures and colonisation with potentially pathogenic bacteria. RESULTS We recruited 1472 women in labour whose mean age was 24.6 years (standard deviation [SD] 4.9). Of these, 955 (64.9%; 95% Confidence Interval [CI] 62.4, 67%) were vaginally colonised with at least one potentially pathogenic bacterial species. The most commonly isolated species were Escherichia coli (n = 508; 34.5%), Klebsiella pneumoniae (n = 144; 9.8%) and Staphylococcus aureus (n = 121; 8.2%). Results from exploratory multivariable regression analyses indicated that having had ≥5 previous pregnancies (adjusted odds ratio [aOR] 0.59; 95% CI 0.35, 0.97) or being ≥30 years old (aOR 1.52; 95% CI 1.03, 2.23) could be associated with vaginal colonisation with any potentially pathogenic bacteria, as well as with vaginal colonisation with S. aureus (aOR 0.33; 95% CI 0.12, 0.88, and aOR 2.17; 95% CI 1.17, 4.00, respectively). Possession of domestic animals in a household (aOR 0.57; 95% CI 0.35, 0.92) could be associated with vaginal colonisation with E. coli. CONCLUSIONS Two-thirds of HIV-1 negative women in labour were vaginally colonised by potentially pathogenic bacteria, mainly E. coli, K. pneumoniae, and S. aureus.
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Affiliation(s)
- Josephine Tumuhamye
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Hans Steinsland
- CISMAC, Centre for International Health, Department of Global Public Health and Primary Care and Department of Biomedicine, University of Bergen, Bergen, Norway
| | - James K Tumwine
- Department of Paediatric and Child Health, Makerere University, Kampala, Uganda
| | - Olive Namugga
- CISMAC, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - David Mukunya
- CISMAC, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Freddie Bwanga
- Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
| | - Halvor Sommerfelt
- CISMAC, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Victoria Nankabirwa
- CISMAC, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Epidemiology and Biostatics school of Public Health, Makerere University, Kampala, Uganda
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A'Hearn-Thomas B, Khatami A, Randis TM, Vurayai M, Mokomane M, Arscott-Mills T, Banda FM, Mazhani T, Lepere T, Gaolebale P, Nchingane S, Chamby A, Gegick M, Suzman E, Steenhoff AP, Ratner AJ. High Rate of Serotype V Streptococcus agalactiae Carriage in Pregnant Women in Botswana. Am J Trop Med Hyg 2020; 100:1115-1117. [PMID: 30915949 DOI: 10.4269/ajtmh.18-0847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Maternal rectovaginal colonization is the major risk factor for early-onset neonatal sepsis due to Group B Streptococcus (GBS), a major cause of early life morbidity and mortality. Transmission generally occurs perinatally from colonized mothers to infants. Vaccines targeting a subset of GBS serotypes are under development, but GBS epidemiology remains poorly understood in many African nations. We performed a cross-sectional study of GBS colonization among pregnant women at two sites in Botswana, a country with minimal prior GBS carriage data. We found a rectovaginal colonization rate of 19%, comparable with studies in other regions; however, we also noted a striking predominance of serotype V (> 45% of strains). Although further studies are required to delineate the burden of invasive GBS disease in Botswana and the generalizability of type V epidemiology, these data provide a useful baseline for understanding the potential local impact of GBS prevention strategies, including vaccines.
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Affiliation(s)
- Brady A'Hearn-Thomas
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Ameneh Khatami
- Department of Microbiology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Tara M Randis
- Department of Microbiology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
| | | | | | - Tonya Arscott-Mills
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Children's Hospital of Philadelphia Department of Pediatrics, Botswana-UPenn Partnership and Global Health Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis M Banda
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tiny Mazhani
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | | | - Anna Chamby
- Department of Microbiology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Margaret Gegick
- Department of Microbiology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Evan Suzman
- Department of Microbiology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Andrew P Steenhoff
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Children's Hospital of Philadelphia Department of Pediatrics, Botswana-UPenn Partnership and Global Health Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam J Ratner
- Department of Microbiology, New York University School of Medicine, New York, New York.,Department of Pediatrics, New York University School of Medicine, New York, New York
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228
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Armistead B, Whidbey C, Iyer LM, Herrero-Foncubierta P, Quach P, Haidour A, Aravind L, Cuerva JM, Jaspan HB, Rajagopal L. The cyl Genes Reveal the Biosynthetic and Evolutionary Origins of the Group B Streptococcus Hemolytic Lipid, Granadaene. Front Microbiol 2020; 10:3123. [PMID: 32038561 PMCID: PMC6985545 DOI: 10.3389/fmicb.2019.03123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/24/2019] [Indexed: 01/31/2023] Open
Abstract
Group B Streptococcus (GBS) is a β-hemolytic, Gram-positive bacterium that commonly colonizes the female lower genital tract and is associated with fetal injury, preterm birth, spontaneous abortion, and neonatal infections. A major factor promoting GBS virulence is the β-hemolysin/cytolysin, which is cytotoxic to several host cells. We recently showed that the ornithine rhamnolipid pigment, Granadaene, produced by the gene products of the cyl operon, is hemolytic. Here, we demonstrate that heterologous expression of the GBS cyl operon conferred hemolysis, pigmentation, and cytoxicity to Lactococcus lactis, a model non-hemolytic Gram-positive bacterium. Similarly, pigment purified from L. lactis is hemolytic, cytolytic, and identical in structure to Granadaene extracted from GBS, indicating the cyl operon is sufficient for Granadaene production in a heterologous host. Using a systematic survey of phyletic patterns and contextual associations of the cyl genes, we identify homologs of the cyl operon in physiologically diverse Gram-positive bacteria and propose undescribed functions of cyl gene products. Together, these findings bring greater understanding to the biosynthesis and evolutionary foundations of a key GBS virulence factor and suggest that such potentially toxic lipids may be encoded by other bacteria.
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Affiliation(s)
- Blair Armistead
- Department of Global Health, University of Washington, Seattle, WA, United States.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Christopher Whidbey
- Department of Global Health, University of Washington, Seattle, WA, United States.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Lakshminarayan M Iyer
- Computational Biology Branch, National Center for Biotechnology Information, National Institutes of Health, Bethesda, MD, United States
| | | | - Phoenicia Quach
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Ali Haidour
- Department of Organic Chemistry, University of Granada, Granada, Spain
| | - L Aravind
- Computational Biology Branch, National Center for Biotechnology Information, National Institutes of Health, Bethesda, MD, United States
| | | | - Heather B Jaspan
- Department of Global Health, University of Washington, Seattle, WA, United States.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Lakshmi Rajagopal
- Department of Global Health, University of Washington, Seattle, WA, United States.,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
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229
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Gizachew M, Tiruneh M, Moges F, Adefris M, Tigabu Z, Tessema B. Molecular characterization of Streptococcus agalactiae isolated from pregnant women and newborns at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Infect Dis 2020; 20:35. [PMID: 31931732 PMCID: PMC6958622 DOI: 10.1186/s12879-020-4776-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background Streptococcus agalctiae (Group B Streptococcus, GBS) is a perinatal pathogen and a leading cause of neonatal infections worldwide. Serotype, sequence type, clonality, antibiotic resistance genes and surface protein profiles of GBS are scarce in Ethiopia, a reason that this study was planned to investigate. . Methods Sixteen colonizing GBS isolates obtained from recto-vaginal swabs of pregnant women and body surfaces of newborns were further analyzed. Minimum inhibitory concentration (MIC) test, and whole genome sequence (WGS) methods were done for antibiotic susceptibility test, and molecular characterization of the isolates. Results All the GBS isolates analyzed were belonged to four capsular serotypes: II, 11/16(68.8%), V, 3/16(18.8%), Ia and VI each with 1/16(6.3%) and five sequence type (ST-2, ST-10, ST-14, ST-569 and ST-933). Sequence type-10 was the most predominant ST followed by ST-569. The five STs were grouped into the four clonal complexes (CC - 1, CC-10, CC-19, and CC-23). Different surface proteins and pili families such as ALP1, ALPHA, ALP23, PI-1 / PI-2A1, PI-1 / PI-2B, and Srr1 were detected from WGS data. All isolates were found to be susceptible to the tested antibiotics except for tetracycline in MIC and WGS test methods used. Tetracycline resistant determinant genes such as TETM and TETL / TETM combination were identified. Conclusion Further studies on serotype and molecular epidemiology will provide a comprehensive data of the GBS capsular serotype and clones available in Ethiopia.
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Affiliation(s)
- Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Zemene Tigabu
- Department of Pediatrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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230
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Yao Z, Jiayin W, Xinyi Z, Ling C, Mingyuan H, Simin M, Yayin L, Xinzhu L, Chao C. Identification of Group B Streptococcus Serotypes and Genotypes in Late Pregnant Women and Neonates That Are Associated With Neonatal Early-Onset Infection in a South China Population. Front Pediatr 2020; 8:265. [PMID: 32537444 PMCID: PMC7266973 DOI: 10.3389/fped.2020.00265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Group B streptococcus (GBS) colonized in late pregnancies has been associated with neonatal early-onset GBS disease (GBS-EOD) in China. Objective: This study investigated if GBS serotype and genotype in late pregnancy is associated with GBS-EOD, providing a reference for GBS-EOD prevention and treatment. Methods: A total of 298 pregnant women with GBS colonization during their late pregnancy and 32 invasive GBS-EOD cases were included in this study for GBS serotyping and genotyping using commercial kits and DNA sequencing. Results: We identified 266 GBS strains from mothers whose newborns were not infected with GBS-EOD. Serotype III [54.9% (146/266)] was the most common serotype, followed by Ib [17.3% (46/266)] and V [10.1% (27/266)]. ST19 was the most prevalent genotype [19.9% (53/266)], followed by ST862 [9.4% (25/266)] and ST12 [7.9% (21/266)]. We found that 32 mothers and their neonates with GBS-EOD had the same GBS strains. In 32 cases of GBS-EOD, the top three serotypes were III, Ia, and Ib, while the top three genotypes were ST17, ST23, and ST19. ST17 was the dominant genotype of serotype III, which was the most common prevalent in GBS-EOD [72.2% (13/18)], and ST23 was the dominant genotype of serotype Ia, the second most prevalent in GBS-EOD [87.5% (6/8)]. There were statistically significant differences in serotypes (p = 0.046) and genotypes (p = 0.000) distribution between the 266 pregnant women without GBS-EOD neonates and 32 cases of GBS-EOD. Conclusion: This study revealed a statistically significant associations of GBS serotype Ia, and ST17 and ST23 between GBS colonization in women during late pregnancy and in neonatal GBS-EOD. The GBS ST23 of serotype Ia and ST17 of serotype III possessed a strong pathogenicity.
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Affiliation(s)
- Zhu Yao
- Department of Neonatology, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - Wu Jiayin
- Department of Clinical Laboratory, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - Zheng Xinyi
- School of Public Health, Xiamen University, Xiamen, China
| | - Chen Ling
- Department of Clinical Laboratory, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - He Mingyuan
- Department of Neonatology, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - Ma Simin
- Department of Neonatology, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - Lin Yayin
- Department of Neonatology, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - Lin Xinzhu
- Department of Neonatology, Women and Children's Hospital of Xiamen University, Xiamen, China
| | - Chen Chao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Mohamed AM, Khan MA, Faiz A, Ahmad J, Khidir EB, Basalamah MA, Aslam A. Group B Streptococcus Colonization, Antibiotic Susceptibility, and Serotype Distribution among Saudi Pregnant Women. Infect Chemother 2020; 52:70-81. [PMID: 32239812 PMCID: PMC7113445 DOI: 10.3947/ic.2020.52.1.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Group B Streptococcus (GBS) comprises the normal flora of the female urogenital tract and can be transferred to neonates during delivery, causing invasive diseases. This study was performed to investigate the colonization rate, antibiotic susceptibility, and serotype of GBS among Saudi pregnant women. Materials and Methods In this cross-sectional study, vagino-rectal swabs from 400 pregnant women were collected over a period of one year. Identification of GBS isolates and determination of their antibiotic susceptibility were performed using the Microscan Walk Away system. The isolates were then typed using both latex agglutination and capsular gene-based multiplex polymerase chain reaction assays. Results Sixty (15.0%) subjects were colonized by GBS, with serotype Ia as the dominant type (30.0%) followed by serotype III and V (25.0%, each). Only 43 (71.7%) isolates were typed by latex agglutination, whereas the remaining isolates were not typable or were non-specifically typed as compared to the genotyping assay, which revealed the specific type of each GBS isolate. The highest resistance rates were observed for erythromycin and clindamycin (16.7%, each), which were mainly restricted to the prevalent serotypes. Conclusion This study is the first to report the distribution of GBS serotypes based on molecular genotyping in Saudi Arabia. GBS colonization was evident among pregnant women, and resistance to erythromycin and clindamycin was predominant among serotypes Ia, III, and V. Molecular genotyping using capsular gene-based multiplex PCR provided reliable typing of the investigated GBS isolates in terms of sensitivity and specificity as compared to conventional serotyping using latex agglutination.
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Affiliation(s)
- Amr Mohamed Mohamed
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia.,Clinical Laboratory Diagnosis, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Mubashir Ahmad Khan
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia.
| | - Aftab Faiz
- Microbiology Department, Maternity and Children hospital, Makkah, Saudi Arabia
| | - Jawwad Ahmad
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
| | - Elsheikh Babiker Khidir
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
| | | | - Akhmed Aslam
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
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232
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Szylit NA, Malburg FL, Piccinato CDA, Ferreira LADP, Podgaec S, Zlotnik E. Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization. EINSTEIN-SAO PAULO 2019; 18:eAO4920. [PMID: 31826077 PMCID: PMC6905166 DOI: 10.31744/einstein_journal/2020ao4920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the prevalence of group B
Streptococci
in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients’ age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B
Streptococcus
(prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B
Streptococcus
in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.
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Affiliation(s)
| | | | | | | | - Sérgio Podgaec
- Hospital Israelita Albert Einstein , São Paulo , SP , Brazil
| | - Eduardo Zlotnik
- Hospital Israelita Albert Einstein , São Paulo , SP , Brazil
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233
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Szylit NA, Malburg FL, Piccinato CDA, Ferreira LADP, Podgaec S, Zlotnik E. Prevalence of rectovaginal colonization by group B
Streptococcus
in pregnant women seen at prenatal care program of a health organization. EINSTEIN-SAO PAULO 2019. [DOI: 10.31744/einstein_journal/2019ao4920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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234
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Gao K, Fu J, Guan X, Zhu S, Zeng L, Xu X, Chang CY, Liu H. Incidence, Bacterial Profiles, And Antimicrobial Resistance Of Culture-Proven Neonatal Sepsis In South China. Infect Drug Resist 2019; 12:3797-3805. [PMID: 31819560 PMCID: PMC6899077 DOI: 10.2147/idr.s223597] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022] Open
Abstract
Background Neonatal sepsis (NS) is one of the leading causes of infant morbidity and mortality, but little is known about pathogen incidence and distribution in China. Methods In this retrospective study (January 2012 to December 2016), culture-proven cases aged less than 28 days with diagnosed NS in the Guangzhou Women and Children’s Medical Center, South China, were analyzed for pathogen incidence and antimicrobial resistance. Results A total of 620 isolates were identified from 597 NS cases. Gram-negative bacteria (n=371, 59.8%) dominated over Gram-positive bacteria (n=218, 35.2%) and fungi (n=30, 4.8%). Klebsiella pneumoniae (21.9%), Escherichia coli (21.9%), group B Streptococcus (GBS, 13.2%), and Staphylococcus aureus (6.8%) were the four most predominant pathogens. In early-onset sepsis (EOS), GBS (30.0%) and E. coli (20.0%) were dominant, whereas in late-onset sepsis (LOS), K. pneumoniae (25.6%) and E. coli (22.4%) were dominant. E. coli (25.2%) and GBS (17.7%) were the most frequently isolated from term patients, whereas K. pneumoniae was the most frequently isolated from preterm patients (34.9%). Of the infected infants, 9.5% died from sepsis, most commonly by E. coli infection (16.2%). Among 91,215 live births (LBs) delivered in the study hospital (2012–2016), 252 infants developed sepsis infection (2.76 per 1000 LBs, 95% CI 2.4–3.1), including EOS (0.78 per 1000 LBs) and LOS (2.13 per 1000 LBs). All GBS isolates were susceptible to β-lactam antibiotics, and S. aureus, including methicillin-resistant isolates, were susceptible to vancomycin. An extended-spectrum β-lactamase producer was identified in 37.3% of E. coli and 50.4% of K. pneumoniae. Conclusion K. pneumoniae was the most frequent pathogen in culture-proven NS in South China, primarily associated with LOS in preterm, whereas GBS was the dominant pathogen in EOS. E. coli was common in both episodes with the highest mortality.
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Affiliation(s)
- Kankan Gao
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Jie Fu
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China.,Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Xiaoshan Guan
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Sufei Zhu
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Lanlan Zeng
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Xiaoming Xu
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
| | - Chien-Yi Chang
- School of Chemistry and Biosciences, University of Bradford, Bradford BD7 1DP, UK
| | - Haiying Liu
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, People's Republic of China
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235
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Carreras-Abad C, Cochet M, Hall T, Ramkhelawon L, Khalil A, Peregrine E, Vinayakarao L, Sivarajan S, Hamid R, Planche T, Sheridan E, Winchester S, Plumb J, Djennad A, Andrews N, Le Doare K, Heath P. Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study. Health Technol Assess 2019; 23:1-40. [PMID: 31855555 PMCID: PMC6936166 DOI: 10.3310/hta23670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Group B streptococcus is the leading cause of infection in infants. Currently, intrapartum antibiotic prophylaxis is the major strategy to prevent invasive group B streptococcus disease. However, intrapartum antibiotic prophylaxis does not prevent maternal sepsis, premature births, stillbirths or late-onset disease. Maternal vaccination may offer an alternative strategy. Multivalent polysaccharide protein conjugate vaccine development is under way and a serocorrelate of protection is needed to expedite vaccine licensure. OBJECTIVES The ultimate aim of this work is to determine the correlate of protection against the major group B streptococcus disease-causing serotypes in infants in the UK. The aim of this feasibility study is to test key operational aspects of the study design. DESIGN Prospective cohort study of pregnant women and their infants in a 6-month period (1 July to 31 December 2018). SETTING Five secondary and tertiary hospitals from London and South England. National iGBS disease surveillance was conducted in all trusts in England and Wales. PARTICIPANTS Pregnant women aged ≥ 18 years who were delivering at one of the selected hospitals and who provided consent during the study period. There were no exclusion criteria. INTERVENTIONS No interventions were performed. MAIN OUTCOME MEASURES (1) To test the feasibility of collecting serum at delivery from a large cohort of pregnant women. (2) To test the key operational aspects for a proposed large serocorrelates study. (3) To test the feasibility of collecting samples from those with invasive group B streptococcus. RESULTS A total of 1823 women were recruited during the study period. Overall, 85% of serum samples were collected at three sites collecting only cord blood. At the two sites collecting maternal, cord and infant blood samples, the collection rate was 60%. A total of 614 women were screened for group B streptococcus with a colonisation rate of 22% (serotype distribution: 30% III, 25% Ia, 16% II, 14% Ib, 14% V and 1% IV). A blood sample was collected from 34 infants who were born to colonised women. Maternal and infant blood and the bacterial isolates for 15 newborns who developed invasive group B streptococcal disease during the study period were collected (serotype distribution: 29% III, 29% II, 21% Ia, 7% Ib, 7% IV and 7% V). LIMITATIONS Recruitment and sample collection were dependent on the presence of research midwives rather than the whole clinical team. In addition, individualised consent limited the number of women who could be approached each day, and site set-up for the national surveillance study and the limited time period of this feasibility study limited recruitment of all eligible participants. CONCLUSIONS We have verified the feasibility of collecting and processing rectovaginal swabs and blood samples in pregnant women, as well as samples from those with invasive group B streptococcal disease. We have made recommendations for the recruitment of cases within the proposed GBS3 study and for controls both within GBS3 and as an extension of this feasibility study. FUTURE WORK A large case-control study comparing specific immunoglobulin G levels in mothers whose infants develop invasive group B streptococcal disease with those in colonised mothers whose infants do not develop invasive group B streptococcal disease is recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN49326091; IRAS project identification number 246149/REC reference number 18/WM/0147. 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. 23, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clara Carreras-Abad
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Madeleine Cochet
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Tom Hall
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Laxmee Ramkhelawon
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Asma Khalil
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elisabeth Peregrine
- Department of Obstetrics and Gynaecology, Kingston Hospital NHS Foundation Trust, London, UK
| | - Latha Vinayakarao
- Department of Obstetrics and Gynaecology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Sharmila Sivarajan
- Department of Obstetrics and Gynaecology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Rosol Hamid
- Department of Obstetrics and Gynaecology, Croydon Health Services NHS Trust, Croydon, UK
| | - Tim Planche
- Microbiology Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Winchester
- Microbiology Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Jane Plumb
- Group B Strep Support Group, Haywards Heath, UK
| | - Abdelmajid Djennad
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Paul Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
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236
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Abstract
BACKGROUND The epidemiology of early-onset sepsis (EOS) in China is poorly understood because of the paucity of high-quality data. We aimed to examine the epidemiology, pathogen distribution and neonatal outcomes of EOS among a large cohort of preterm infants in China. METHODS All infants born at <34 weeks of gestation and admitted to 25 tertiary neonatal intensive care units in China from April 2015 to May 2018 were enrolled. EOS was defined as a culture-confirmed infection that occurred within 72 hours after birth. RESULTS Among 27,532 enrolled infants, 321 (11.7 cases per 1000 admissions) infants developed EOS, and 61 (19.0%) infants died within seven days after EOS onset. The incidence of EOS among inborn infants in 18 perinatal centers was 9.7 cases per 1000 live births <34 weeks' gestation (186/19,084). The case fatality rate was 22.6% (42/186). Gram-negative bacteria were responsible for 61.7% of EOS and 82.0% of EOS-related deaths. Escherichia coli (20.3%) was the leading pathogen, followed by Coagulase-negative staphylococcus (16.5%), Achromobacter xylosoxidans (9.0%) and Klebsiella pneumoniae (8.1%). Group B streptococci infections were relatively rare (2.5%). EOS was an independent risk factor for all-cause mortality and retinopathy of prematurity. CONCLUSIONS There is a high burden of EOS among preterm infants in China with a distinctive pathogen distribution. Longitudinal epidemiologic monitoring, further investigation of causative pathogens and development of targeted strategies for prevention and treatment of EOS are needed.
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237
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Modulation of Death and Inflammatory Signaling in Decidual Stromal Cells following Exposure to Group B Streptococcus. Infect Immun 2019; 87:IAI.00729-19. [PMID: 31548323 DOI: 10.1128/iai.00729-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023] Open
Abstract
Group B Streptococcus (GBS) is an opportunistic bacterial pathogen that contributes to miscarriage, preterm birth, and serious neonatal infections. Studies have indicated that some multilocus sequence types (STs) of GBS are more likely to cause severe disease than others. We hypothesized that the ability of GBS to elicit varying host responses in maternal decidual tissue during pregnancy is an important factor regulating infection and disease severity. To address this hypothesis, we utilized an antibody microarray to compare changes in production and activation of host signaling proteins in decidualized telomerase-immortalized human endometrial stromal cells (dT-HESCs) following infection with GBS strains from septic neonates or colonized mothers. GBS infection increased levels of total and phosphorylated mitogen-activated protein kinase (MAPK) family members such as p38 and JNK and induced nuclear factor kappa B (NF-κB) pathway activation. Infection also altered the regulation of additional proteins that mediate cell death and inflammation in a strain-specific manner, which could be due to the observed variation in attachment to and invasion of the decidual stromal cells and ability to lyse red blood cells. Further analyses confirmed array results and revealed that p38 promotes programmed necrosis in dT-HESCs. Together, the observed signaling changes may contribute to deregulation of critical developmental signaling cascades and inflammatory responses following infection, both of which could trigger GBS-associated pregnancy complications.
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238
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Collin SM, Lamb P, Jauneikaite E, Le Doare K, Creti R, Berardi A, Heath PT, Sriskandan S, Lamagni T. Hospital clusters of invasive Group B Streptococcal disease: A systematic review. J Infect 2019; 79:521-527. [PMID: 31733233 DOI: 10.1016/j.jinf.2019.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals. METHODS Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where 'cluster' was defined as ≥2 linked cases. PROSPERO CRD42018096297. RESULTS Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset (<7 days of life; n = 3), late-onset (7-90 days; n = 13) index case or colonized infant (n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3-17, range 0-50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified. CONCLUSIONS Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics.
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Affiliation(s)
- Simon M Collin
- Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Peter Lamb
- Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Elita Jauneikaite
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK; NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK; MRC/Uganda Virus Research Institute (UVRI) and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Pathogen Immunity Group, Public Health England, Porton Down, UK
| | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Maternal and Child Department, University Hospital, Modena, Italy
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; MRC Centre for Molecular Bacteriology & Infection, Imperial College, London, UK
| | - Theresa Lamagni
- Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK
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239
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Ratner AJ. Enhanced Postnatal Acquisition of Hypervirulent Group B Streptococcus. Clin Infect Dis 2019; 69:1749-1751. [PMID: 30945730 PMCID: PMC6821193 DOI: 10.1093/cid/ciz035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Adam J Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York
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240
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Sweeney EL, Gardiner S, Tickner J, Trim L, Beagley KW, Carey AJ. Group B Streptococcus serotypes Ia and V induce differential vaginal immune responses that may contribute to long term colonization of the female reproductive tract. Am J Reprod Immunol 2019; 83:e13199. [PMID: 31626718 DOI: 10.1111/aji.13199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023] Open
Abstract
PROBLEM Group B Streptococcus (GBS) is a common colonizer of the female genital tract at the time of pregnancy and has been associated with severe neonatal infections. Despite trials for GBS vaccines already being underway, the factors influencing vaginal GBS colonization and clearance are currently poorly understood. METHOD OF STUDY Within this study, we investigated the host immune responses to GBS infections in mice that affect GBS vaginal colonization and clearance. Cervicovaginal swabs were used to measure vaginal GBS persistence, and vaginal cytokine responses were measured using the BioPlex® system. Lymphocytes isolated from spleens were stimulated with UV-killed GBS to examine systemic cellular responses. Additional in vitro cellular experiments using human vaginal epithelial cells were also performed, examining the effect pregnancy level hormones had on GBS adhesion, invasion, and cytokine responses. RESULTS We observed significant differences in the ability of GBS serotype V infections to persist, compared with GBS serotype Ia vaginal infections. Vaginal cytokine response examination identified temporal changes in cytokine production (IL10, IFNγ, IL6, IL1β, and TNFα) in relation to GBS serotype and clearance or colonization. Lymphocyte proliferation assays also revealed robust cellular immune responses to GBS vaginal infections irrespective of clearance or colonization. In vitro human cellular analyses also identified that vaginal epithelial cell line cytokine production was suppressed in the presence of hormones despite no alteration in adhesion/invasion. CONCLUSION Here, we establish previously unknown, serotype specific, temporal immune responses which may be associated with vaginal GBS colonization or clearance in the female genital tract.
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Affiliation(s)
- Emma L Sweeney
- Institute of Health & Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Stephanie Gardiner
- Institute of Health & Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jacob Tickner
- Institute of Health & Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Logan Trim
- Institute of Health & Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kenneth W Beagley
- Institute of Health & Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Alison J Carey
- Institute of Health & Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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241
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Bulabula ANH, Dramowski A, Mehtar S. Transmission of multidrug-resistant Gram-negative bacteria from colonized mothers to their infants: a systematic review and meta-analysis. J Hosp Infect 2019; 104:57-67. [PMID: 31604126 DOI: 10.1016/j.jhin.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neonatal sepsis remains a leading cause of neonatal mortality. Maternal bacterial colonization plays a major role in transmission to the infant, with potential for subsequent development of neonatal sepsis with maternally derived strains. AIM To review the molecular evidence supporting transmission of multidrug-resistant Gram-negative bacteria (MDR-GNB) from colonized mothers to their infants and the risk factors for MDR-GNB transmission. METHODS PubMed and Scopus were searched for studies investigating the mechanisms, risk factors for and/or scale of transmission of MDR-GNB from colonized mothers to their infants. Random effects meta-analyses were performed to determine pooled proportions of MDR-GNB transmission and the neonatal outcomes of transmission. FINDINGS Eight studies were included in the narrative description and six in the meta-analysis. Five studies used pulsed-field gel electrophoresis to assess relatedness of isolates from colonized mothers and their infants. Pooled proportion of MDR-GNB transmission from colonized mothers to their infants was 27% (95% confidence interval (CI): 8-47%). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were the most frequently studied MDR-GNB pathogens transmitted between mother-infant pairs. Following mother-to-infant transmission of an MDR-GNB pathogen, the pooled proportion for the outcome of neonatal colonization was 19% (95% CI: 3-35%). CONCLUSION This systematic review strongly supports MDR and/or ESBL Enterobacteriaceae transmission from colonized mothers to their infants, with subsequent infant colonization. The risk factors contributing to transmission of MDR-GNB between colonized mothers and their infants warrants further research.
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Affiliation(s)
- A N H Bulabula
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Infection Control Africa Network, Cape Town, South Africa.
| | - A Dramowski
- Infection Control Africa Network, Cape Town, South Africa; Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - S Mehtar
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Infection Control Africa Network, Cape Town, South Africa
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242
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Furfaro LL, Chang BJ, Kahler CM, Payne MS. Genomic characterisation of perinatal Western Australian Streptococcus agalactiae isolates. PLoS One 2019; 14:e0223256. [PMID: 31577825 PMCID: PMC6774530 DOI: 10.1371/journal.pone.0223256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
As a leading cause of neonatal sepsis, Streptococcus agalactiae, commonly known as Group B Streptococcus, is a major neonatal pathogen. Current global screening practices employ risk- or culture-based protocols for detection of these organisms. In Western Australia (WA), universal culture-based screening is provided, with subsequent intrapartum antibiotic prophylaxis for all S. agalactiae-positive women during labour. Widespread antibiotic exposure is not ideal and this is one of the factors driving development of vaccines against S. agalactiae. Vaccine candidates have focused on the capsule, surface proteins and pilus types, however, capsule serotypes are known to vary geographically. The aim of this study was to use genome sequencing to gain an understanding of the circulating genotypes in WA, and to assess variations in the associated gene pools. We sequenced 141 antenatal carriage (vaginal/rectal) isolates and 10 neonatal invasive disease isolates from WA. Based on the global PubMLST database, the 151 strains were characterised into 30 sequence types, with clustering of these mainly into clonal complexes 1, 12, 17, 19 and 23. Of the genes encoding eleven surface proteins that were analysed, the most prevalent were fbp, lmb and scpB which were present in ≥ 98% of isolates. A cluster of non-haemolytic isolates, one of which was a neonatal invasive disease isolate, appeared to lack the entire cyl locus. Admixture analysis of population structure revealed evidence of genetic transfer among the WA isolates across structural groups. When compared against the PubMLST S. agalactiae data, WA isolates showed high levels of strain diversity with minimal apparent clustering. This is the first whole genome sequence study of WA S. agalactiae isolates and also represents the first addition of Australian isolate data to PubMLST. This report provides insight into the distribution and diversity of vaccine targets of S. agalactiae within Western Australia, indicating that the most appropriate capsular vaccine for this population would be the proposed pentavalent (Cps Ia, Ib, II, III and V) preparation, whilst vaccines targeting surface proteins should ideally utilise Fbp, Lmb and/or ScpB.
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Affiliation(s)
- Lucy L. Furfaro
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Barbara J. Chang
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, Western Australia, Australia
| | - Charlene M. Kahler
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew S. Payne
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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243
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Gopal Rao G, Hiles S, Bassett P, Lamagni T. Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross-sectional study. BJOG 2019; 126:1347-1353. [PMID: 30734508 DOI: 10.1111/1471-0528.15648] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the epidemiology of maternal group B streptococcus (GBS) colonisation by racial group. DESIGN Cross-sectional study. SETTING Antenatal clinics in London North West University Healthcare NHS Trust. POPULATION Pregnant women. METHODS Group B streptococcus (GBS) colonisation status was recorded during a screening programme for the prevention of invasive early-onset GBS infection. Information regarding age, address, ethnicity, parity, mode of delivery, body mass index (BMI), and diabetes was routinely collected. Data were analysed by multivariable analysis. MAIN OUTCOME MEASURES Association between GBS colonisation and putative risk factors. RESULTS Overall, 29.1% (1836/6309) of the women were colonized with GBS. Multivariable analysis showed significantly higher colonisation among women of black African origin (39.5%; OR = 1.57) compared with white British women (27.4%), and lowest colonisation in women of South Asian origin (23.3%; OR = 0.8). Higher parity (≥2) was associated with higher colonisation (35.3%), with the odds of colonisation over 40% higher than for nulliparous women. Increasing BMI was associated with an incremental rise in colonisation from 23 to 35%. Colonisation was not associated with age, season or mode of testing. CONCLUSION This study identified high maternal GBS colonisation rates in a racially and socially diverse population. The highest rates were seen in women of black African origin and also with higher parity and BMI. Further research is needed to understand the relationship between these factors and rectovaginal colonisation. TWEETABLE ABSTRACT Study of group B streptococcus colonisation in pregnant women in London shows highest rates in black African women and those with high BMI and parity.
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Affiliation(s)
| | - S Hiles
- Northwick Park Hospital, Harrow, UK
| | | | - T Lamagni
- National Infection Service, Public Health England, London, UK
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244
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Epidemiology of group B streptococcal infection in pregnant women and diseased infants in mainland China. Pediatr Neonatol 2019; 60:487-495. [PMID: 31445795 DOI: 10.1016/j.pedneo.2019.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/13/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and an important cause of maternal disease in many countries; however, no accurate population-based epidemiological data on GBS is yet available in mainland China. In this systematic literature review, we obtained published data regarding the maternal GBS colonization rate, incidence of invasive GBS disease in infants, clinical screening, and the associated GBS typing and clinical outcomes in China. The maternal GBS colonization rate in mainland China ranged from 3.7 to 14.52%, and the incidence of invasive GBS disease in infants was 0.55-1.79 per 1000 live births, with a case fatality risk ranging from 6.45 to 7.1%. Serotype III was the dominant serotype that was observed in GBS isolates. GBS detection and identification has become more commonplace, due to the availability of polymerase chain reaction and DNA microarray technologies. Immunizing pregnant women against GBS is an emerging approach through which newborns are protected from GBS. The available data suggest that five GBS serotypes (Ia, Ib, II, III, and V) account for the majority of the cases of GBS disease in mainland China. Furthermore, conjugate vaccines comprising some or all of these serotypes are of potential value in the prevention of GBS infection.
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245
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Vielot NA, Toval-Ruíz CE, Weber RP, Becker-Dreps S, Alemán Rivera TDJ. Rectovaginal group B streptococcus colonization among pregnant women in Nicaragua: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:2418-2426. [PMID: 31510821 DOI: 10.1080/14767058.2019.1667324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Maternal colonization with group B Streptococcus (GBS) is a predictor of neonatal sepsis. In Nicaragua, neonatal sepsis is a major cause of hospitalization, but it can be prevented with intrapartum antibiotic prophylaxis. We undertook this study to estimate the pooled prevalence of rectovaginal GBS colonization among pregnant women 35-40-week gestation in Nicaragua, and sensitivity of GBS isolates to various antibiotics. METHODS We systematically searched electronic databases of peer-reviewed and unpublished literature using prespecified search terms. We included English- and Spanish-language studies of rectovaginal GBS colonization and/or antibiotic sensitivity of GBS isolates that followed internationally-recognized diagnostic standards, from various sites and years. Two reviewers independently abstracted data and assessed risk of study bias. We then meta-analyzed the pooled prevalence of rectovaginal GBS colonization and antibiotic sensitivity of GBS isolates. We performed subgroup analyses by geographic location, urbanicity, and study risk of bias. MAIN RESULTS Prevalence of rectovaginal GBS colonization from 13 samples in 11 studies was 0.14 (95% CI: 0.09, 0.21). Effect size heterogeneity was identified between coastal (0.12 [95% CI: 0.07, 0.19]) and central study sites (0.23 [95% CI: 0.18, 0.28]), and between predominantly rural (0.06 [95% CI: 0.02, 0.10]) and urban (0.28 [95% CI: 0.19, 0.37]) samples of pregnant women. GBS sensitivity to penicillin, the first-line antibiotic for intrapartum prophylaxis, was 0.89 (95% CI: 0.71, 1.00) based on seven studies. CONCLUSIONS Maternal GBS colonization was substantial in some study sites. Most GBS isolates are sensitive to recommended antibiotics, and intrapartum antibiotic prophylaxis may effectively prevent neonatal sepsis in Nicaragua.
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Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christian E Toval-Ruíz
- Department of Microbiology and Parasitology, National Autonomous University of Nicaragua, León, Nicaragua
| | - Rachel Palmieri Weber
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teresa de Jesús Alemán Rivera
- Department of Microbiology and Parasitology, National Autonomous University of Nicaragua, León, Nicaragua.,Demography and Health Research Center (CIDS), National Autonomous University of Nicaragua, León, Nicaragua
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246
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Patras KA, Derieux J, Al-Bassam MM, Adiletta N, Vrbanac A, Lapek JD, Zengler K, Gonzalez DJ, Nizet V. Group B Streptococcus Biofilm Regulatory Protein A Contributes to Bacterial Physiology and Innate Immune Resistance. J Infect Dis 2019; 218:1641-1652. [PMID: 29868829 DOI: 10.1093/infdis/jiy341] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background Streptococcus agalactiae (group B Streptococcus [GBS]) asymptomatically colonizes approximately 20% of adults; however, GBS causes severe disease in susceptible populations, including newborns, pregnant women, and elderly individuals. In shifting between commensal and pathogenic states, GBS reveals multiple mechanisms of virulence factor control. Here we describe a GBS protein that we named "biofilm regulatory protein A" (BrpA) on the basis of its homology with BrpA from Streptococcus mutans. Methods We coupled phenotypic assays, RNA sequencing, human neutrophil and whole-blood killing assays, and murine infection models to investigate the contribution of BrpA to GBS physiology and virulence. Results Sequence analysis identified BrpA as a LytR-CpsA-Psr enzyme. Targeted mutagenesis yielded a GBS mutant (ΔbrpA) with normal ultrastructural morphology but a 6-fold increase in chain length, a biofilm defect, and decreased acid tolerance. GBS ΔbrpA stimulated increased neutrophil reactive oxygen species and proved more susceptible to human and murine blood and neutrophil killing. Notably, the wild-type parent outcompeted ΔbrpA GBS in murine sepsis and vaginal colonization models. RNA sequencing of ΔbrpA uncovered multiple differences from the wild-type parent, including pathways of cell wall synthesis and cellular metabolism. Conclusions We propose that BrpA is an important virulence regulator and potential target for design of novel antibacterial therapeutics against GBS.
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Affiliation(s)
- Kathryn A Patras
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla
| | - Jaclyn Derieux
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla
| | - Mahmoud M Al-Bassam
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla
| | - Nichole Adiletta
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla
| | - Alison Vrbanac
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla
| | - John D Lapek
- Department of Pharmacology, School of Medicine, University of California-San Diego, La Jolla.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla
| | - Karsten Zengler
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla
| | - David J Gonzalez
- Department of Pharmacology, School of Medicine, University of California-San Diego, La Jolla.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla
| | - Victor Nizet
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California-San Diego, La Jolla.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla
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247
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Alvim DCSS, Ferreira AFM, Leal MA, Oliveira LMA, Botelho AMN, Botelho ACN, Figueiredo AMS, Fracalanzza SEL, Teixeira LM, Pinto TCA. Biofilm production and distribution of pilus variants among Streptococcus agalactiae isolated from human and animal sources. BIOFOULING 2019; 35:938-944. [PMID: 31646898 DOI: 10.1080/08927014.2019.1678592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/28/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) is a major pathogen in humans and animals. Pili and biofilm may be important virulence factors in this bacterial species. Here, biofilm production and the distribution of pilus variants among 134 GBS isolates from human and animal sources were evaluated. Biofilm production was significantly enhanced in 1% glucose-supplemented medium (p < 0.05). Using this medium, most GBS strains were strong biofilm producers. Biomass was mainly composed of proteins, followed by extracellular DNA, while polysaccharides represented a minor portion. All GBS strains presented at least one pilus variant. PI-2a was the most common among human GBS while PI-2b was the most common among animal isolates. Human GBS harboring PI-2b and animal GBS harboring PI-2a presented significantly reduced biofilm production (p = 0.0033). In conclusion, strong biofilm production seems to be a common characteristic in GBS, and association of the clinical source with the pilus variant may be crucial for this.
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Affiliation(s)
| | | | - Matheus Amaral Leal
- Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio De Janeiro, Rio De Janeiro, Brazil
| | | | - Ana Maria Nunes Botelho
- Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio De Janeiro, Rio De Janeiro, Brazil
| | - Ana Caroline Nunes Botelho
- Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio De Janeiro, Rio De Janeiro, Brazil
| | - Agnes Marie Sá Figueiredo
- Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio De Janeiro, Rio De Janeiro, Brazil
| | | | - Lucia Martins Teixeira
- Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio De Janeiro, Rio De Janeiro, Brazil
| | - Tatiana Castro Abreu Pinto
- Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio De Janeiro, Rio De Janeiro, Brazil
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248
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Marziali G, Foschi C, Parolin C, Vitali B, Marangoni A. In-vitro effect of vaginal lactobacilli against group B Streptococcus. Microb Pathog 2019; 136:103692. [PMID: 31445119 DOI: 10.1016/j.micpath.2019.103692] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/29/2019] [Accepted: 08/21/2019] [Indexed: 01/31/2023]
Abstract
Streptococcus agalactiae(GBS) is a leading cause of infection during pregnancy, preterm birth and neonatal infection, with a significant clinical and socio-economic impact. To prevent maternal GBS vaginal colonization, new antibiotic-free approaches, based on lactobacilli probiotics, are advisable. The aim of this study was to assess the anti-GBS activity of 14 vaginal Lactobacillus strains, belonging to different species (L. crispatus, L. gasseri, L. vaginalis), isolated from healthy pre-menopausal women. In particular, we performed 'inhibition' experiments, evaluating the ability of both Lactobacillus cells and culture supernatants in reducing Streptococcus viability, after 60 min contact time. First, we demonstrated that the acidic milieu, produced by vaginal lactobacilli metabolism, is crucial in counteracting GBS growth in a pH-dependent manner. Experiments with organic/inorganic acid solutions confirmed the strict correlation between pH levels and the anti-GBS activity. GBS was more sensitive to lactic acid than to hydrochloric acid, indicating that the presence of H+ ions is necessary but not sufficient for the inhibitory activity. Moreover, experiments with Lactobacillus pH-adjusted supernatants led to exclude a direct role in the anti-GBS activity by other bioactive molecules. Second, we found that only a few Lactobacillus strains were able to reduce Streptococcus viability by means of cell pellets. The anti-GBS effect displayed by Lactobacillus cells was related to the their ability to interact and aggregate with Streptococcus cells. We found that the anti-GBS activity was retained after methanol/proteinase K treatment, but lost after lysozyme exposure of Lactobacillus cells. Therefore, we supposed that non-proteinaceous components of Lactobacillus cell wall could be responsible for the anti-GBS activity. In conclusion, we identified specific Lactobacillus strains able to interfere with GBS viability by multiple strategies and we elucidated some of the mechanisms of action. These strains could serve as probiotic formulations for the prevention of GBS vaginal colonization.
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Affiliation(s)
- Giacomo Marziali
- Microbiology, DIMES, University of Bologna, Via Massarenti 9, Bologna, Italy
| | - Claudio Foschi
- Microbiology, DIMES, University of Bologna, Via Massarenti 9, Bologna, Italy.
| | - Carola Parolin
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, Bologna, Italy
| | - Beatrice Vitali
- Department of Pharmacy and Biotechnology, University of Bologna, Via San Donato 19/2, Bologna, Italy
| | - Antonella Marangoni
- Microbiology, DIMES, University of Bologna, Via Massarenti 9, Bologna, Italy
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249
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Seale AC, Baker CJ, Berkley JA, Madhi SA, Ordi J, Saha SK, Schrag SJ, Sobanjo-Ter Meulen A, Vekemans J. Vaccines for maternal immunization against Group B Streptococcus disease: WHO perspectives on case ascertainment and case definitions. Vaccine 2019; 37:4877-4885. [PMID: 31303524 PMCID: PMC6677922 DOI: 10.1016/j.vaccine.2019.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/18/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
Group B Streptococcus (GBS) is an important cause of disease in young infants, stillbirths, pregnant and post-partum women. GBS vaccines for maternal immunization are in development aiming to reduce this burden. Standardisation of case definitions and ascertainment methodologies for GBS disease is needed to support future trials of maternal GBS vaccines. Considerations presented here may also serve to promote consistency in observational studies and surveillance, to better establish disease burden. The World Health Organization convened a working group to provide consensus guidance for case ascertainment and case definitions of GBS disease in stillbirths, infants, pregnant and post-partum women, with feedback sought from external stakeholders. In intervention studies, case capture and case ascertainment for GBS disease should be based on antenatal recruitment of women, with active follow-up, systematic clinical assessment, standardised sampling strategies and optimised laboratory methods. Confirmed cases of invasive GBS disease in stillbirths or infants should be included in a primary composite endpoint for vaccine efficacy studies, with GBS cultured from a usually sterile body site (may be post-mortem). For additional endpoints, or observational studies, confirmed cases of GBS sepsis in pregnant and post-partum women should be assessed. Culture independent diagnostic tests (CIDTs) may detect additional presumed cases, however, the use of these diagnostics needs further evaluation. Efficacy of vaccination against maternal and neonatal GBS colonisation, and maternal GBS urinary tract infection could be included as additional, separate, endpoints and/or in observational studies. Whilst the focus here is on specific GBS disease outcomes, intervention studies also present an opportunity to establish the contribution of GBS across adverse perinatal outcomes, including all-cause stillbirth, preterm birth and neonatal encephalopathy.
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Affiliation(s)
- Anna C Seale
- London School of Hygiene & Tropical Medicine, Keppel Street, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Carol J Baker
- Department of Pediatric, University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, & Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Jaume Ordi
- ISGlobal, Barcelona Institute of Global Health, Barcelona, Spain; Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Samir K Saha
- Bangladesh Institute of Child Health, Dhaka, Bangladesh
| | - Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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250
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Hayes K, Cotter L, O'Halloran F. In vitro synergistic activity of erythromycin and nisin against clinical Group B Streptococcus isolates. J Appl Microbiol 2019; 127:1381-1390. [PMID: 31342602 DOI: 10.1111/jam.14400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/04/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Abstract
AIMS This study investigated the potential synergy between erythromycin and nisin against clinical Group B Streptococcus (GBS) strains. METHODS AND RESULTS The combination of erythromycin and nisin was examined for synergistic activity using checkerboard and time-kill assays against invasive and colonizing GBS strains. Additionally, the immunological effect of the antibiotic combination was investigated in vitro using human U937 cells and ELISA analysis. Checkerboard assays confirmed an additive effect when the antimicrobials were combined, while time-kill assays demonstrated a synergistic effect when antimicrobials were combined for invasive GBS isolates. Furthermore, a significantly lower TNF-alpha response (P < 0·05) was observed in U937 cells challenged with GBS when erythromycin and nisin were used in combination. CONCLUSIONS The results suggest that erythromycin and nisin can act synergistically to inhibit the growth of GBS. SIGNIFICANCE AND IMPACT OF THE STUDY Group B Streptococcus is the leading cause of invasive neonatal disease worldwide and is becoming increasingly more prevalent in adults. Resistance to some conventionally used antibiotics, such as erythromycin and clindamycin, continue to rise among GBS, indicating a need for alternative treatments. This study demonstrates the potential of an erythromycin-nisin combination for treatment of GBS infections and encourages further investigation of this treatment option.
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Affiliation(s)
- K Hayes
- Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Cork, Ireland
| | - L Cotter
- Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Cork, Ireland
| | - F O'Halloran
- Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Cork, Ireland
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