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Lemaire C, Cheminet M, Duployez C, Artus M, Ballaa Y, Devos L, Plainvert C, Poyart C, Le Gall F, Tazi A, Lanotte P. A LAMP-based assay for the molecular detection of group B Streptococcus. Eur J Clin Microbiol Infect Dis 2023; 42:1245-1250. [PMID: 37702956 DOI: 10.1007/s10096-023-04656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Streptococcus agalactiae remains a major pathogen in human health, especially in neonatal infection. Detection in pregnant women is essential to initiate intrapartum antibiotic prophylaxis. This study compared the HiberGene loop-mediated isothermal amplification (LAMP) assay to culture, the reference method, for the detection of group B Streptococcus (GBS) in pregnant women. METHODS This was a prospective multicenter study conducted in four French hospitals. Three hundred fifty-four non-redundant routine care vaginal swabs were analyzed by both methods, LAMP assay and culture. Clinicians and patients were blinded to the results of the LAMP assay. RESULTS Three hundred thirty-seven samples presented concordant results, 15 presented discordant results, and 2 were invalid using the LAMP assay (excluded from the study). Compared to culture, the LAMP assay had a sensitivity of 87.7%, a specificity of 98%, a negative predictive value of 97.6%, and a positive predictive value of 89.3%. CONCLUSION The HiberGene GBS LAMP assay is an easy test that possesses good performances compared with the reference method, culture. It could be used in case of emergency when a quick result is needed.
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Affiliation(s)
- Coralie Lemaire
- Service de Bactériologie-Virologie, CHRU de Tours, Université de Tours, 37044, Tours, France
| | - Mélinda Cheminet
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Service de Bactériologie, Université Paris Cité, 75014, Paris, France
| | - Claire Duployez
- Laboratoire de Bactériologie, CHU de Lille, Université de Lille, 59000, Lille, France
| | - Mathilde Artus
- Laboratoire de Biologie Médicale, CH de Quimper, 29000, Quimper, France
| | - Yassine Ballaa
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Service de Bactériologie, Université Paris Cité, 75014, Paris, France
| | - Laura Devos
- Laboratoire de Bactériologie, CHU de Lille, Université de Lille, 59000, Lille, France
| | - Céline Plainvert
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Service de Bactériologie, Université Paris Cité, 75014, Paris, France
- Centre National de Référence Des Streptocoques, Hôpital Cochin, 75014, Paris, France
| | - Claire Poyart
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Service de Bactériologie, Université Paris Cité, 75014, Paris, France
- Centre National de Référence Des Streptocoques, Hôpital Cochin, 75014, Paris, France
| | - Florence Le Gall
- Laboratoire de Biologie Médicale, CH de Quimper, 29000, Quimper, France
| | - Asmaa Tazi
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Service de Bactériologie, Université Paris Cité, 75014, Paris, France
- Centre National de Référence Des Streptocoques, Hôpital Cochin, 75014, Paris, France
| | - Philippe Lanotte
- Service de Bactériologie-Virologie, CHRU de Tours, Université de Tours, 37044, Tours, France.
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Samb A, Dierikx TH, Bijleveld YA, de Haan TR, Hodiamont CJ, van Leeuwen E, van Kaam AHLC, Mathôt RAA, Visser DH. Benzylpenicillin concentrations in umbilical cord blood and plasma of premature neonates following intrapartum doses for group B streptococcal prophylaxis. Matern Health Neonatol Perinatol 2023; 9:9. [PMID: 37391853 DOI: 10.1186/s40748-023-00163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/24/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND AND METHOD Dutch obstetrics guideline suggest an initial maternal benzylpenicillin dose of 2,000,000 IU followed by 1,000,000 IU every 4 h for group-B-streptococci (GBS) prophylaxis. The objective of this study was to evaluate whether concentrations of benzylpenicillin reached concentrations above the minimal inhibitory concentrations (MIC) in umbilical cord blood (UCB) and neonatal plasma following the Dutch guideline. RESULTS Forty-six neonates were included. A total of 46 UCB samples and 18 neonatal plasma samples were available for analysis. Nineteen neonates had mothers that received intrapartum benzylpenicillin. Benzylpenicillin in UCB corresponded to concentrations in plasma drawn directly postpartum (R2 = 0.88, p < 0.01). A log-linear regression suggested that benzylpenicillin concentrations in neonates remained above the MIC threshold 0.125 mg/L up to 13.0 h after the last intrapartum dose. CONCLUSIONS Dutch intrapartum benzylpenicillin doses result in neonatal concentrations above the MIC of GBS.
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Affiliation(s)
- Amadou Samb
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands.
| | - Thomas H Dierikx
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Pediatric Gastroenterology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Yuma A Bijleveld
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Timo R de Haan
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Caspar J Hodiamont
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Obstetrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton H L C van Kaam
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ron A A Mathôt
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Douwe H Visser
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Vertical Transmission, Risk Factors, and Antimicrobial Resistance Patterns of Group B Streptococcus among Mothers and Their Neonates in Southern Ethiopia. CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:8163396. [PMID: 35860035 PMCID: PMC9293564 DOI: 10.1155/2022/8163396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 12/03/2022]
Abstract
Background Group B Streptococcus (GBS) contributes to maternal and neonatal morbidity and mortality by increasing intrauterine infection or vertical transmission at the time of birth. Despite many efforts to reduce the potential risk of vertical transmission, GBS remains the main cause of serious disease (neonatal sepsis, meningitis, and/or pneumonia) in vulnerable newborns during the first week of life. This study aimed to assess vertical transmission, risk factors, and antimicrobial resistance patterns of GBS among pregnant women and their neonates. Methods A facility-based cross-sectional study was conducted among mothers and their neonates from February to May 2021. A total of 201 pregnant women with their neonates participated in this study. A well-designed questionnaire was used to collect sociodemographic and clinical data. A vaginal swab from mother before delivery and neonatal nasal and ear canal swab samples were taken as soon as after delivery within 30 minutes. Vaginal swabs, neonatal ear canal, and nasal swabs were placed into Todd–Hewitt broth and incubated at 37°C for 18–24 hours at 35–37°C in 5% CO2 conditions and then subcultured on 5% sheep blood agar for 18–48 hours. Presumptive identification of GBS was made by morphology, Gram stain, catalase, and hemolytic activity on sheep blood agar plates. CAMP and bacitracin susceptibility tests were used as confirmatory tests for GBS. Data were analyzed using SPSS version 21. P value ≤0.05 was considered statistically significant. Results Vertical transmission rates of GBS (mother to neonates) were 11.9%. The prevalence of GBS among pregnant women and newborns was 24/201 (11.9%) (95% CI = 7.5–16.9) and 11/201 (5.5%) (95% CI = 2.5–9.0), respectively. The history of prolonged rupture of membranes (AOR = 3.5, CI = 2.2–18.8) and urinary tract infection (AOR = 2.9, CI = 1.7–16.3) were associated factors for maternal GBS colonization. Gestational age of <37 weeks (p=0.008), low birth weight of <2.5 kg (p=0.001), and maternal history of vaginal discharge (p=0.048) were associated factors for neonatal GBS colonization. Low antibiotic resistance was observed for erythromycin 8.6%, clindamycin 5.7%, and chloramphenicol 2.9%. Conclusion In this study, high vertical transmission (mother to neonates) rate was observed. The prevalence of vaginal GBS colonization of women at delivery was 11.9% and significantly associated with the history of prolonged rupture of membranes and urinary tract infections. Gestational age of <37 weeks, low birth weight of <2.5 kg, and maternal history of vaginal discharge were associated with neonatal GBS colonization. Hence, there is a need for antenatal culture-based GBS screening, risk factor-based interventions, and regular follow-up of drug resistance patterns for proper treatment and management of GBS.
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Hartvigsen CM, Nielsen SY, Møller JK, Khalil MR. Reduction of intrapartum antibiotic prophylaxis by combining risk factor assessment with a rapid bedside intrapartum polymerase chain reaction testing for group B streptococci. Eur J Obstet Gynecol Reprod Biol 2022; 272:173-176. [PMID: 35334420 DOI: 10.1016/j.ejogrb.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the impact of administering Intrapartum Antibiotic Prophylaxis (IAP) to laboring women with one or more risk factors for Early Onset Group B Streptococcal neonatal infection (EOGBS) based on the result of a rapid bedside test for Group B Streptococci (GBS). STUDY DESIGN Quality assessment study. METHODS Three-hundred-sixty-six laboring women admitted to our maternity ward, with one or more risk factors for EOGBS, were prospectively included. Rectovaginal swab-samples were examined bedside by the GenomEra® GBS Polymerase Chain Reaction (PCR) assay upon admission. Time from administration of IAP to delivery was registered. According to national guidelines, one-hundred-two women mandatorily received IAP independent of the PCR test result fulfilling one of the following three risk factors: prior infant with EOGBS, preterm labor before 35 gestational week, temperature ≥ 38 °C during labor. Women with GBS bacteriuria during current pregnancy, rupture of membranes ≥ 18 h IAP, and preterm labor between 35 and 37 gestational week, received IAP solely if the PCR test was positive. Predictive values were calculated for each risk factor. RESULTS Previous GBS bacteriuria was strongly associated (PPV = 71%) with a positive GBS PCR test, whilst the corresponding positive percent of ROM > 18 h and of GA 35-37 was only PPV = 16% and 22%, respectively. Seventy-four women, 74/251 (31%), received IAP because they were GBS PCR positive. IAP was thus reduced by about two-thirds compared to the risk-based strategy of offering IAP to all women with one or more risk factors for EOGBS. Two women, 2/254 (0.8%), received inferior care, as they did not receive IAP within the recommended 4 h prior to delivery due to the extra time spend on the test procedure. CONCLUSION Bedside intrapartum PCR testing of women with risk factors for EOGBS effectively diminishes use of IAP during labor compared to the present risk factor-based strategy alone. In this project, the extra time spend on the PCR test procedure did not lead to noticeable delay in IAP.
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Affiliation(s)
- C M Hartvigsen
- Department of Gynecology and Obstetrics, Kolding Sygehus, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.
| | - S Y Nielsen
- Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus C, Denmark
| | - J K Møller
- Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - M R Khalil
- Department of Gynecology and Obstetrics, Kolding Sygehus, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
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Campion S, Inselman A, Hayes B, Casiraghi C, Joseph D, Facchinetti F, Salomone F, Schmitt G, Hui J, Davis-Bruno K, Van Malderen K, Morford L, De Schaepdrijver L, Wiesner L, Kourula S, Seo S, Laffan S, Urmaliya V, Chen C. The benefits, limitations and opportunities of preclinical models for neonatal drug development. Dis Model Mech 2022; 15:dmm049065. [PMID: 35466995 PMCID: PMC9066504 DOI: 10.1242/dmm.049065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Increased research to improve preclinical models to inform the development of therapeutics for neonatal diseases is an area of great need. This article reviews five common neonatal diseases - bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, perinatal hypoxic-ischemic encephalopathy and neonatal sepsis - and the available in vivo, in vitro and in silico preclinical models for studying these diseases. Better understanding of the strengths and weaknesses of specialized neonatal disease models will help to improve their utility, may add to the understanding of the mode of action and efficacy of a therapeutic, and/or may improve the understanding of the disease pathology to aid in identification of new therapeutic targets. Although the diseases covered in this article are diverse and require specific approaches, several high-level, overarching key lessons can be learned by evaluating the strengths, weaknesses and gaps in the available models. This Review is intended to help guide current and future researchers toward successful development of therapeutics in these areas of high unmet medical need.
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Affiliation(s)
- Sarah Campion
- Pfizer Worldwide Research, Development, and Medical, Groton, CT 06340, USA
| | - Amy Inselman
- U.S. Food and Drug Administration, National Center for Toxicological Research, Division of Systems Biology, Jefferson, AR 72079, USA
| | - Belinda Hayes
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Costanza Casiraghi
- Department of Experimental Pharmacology and Translational Science, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy
| | - David Joseph
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Fabrizio Facchinetti
- Department of Experimental Pharmacology and Translational Science, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy
| | - Fabrizio Salomone
- Department of Experimental Pharmacology and Translational Science, Chiesi Farmaceutici S.p.A., 43122 Parma, Italy
| | - Georg Schmitt
- Pharma Research and Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche, 4070 Basel, Switzerland
| | - Julia Hui
- Bristol Myers Squibb, Nonclinical Research and Development, Summit, NJ 07901, USA
| | - Karen Davis-Bruno
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Karen Van Malderen
- Federal Agency for Medicines and Health Products (FAMHP), Department DG PRE authorization, 1210 Brussels, Belgium
| | - LaRonda Morford
- Eli Lilly, Global Regulatory Affairs, Indianapolis, IN 46285, USA
| | | | - Lutz Wiesner
- Federal Institute for Drugs and Medical Devices, Clinical Trials, 53175 Bonn, Germany
| | - Stephanie Kourula
- Janssen R&D, Drug Metabolism & Pharmacokinetics, 2340 Beerse, Belgium
| | - Suna Seo
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, MD 20993, USA
| | - Susan Laffan
- GlaxoSmithKline, Non-Clinical Safety, Collegeville, PA 19406, USA
| | | | - Connie Chen
- Health and Environmental Sciences Institute, Washington, DC 20005, USA
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Lemaire C, Le Gallou B, Lanotte P, Mereghetti L, Pastuszka A. Distribution, Diversity and Roles of CRISPR-Cas Systems in Human and Animal Pathogenic Streptococci. Front Microbiol 2022; 13:828031. [PMID: 35173702 PMCID: PMC8841824 DOI: 10.3389/fmicb.2022.828031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/10/2022] [Indexed: 12/26/2022] Open
Abstract
Streptococci form a wide group of bacteria and are involved in both human and animal pathologies. Among pathogenic isolates, differences have been highlighted especially concerning their adaptation and virulence profiles. CRISPR-Cas systems have been identified in bacteria and many streptococci harbor one or more systems, particularly subtypes I-C, II-A, and III-A. Since the demonstration that CRISPR-Cas act as an adaptive immune system in Streptococcus thermophilus, a lactic bacteria, the diversity and role of CRISPR-Cas were extended to many germs and functions were enlarged. Among those, the genome editing tool based on the properties of Cas endonucleases is used worldwide, and the recent attribution of the Nobel Prize illustrates the importance of this tool in the scientific world. Another application is CRISPR loci analysis, which allows to easily characterize isolates in order to understand the interactions of bacteria with their environment and visualize species evolution. In this review, we focused on the distribution, diversity and roles of CRISPR-Cas systems in the main pathogenic streptococci.
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Affiliation(s)
- Coralie Lemaire
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Brice Le Gallou
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Philippe Lanotte
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
- *Correspondence: Philippe Lanotte,
| | - Laurent Mereghetti
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Adeline Pastuszka
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
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Barros RR, Alves KB, Luiz FBO, Ferreira DG. Prevalence of Streptococcus agalactiae capsular types among pregnant women in Rio de Janeiro and the impact of a capsular based vaccine. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-979020222e20633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Invasive Group B Streptococcal Disease in Neonates and Infants, Italy, Years 2015-2019. Microorganisms 2021; 9:microorganisms9122579. [PMID: 34946181 PMCID: PMC8708122 DOI: 10.3390/microorganisms9122579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/31/2023] Open
Abstract
Invasive infections by group B streptococci (iGBS) are the leading cause of sepsis and meningitis in the first three months of life worldwide. The clinical and microbiological characteristics of neonatal and infant iGBS in Italy during the years 2015–2019 were investigated. Voluntary-based surveillance reported 191 cases (67 early-onset (EOD) and 124 late-onset disease (LOD)) and 89 bacterial isolates were received. The main clinical manifestations were sepsis (59.2%) followed by meningitis (21.5%), bacteremia (12.0%) and septic shock (6.3%). Hospitalized preterm babies accounted for one third of iGBS and constituted the most fragile population in terms of mortality (8.2%) and brain damage (16.4%). GBS serotype III was predominant in EOD (56%) and caused almost all LOD (95%). The rate of resistance to clindamycin reached 28.8%. Most of clindamycin-resistant GBS strains (76%) were serotype III-ST17 and possessed the genetic markers of the emerging multidrug resistant (MDR) CC-17 sub-clone. Our data revealed that iGBS is changing since it is increasingly reported as a healthcare-associated infection (22.6%), mainly caused by MDR-CC17. Continuous monitoring of the clinical and microbiological characteristics of iGBS remains of primary importance and it represents, at present, the most effective tool to support prevention strategies and the research on the developing GBS vaccine.
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Slotved HC, Møller JK, Khalil MR, Nielsen SY. The serotype distribution of Streptococcus agalactiae (GBS) carriage isolates among pregnant women having risk factors for early-onset GBS disease: a comparative study with GBS causing invasive infections during the same period in Denmark. BMC Infect Dis 2021; 21:1129. [PMID: 34724923 PMCID: PMC8561911 DOI: 10.1186/s12879-021-06820-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 01/12/2023] Open
Abstract
Background We describe the serotype distribution of Streptococcus agalactiae (GBS) carriage isolates from women in labor and among GBS isolates causing invasive infections during the same period to see if the distribution of carriage serotypes reflects the GBS serotypes causing invasive diseases including early-onset disease (EOGBS). Methods Data on invasive isolates from 2019 including serotype, erythromycin and clindamycin susceptibility was retrieved from the Danish national reference laboratory, Statens Serum Institut. Carriage isolates were collected from women with risk factors for EOGBS enrolled at delivery at the maternity ward at a Danish University Hospital, first half of 2019. Results Among carriage isolates, the dominant serotype was IX (21 %) followed by serotype III (19 %). The resistance to erythromycin and clindamycin was 21 and 26 %, respectively. Among invasive GBS isolates, no case of EOGBS with serotype IX was detected but the distribution of serotypes were otherwise similar to the GBS carrier strains. The corresponding resistance to erythromycin and clindamycin was 23 and 15 %, respectively. Penicillin resistance was not detected among carriage nor invasive isolates. Conclusions The distribution of serotypes among carriage and invasive GBS reflects the assumption that EOGBS occur following transmission of GBS from mother to newborn, with the exception of serotype IX. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06820-2.
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Affiliation(s)
- Hans-Christian Slotved
- Department of Bacteria, Parasites and, Fungi, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen, Denmark.
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Mohammad Rohi Khalil
- Department of Gynecology and Obstetrics, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Stine Yde Nielsen
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Urinary Tract Infections Spectrum During Pregnancy: Etiopathogenesis and Outcome. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background :The occurence of urinary tract infections (UTIs) in the course of a normal pregnancy should always be early diagnosed and treated, even asymptomatic as it could evolve to threatening pathological conditions, like sepsis with acute kidney injury, or preeclampsia. The aim of study was to establish a cartographic projection of the risk factors and etiopathogenesis of urinary tract infections diagnosed during pregnancy, with the purpose to control their severity and evaluate the therapeutic strategies used to reduce maternal and fetal risks.
Material and methods: The study included 175 patients, pregnant women, diagnosed with UTIs hospitalized in the Nephrology Clinic and Obstetrics-Gynecology Clinic of the Emergency Clinical County Hospital of Constanta, in an interval of time of 4 years, between 2017-2021.
Results: Out of the 247 patients recruited in our study, the distribution according to the trimester of pregnancy, there were : 72 pregnant women in the first trimester (41.14%), 35 in the second trimester (20.0%) and 68 in the third trimester (38.86%). The frequency of pregnant women who had other favorising conditions and detectable risk factors was 70.29%. The clinical manifestations of UTIs in our study group were distributed as follows : 36 (20.57%) asymptomatic bacteriuria, 56 (32.0%) acute cystitis, 44 (25.14%) recurrent lower urinary tract infections, and 39 (22.29%) acute pyelonephritis. There is an association (p ---lt--- 0.001) between the type of clinical form of UTIs and a certain trimester of pregnancy, for example the highest frequency of acute pyelonephritis (AP) was noticed in the third trimester of pregnancy (71.8%, 28/39). Out of 39 pregnant women with AP, 71.8% (28) had associated ureterohydronephrosis (UHN). E. Coli was present in 41.71% of pregnant women., followed by Klebsiella pneumoniae, Enterococcus faecalis and, less frequently, Staphylococcus aureus and Proteus mirabilis. The most frequently used antibiotics in pregnancy were: 2nd and 3rd generations of cephalosporins (42.29%), followed by ampicillin (34.29%); less used were amoxicillin with clavulanic acid (10.29%), quinolones (6.29%) and nitrofurantoin (6.86%). Most of the pregnant women (94.28%, 165/175) had remission of fever within 24-48 h of using appropriate antibiotic therapy. The recurrence rate was 22.28 %, (39/175).
Conclusion All clinical forms of UTIs could be present during pregnancy, but the most common are lower urinary tract infections and the most involved germ is E. Coli. UHN is a factor that influences the occurence of UTIs, being the most common favorising condition.
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Rostami S, Moeineddini L, Ghandehari F, Khorasani MR, Shoaei P, Ebrahimi N. Macrolide-resistance, capsular genotyping and associated factors of group B Streptococci colonized pregnant women in Isfahan, Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:183-189. [PMID: 34540153 PMCID: PMC8408030 DOI: 10.18502/ijm.v13i2.5979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Group B streptococcus (GBS) can cause severe and invasive infections in pregnant women, infants, and adults. This study aimed to investigate the risk factors of GBS colonization in pregnant women and determine the macrolide resistance and capsular type of isolates. Materials and Methods: In a cross-sectional study, a total of 200 pregnant women were screened for GBS colonization by phenotypic methods. Antibiotic susceptibility pattern of colonizing isolates and ermB, ermTR, mefA/E genes were detected. Also, molecular capsular types of isolates were distinguished. Results: The overall prevalence of colonization of participates with GBS was 13.5%. Statistical analysis showed that there was no association between risk factors and colonization with GBS. The highest resistance was observed to erythromycin (44.4%) followed by clindamycin (29.6%), penicillin, ampicillin, and ceftriaxone (18.5%), levofloxacin (11.1%), and 29.6% isolates were multidrug-resistant. ermTR and mefA/E genes were detected in 37% and 11.1% isolates; respectively and the ermB gene was not detected. The most common capsular type was type Ib (44.4%) followed by type III (40.7%), type II (11.1), and type Ia (3.7%). Conclusion: In the present study, the prevalence of GBS was in the medium range. Resistance to key antibiotic agents was relatively high. Also, capsular serotype Ib was the predominant serotype, which emphasizes the importance of monitoring the molecular typing of the GBS isolates regularly.
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Affiliation(s)
- Soodabeh Rostami
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Moeineddini
- Department of Microbiology, Falavarjan Islamic Azad University, Isfahan, Iran
| | | | - Marzieh Rahim Khorasani
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Shoaei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Ebrahimi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Molecular Characteristics of IS 1216 Carrying Multidrug Resistance Gene Cluster in Serotype III/Sequence Type 19 Group B Streptococcus. mSphere 2021; 6:e0054321. [PMID: 34319128 PMCID: PMC8386385 DOI: 10.1128/msphere.00543-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Streptococcus agalactiae is the leading cause of meningitis in newborns and a significant cause of invasive diseases in pregnant women and adults with underlying diseases. Antibiotic resistance against erythromycin and clindamycin in group B streptococcus (GBS) isolates has been increasing worldwide. GBS expresses the Srr1 and Srr2 proteins, which have important roles in bacterial infection. They have been investigated as novel vaccine candidates against GBS infection, with promising results. But a recent study detected non-srr1/2-expressing clinical isolates belonging to serotype III. Thus, we aimed to analyze the genotypes of non-srr1/2 GBS clinical isolates collected between 2013 and 2016 in South Korea. Forty-one (13.4%) of the 305 serotype III isolates were identified as non-srr1/2 strains, including sequence type 19 (ST19) (n = 16) and ST27 (n = 18) strains. The results of the comparative genomic analysis of the ST19/serotype III/non-srr1/2 strains further revealed four unique gene clusters. Site 4 in the srr1 gene locus was replaced by an lsa(E)-lnu(B)-aadK-aac-aph-aadE-carrying multidrug-resistant gene cluster flanked by two IS1216 transposases with 99% homology to the enterococcal plasmid pKUB3007-1. Despite the Srr1 and Srr2 deficiencies, which resulted in reduced fibrinogen binding, the adherence of non-srr1/2 strains to endothelial and epithelial cells was comparable to that of Srr1- or Srr2-expressing strains. Moreover, their virulence in mouse models of meningitis was not significantly affected. Furthermore, additional adhesin-encoding genes, including a gene encoding a BspA-like protein, which may contribute to colonization by non-srr1/2 strains, were identified via whole-genome analysis. Thus, our study provides important findings that can aid in the development of vaccines and antibiotics against GBS. IMPORTANCE Most previously isolated group B streptococcus (GBS) strains express either the Srr1 or Srr2 glycoprotein, which plays an important role in bacterial colonization and invasion. These glycoproteins are potential protein vaccine candidates. In this study, we first report GBS clinical isolates in which the srr1/2 gene was deleted or replaced with foreign genes. Despite Srr1/2 deficiency, in vitro adherence to mammalian cells and in vivo virulence in murine models were not affected, suggesting that the isolates might have another adherence mechanism that enhanced their virulence aside from Srr1/2-fibrinogen-mediated adherence. In addition, several non-srr1/2 isolates replaced the srr1/2 gene with the lnu(B) and lsa(E) antibiotic resistance genes flanked by IS1216, effectively causing multidrug resistance. Collectively, we believe that our study identifies the underlying genes responsible for the pathogenesis of new GBS serotype III. Furthermore, our study emphasizes the need for alternative antibiotics for patients who are allergic to β-lactams and for those who are pregnant.
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Gao J, Tang Y, Sun X, Chen Q, Peng Y, Tsai CJY, Chen Q. Downregulation of Ribosomal Contents and Kinase Activities Is Associated with the Inhibitive Effect on the Growth of Group B Streptococcus Induced by Placental Extracellular Vesicles. BIOLOGY 2021; 10:664. [PMID: 34356519 PMCID: PMC8301483 DOI: 10.3390/biology10070664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Like many other cell types, the human placenta produces large amounts of extracellular vesicles (EVs). Increasing evidence has shown that placental EVs contribute to the regulation of maternal immune and vascular systems during pregnancy via the transfer of their cargos. In this study, we investigated the effect of placental EVs on the growth of opportunistic pathogens that commonly colonise the female reproductive tract. METHODS Gram-positive bacterium Group B Streptococcus (GBS) and Gram-negative bacterium Escherichia coli (E. coli) were treated with placental EVs that were collected from placental explant cultures, and the growth, susceptibility, and resistance to antibiotics of the bacteria were measured. In addition, comparative proteomics analysis was also performed for the GBS with or without exposure to placental EVs. RESULTS When treated with placental micro-EVs or nano-EVs, the GBS growth curve entered the stationary phase earlier, compared to untreated GBS. Treatment with placental EVs also inhibited the growth of GBS on solid medium, compared to untreated GBS. However, these biological activities were not seen in E. coli. This attenuative effect required interaction of placental EVs with GBS but not phagocytosis. In addition, the susceptibility or resistance to antibiotics of GBS or E. coli was not directly affected by treatment with placental EVs. The proteomic and Western blotting analysis of GBS that had been treated with placental EVs suggested that the downregulation of cellular components and proteins associated with phosphorylation and cell energy in GBS may contribute to these attenuative effects. CONCLUSION We demonstrated the attenuative effect of the growth of GBS treated with placental EVs. Downregulation of cellular components and proteins associated with phosphorylation and cell energy may contribute to the physiological changes in GBS treated with placental EVs.
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Affiliation(s)
- Jing Gao
- Department of Medical Laboratory, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai 200081, China; (J.G.); (Y.P.)
| | - Yunhui Tang
- Department of Family Planning, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai 200081, China
| | - Xinyi Sun
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland 1142, New Zealand; (X.S.); (Q.C.)
| | - Qiujing Chen
- Institute of Cardiovascular Disease, Ruijing Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200081, China;
| | - Yiqian Peng
- Department of Medical Laboratory, The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai 200081, China; (J.G.); (Y.P.)
| | - Catherine Jia-Yun Tsai
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland 1142, New Zealand;
| | - Qi Chen
- Department of Obstetrics & Gynaecology, The University of Auckland, Auckland 1142, New Zealand; (X.S.); (Q.C.)
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Finale E, Spadea T, Mondo L, Arnulfo A, Capuano A, Ghiotti P, Barbaglia M, Guala A. Streptococcus agalactiae in pregnancy and the impact of recommendations on adherence to guidelines: an Italian area-based study. J Matern Fetal Neonatal Med 2021; 35:7826-7830. [PMID: 34112050 DOI: 10.1080/14767058.2021.1937982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Streptococcus agalactiae, a species of β-haemolytic streptococcus belonging to Lancefield's group B (GBS), is known as a common infecting agent transmitted to infants during childbirth, causing sepsis, meningitis, or both, with a high incidence of mortality. Following the observation of a great variability between regional laboratories both in the methodology and in the results of tests for the detection of GBS in pregnancy, with high percentages of false negative results, in 2010 the Department for Health Policies of Piedmont, Italian region, issued specific recommendations for adhere to international guidelines. Our aim was to assess whether the impact of the publication of the recommendations has been lasting over time. METHODS We analyzed the regional birth certificate register from 2006 to 2018, to evaluate the annual number of deliveries, the number of Streptococcus agalactiae tests in pregnancy and the percentage of positive culture results. We also evaluated the consistency of the percentage of positive tests with the expectations based on the guidelines and compared the two time periods before and after introduction of regional recommendations using a multivariate regression model. RESULTS The mean proportion of women tested for GBS vaginal-rectal swabs during pregnancy increased from 83.5% in 2006 to 90.7% in 2018 with the biggest rise in 2010, the t-test for the comparison of the two means was statistically significant (p < .001). The mean positivity rate increased from 12.7% to 19.2%, with a rise in 2010, with a significant t-test (p < .001). CONCLUSION The results suggested a significant impact of the recommendations on the compliance and results regarding the carrying out and culture of vagino-rectal swabs for GBS, with better appropriateness of peripartum antibiotic therapy and possible reduction of GBS related neonatal sepsis.
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Affiliation(s)
- Enrico Finale
- Dipartimento Materno-Infantile ASL VCO, Verbania, Italia
| | - Teresa Spadea
- Servizio Sovrazonale di Epidemiologia ASL TO3, Grugliasco, Italia
| | - Luisa Mondo
- Servizio Sovrazonale di Epidemiologia ASL TO3, Grugliasco, Italia
| | | | - Andrea Capuano
- Dipartimento Materno-Infantile ASL VCO, Verbania, Italia
| | | | | | - Andrea Guala
- Dipartimento Materno-Infantile ASL VCO, Verbania, Italia
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Khalil MR, Thorsen PB, Møller JK, Uldbjerg N. Polymerase chain reaction for Group B Streptococci (GBS) at labor highly correlates with vaginal GBS load. J Matern Fetal Neonatal Med 2021; 35:6782-6786. [PMID: 33969778 DOI: 10.1080/14767058.2021.1922383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore factors associated with a high vaginal GBS load during labor considering (1) the recto-vaginal GBS load at 35-37 weeks' gestation determined by culture and (2) the vaginal GBS colonization determined by a polymerase chain reaction (PCR) assay during labor. METHODS From an unselected cohort of 902 pregnant women, we obtained (1) recto-vaginal swabs for culture of GBS at 35-37 weeks' gestation (GBSrectovag-36), (2) vaginal swabs for GBS PCR detection at labor (PCRvag-labor), and (3) vaginal swabs for culture of GBS at labor (GBSvag-labor). The GBS load was classified semi quantitatively according to a culture protocol without prior broth enrichment of the swab samples: none (0), few (+), some (++), or many (+++) GBS colonies. RESULTS Among 902 unselected pregnant women, 859 (95%) had a vaginal swab culture taken at labor, which was classified semi quantitatively. High load GBSvag-labor (+++) were found in 31 participants. GBSrectovag-36 showed a sensitivity of 90% (28/31) and a PPV of 23% (28/121), whereas PCRvag-labor had a sensitivity of 98% (30/31, non-significant difference) and a PPV of 42% (30/71, p < .01). PCR at labor had a lower sensitivity (78%) for detection of vaginal colonization with GBS at labor (any load) compared to recto/vaginal colonization with GBS at 36 weeks (92%). Vaginal colonization with GBS at 36 weeks seemed to have a lower sensitivity for detecting GBS in vagina at labor for high load (48%) and for any load (39%). CONCLUSION PCR at labor has higher detection rate (non-significant) and PPV in identification of laboring women with a high load of vaginal GBS compared with recto-vaginal culture at 36 weeks' gestation.
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Affiliation(s)
- Mohammed Rohi Khalil
- Department of Gynecology and Obstetrics, University Hospital of Southern Denmark, Lillebaelt Hospital, Kolding, Denmark
| | - Poul Bak Thorsen
- Department of Gynecology and Obstetrics, University Hospital of Southern Denmark, Lillebaelt Hospital, Kolding, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Ari MD, Iskander J, Araujo J, Casey C, Kools J, Chen B, Swain R, Kelly M, Popovic T. A science impact framework to measure impact beyond journal metrics. PLoS One 2020; 15:e0244407. [PMID: 33351845 PMCID: PMC7755179 DOI: 10.1371/journal.pone.0244407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/08/2020] [Indexed: 11/19/2022] Open
Abstract
Measuring the impact of public health science or research is important especially when it comes to health outcomes. Achieving the desired health outcomes take time and may be influenced by several contributors, making attribution of credit to any one entity or effort problematic. Here we offer a science impact framework (SIF) for tracing and linking public health science to events and/or actions with recognized impact beyond journal metrics. The SIF was modeled on the Institute of Medicine's (IOM) Degrees of Impact Thermometer, but differs in that SIF is not incremental, not chronological, and has expanded scope. The SIF recognizes five domains of influence: disseminating science, creating awareness, catalyzing action, effecting change and shaping the future (scope differs from IOM). For public health, the goal is to achieve one or more specific health outcomes. What is unique about this framework is that the focus is not just on the projected impact or outcome but rather the effects that are occurring in real time with the recognition that the measurement field is complex, and it takes time for the ultimate outcome to occur. The SIF is flexible and can be tailored to measure the impact of any scientific effort: from complex initiatives to individual publications. The SIF may be used to measure impact prospectively of an ongoing or new body of work (e.g., research, guidelines and recommendations, or technology) and retrospectively of completed and disseminated work, through linking of events using indicators that are known and have been used for measuring impact. Additionally, linking events offers an approach to both tell our story and also acknowledge other players in the chain of events. The value added by science can easily be relayed to the scientific community, policy makers and the public.
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Affiliation(s)
- Mary D. Ari
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - John Iskander
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - John Araujo
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Christine Casey
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - John Kools
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Bin Chen
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Robert Swain
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Miriam Kelly
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Tanja Popovic
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Wang T, Udomkittivorakul N, Bonfield M, Nadeem A, Gray J, Deshmukh H. Early life antibiotic exposure and host health: Role of the microbiota-immune interaction. Semin Perinatol 2020; 44:151323. [PMID: 33187735 DOI: 10.1016/j.semperi.2020.151323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The neonatal population is at high risk for infections secondary to a unique, developing immune system. While a multitude of factors direct the development of the immune system, the role of environmental exposures on the microbiota may play a critical and potentially modifiable role. Recent evidence suggests that the disruption of the microbiota through the use of antibiotics not only leads to an immediately increased risk for neonatal complications but also long-term health issues related to autoimmune and inflammatory diseases. The exact cellular and molecular mechanisms behind these associations between the microbiota and neonatal outcomes are still under investigation. This review will examine the mechanistic interactions between the microbiota and the immune system, particularly in early life, along with how antibiotic mediated aberrations of the microbiome potentially lead to disease.
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Affiliation(s)
- Timothy Wang
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA.
| | - Natsumon Udomkittivorakul
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
| | - Madeline Bonfield
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA; Immunology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Amraha Nadeem
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
| | - Jerilyn Gray
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
| | - Hitesh Deshmukh
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45219, USA
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Systematic review of Group B Streptococcal capsular types, sequence types and surface proteins as potential vaccine candidates. Vaccine 2020; 38:6682-6694. [PMID: 32888741 PMCID: PMC7526974 DOI: 10.1016/j.vaccine.2020.08.052] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 01/31/2023]
Abstract
Most comprehensive review of Group B Streptococcal serotypes through 2018. First systematic review of Group B Streptococcal strain type and protein data. Theoretically candidate vaccines may protect against 93-99% disease-causing strains. More studies on GBS strains in low- and middle-income countries are needed.
Background 21 million pregnant women worldwide (18%) are estimated to carry Group B Streptococcus (GBS), which is a risk for invasive disease in newborns, pregnant women, and stillbirths. Adults ≥ 60 years or with underlying health conditions are also vulnerable to invasive GBS disease. We undertook systematic reviews on GBS organism characteristics including: capsular polysaccharide (serotype), sequence type (multi-locus sequence types (MLST)), and virulence proteins. We synthesised data by at-risk populations, to inform vaccine development. Methods We conducted systematic reviews and meta-analyses to estimate proportions of GBS serotypes for at risk populations: maternal colonisation, invasive disease in pregnant women, stillbirths, infants 0–90 days age, and older adults (≥60 years). We considered regional variation and time trends (2001–2018). For these at-risk population groups, we summarised reported MLST and surface proteins. Results Based on 198 studies (29247isolates), 93–99% of GBS isolates were serotypes Ia, Ib, II, III, IV and V. Regional variation is likely, but data gaps are apparent, even for maternal colonisation which has most data. Serotype III dominates for infant invasive disease (60%) and GBS-associated stillbirths (41%). ST17 accounted for a high proportion of infant invasive disease (41%; 95%CI: 35–47) and was found almost exclusively in serotype III strains, less present in maternal colonisation (9%; 95%CI:6–13),(4%; 95%CI:0–11) infant colonisation, and adult invasive disease (4%, 95%CI:2–6). Percentages of strains with at least one of alp 1, alp2/3, alpha C or Rib surface protein targets were 87% of maternal colonisation, 97% infant colonisation, 93% infant disease and 99% adult invasive disease. At least one of three pilus islands proteins were reported in all strains. Discussion A hexavalent vaccine (serotypes Ia, Ib, II, III, IV and V) might provide comprehensive cover for all at-risk populations. Surveillance of circulating, disease-causing target proteins is useful to inform vaccines not targeting capsular polysaccharide. Addressing data gaps especially by world region and some at-risk populations (notably stillbirths) is fundamental to evidence-based decision-making during vaccine design.
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Khalil MR, Uldbjerg N, Thorsen PB, Møller JK. Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35-37 weeks of pregnancy. Int J Gynaecol Obstet 2020; 151:124-127. [PMID: 32521063 DOI: 10.1002/ijgo.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/02/2020] [Accepted: 06/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether systematic antepartum screening for Group B Streptococci (GBS) by urine culture improves the risk factor-based selection of pregnant women for intrapartum GBS screening with a rapid polymerase chain reaction (PCR) assay. METHODS A prospective observational study was conducted between April 2013 and June 2014. GBS colonization judged by urine culture at 35-37 weeks of gestation was compared with the result of a vaginal GBS PCR test at labor as outcome. The results of urine culture were used as exposure variable. The PCR test was performed on intrapartum vaginal samples. RESULTS Screening for urine GBS in 902 unselected pregnant Danish women at 35-37 weeks of gestation predicted intrapartum PCR GBS status with a sensitivity of 33.6%. A positive predictive value of 41.2% was seen among women with low GBS counts (<104 CFU/mL) and 83.3% among women with high GBS counts (≥104 CFU/mL). Systematic GBS screening of urine at 35-37 weeks of gestation added 30.9% extra women for intrapartum GBS PCR screening in the study group. CONCLUSION Systematic antepartum GBS screening of urine should be implemented in order to improve risk stratification for early onset GBS by offering laboring women an intrapartum GBS PCR test.
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Affiliation(s)
- Mohammed R Khalil
- Department of Gynecology and Obstetrics, University Hospital of Southern Denmark, Lillebaelt Hospital, Kolding, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Poul B Thorsen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Vejle Hospital, Vejle, Denmark
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20
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Nielsen SY, Møller JK, Khalil MR. A comparison of GenomEra® GBS PCR and GeneXpert ® GBS PCR assays with culture of GBS performed with and without broth pre-enrichment. Eur J Clin Microbiol Infect Dis 2020; 39:1945-1950. [PMID: 32535806 PMCID: PMC7497322 DOI: 10.1007/s10096-020-03934-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/24/2020] [Indexed: 12/31/2022]
Abstract
This study was designed to compare the performance of GeneXpert® and GenomEra® group B streptococcus (GBS) PCR assays, held up against standard culture of GBS performed with and without broth pre-enrichment. In Denmark, the strategy for preventing early onset GBS infection (EOGBS) is risk factor based. Three hundred and sixty six women fulfilling one or more of the criteria for presence of risk factors for EOGBS were prospectively included. Rectovaginal swab samples were taken intrapartum and tested bed-site by the GenomEra® and the GeneXpert® GBS PCR assays and cultured at the microbiology laboratory using Granada agar plates with and without prior growth of sampling material in selective enrichment broth. Among 366 participants tested intrapartum, 99 were GBS-positive by culture, 95 by GenomEra, and 95 by GeneXpert. Compared with culture, the GenomEra and the GeneXpert performed with a sensitivity of 91.8% and 91.7% and a specificity of 98.1% and 97.3%, respectively. A combined reference standard was established by defining true positives as either culture-positive samples or culture-negative samples where both the GeneXpert and the GenomEra GBS PCR assays were positive. Using this, the sensitivity increased to 92.2% and the specificity to 99.6% for GenomEra and to 92.0% and 96.8% for GeneXpert. The use of selective broth enrichment found only three additional GBS culture-positive samples. The performance of the two PCR methods examined was very similar and close to the findings by culture, and both PCR assays are thus applicable as rapid intrapartum bed-site tests.
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Affiliation(s)
- S Y Nielsen
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Odense, Denmark. .,Department of Clinical Microbiology, Vejle Hospital, Aarhus University Hospital, Aarhus, Denmark.
| | - J K Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Odense, Denmark
| | - M R Khalil
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Odense, Denmark
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21
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Vieira LL, Perez AV, Machado MM, Kayser ML, Vettori DV, Alegretti AP, Ferreira CF, Vettorazzi J, Valério EG. Group B Streptococcus detection in pregnant women: comparison of qPCR assay, culture, and the Xpert GBS rapid test. BMC Pregnancy Childbirth 2019; 19:532. [PMID: 31888631 PMCID: PMC6937909 DOI: 10.1186/s12884-019-2681-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
Background Group B Streptococcus (GBS) is one of the most important causative agents of neonatal sepsis. As administration of prophylactic antibiotics during labor can prevent GBS infection, routine screening for this bacterium in prenatal care before the onset of labor is recommended. However, many women present in labor without having undergone such testing during antenatal care, and the turnaround time of detection methods is insufficient for results to be obtained before delivery. Methods Vaginal and anorectal specimens were collected from 270 pregnant women. Each sample was tested by Xpert GBS, qPCR, and culture for GBS detection. Results The overall prevalence of maternal GBS colonization was 30.7% according to Xpert GBS, 51.1% according to qPCR, and 14.3% according to cultures. Considering the qPCR method as the reference, the Xpert GBS had a sensitivity of 53% and specificity of 93%. Positive Xpert GBS results were correlated to marital status (married or cohabitating) and with prematurity as a cause of neonatal hospitalization. Positive cultures were related with ischemic–hypoxic encephalopathy requiring therapeutic hypothermia. Conclusions Combined enrichment/qPCR and the Xpert GBS rapid test found a high prevalence of GBS colonization. The Xpert GBS technique gives faster results and could be useful for evaluating mothers who present without antenatal GBS screening results and are at risk of preterm labor, thus allowing institution of prophylactic antibiotic therapy.
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Affiliation(s)
- Laura L Vieira
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Amanda V Perez
- Serviço de Obstetrícia e Ginecologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350/1124, Santa Cecília, Porto Alegre, RS, CEP: 90035-903, Brazil.
| | - Monique M Machado
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Michele L Kayser
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Daniela V Vettori
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ana Paula Alegretti
- Department of Molecular Biology, Clinical Hospital of Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Charles F Ferreira
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Janete Vettorazzi
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Edimárlei G Valério
- Department of Gynaecology and Obstetrics Postgraduation Program in Health Sciences: Gynaecology and Obstetrics (PPGGO), School of Medicine (FAMED), Clinical Hospital of Porto Alegre (HCPA). Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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22
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Wójkowska-Mach J, Chmielarczyk A, Strus M, Lauterbach R, Heczko P. Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention. J Clin Med 2019; 8:E1750. [PMID: 31640253 PMCID: PMC6832148 DOI: 10.3390/jcm8101750] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
The term neonatal sepsis is used to describe a generalized bloodstream infection of bacterial, viral, or fungal origin which is associated with hemodynamic changes and other clinical symptoms and signs, however, there is no unified definition. There are no basic criteria regarding differentiation of early-onset sepsis (EOS) versus late-onset sepsis (LOS). Stratification used in studies on neonatal sepsis also rarely includes the general condition of the newborn according to unambiguous assessment at birth, which hampers the establishment of a clear, uniform epidemiological description of neonatal sepsis. We aim to review the published data about the epidemiology and microbiology of sepsis in Organization for Economic Cooperation and Development (OECD) countries. Data was also collected on sepsis prevention programs that can be implemented in neonatal units. The outcomes of interest were incidence or incidence density of EOS and LOS, microbiology of EOS and LOS, and data on the methodology of the research, in particular the criteria for inclusion and exclusion of newborns from the study. Pubmed, EMBASE, LILACS Embase, Scopus, and Google Scholar were used. For the preselection step, inclusion criteria included: "bloodstream infection" or "neonatal sepsis" (MesH), "very low birth weight", and "country" full-text studies, human, and English language. Exclusion criteria included: studies published in languages other than English and studies available only as an abstracts. For proper selection, inclusion criteria included: information about epidemiology or microbiology bloodstream infection (BSI), study population and case definitions, exclusion criteria, narrative reviews, commentaries, case studies, pilot studies, study protocols, pediatric studies, and only clinical data (without microbiology or epidemiology) or studies with only one etiological factor analysis. The data review indicated the lack of an unequivocal, unified definition and no unambiguous basic criteria with regard to differentiation of EOS versus LOS. Among infants <1500 g, studies reported an EOS rate from 7% to 2%. For studies using other definitions (mostly all inborn babies), the rate of EOS ranged from 1% to 3%. The LOS incidences were much more varied among countries; the highest rates were in the multicenter studies focused on very low birth weight (VLBW) infants. The main pathogens in EOS are GBS and Gram-negative bacteria in LOS. Our review data shows that LOS microbiology is very diverse and that Gram-positive cocci, especially staphylococci, predominate versus Gram-negative rods. Unfortunately, the lack of uniform, international prevention programs results in high newborn morbidity and insufficient postnatal prevention of late-onset infections.
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Affiliation(s)
- Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
| | - Agnieszka Chmielarczyk
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
| | - Magdalena Strus
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
| | - Ryszard Lauterbach
- Neonatology Clinic, University Hospital, Jagiellonian University Medical College, 31-121 Kraków, Poland.
| | - Piotr Heczko
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland.
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23
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Lin Y, Ye J, Luo M, Hu B, Wu D, Wen J, Yang C, Li Y, Ning Y. Group B Streptococcus DNA Copy Numbers Measured by Digital PCR Correlates with Perinatal Outcomes. Anal Chem 2019; 91:9466-9471. [PMID: 31269399 DOI: 10.1021/acs.analchem.8b05872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Group B Streptococcus (GBS) is a one of the main causes of perinatal disease, yet the method for GBS detection, broth-enriched culture, is time-consuming and has low sensitivity and accuracy. We aimed to develop a GBS digital PCR (GBS-dPCR) assay for detecting GBS colonization. More rapid and accurate detection of GBS colonization could increase GBS diagnosis and treatment closer to delivery. A single-center, retrospective, case-controlled study was performed. A total of 182 rectovaginal swabs from pregnant women, who were undergoing prenatal screening by broth-enriched culture, were evaluated using GBS-dPCR targeting the cfb gene of GBS. Pregnant women with GBS colonization were followed up for correlation analysis between GBS DNA copy numbers and perinatal outcomes. The results of the GBS-dPCR assay were compared to those from the broth-enriched culture, which is the gold standard for GBS detection. The sensitivity and specificity of GBS-dPCR were 98% and 92.5%, respectively. By discrepant result analysis, the specificity of GBS-dPCR was raised to 97.4%. The incidence of premature rupture of membrane (PROM) and neonatal infection were statistically significantly positively correlated with GBS DNA copy numbers. GBS-dPCR has the advantage of directly detecting GBS colonization from swabs with high specificity and sensitivity, while reducing turnaround time (<4 h). Analysis of clinical samples with GBS-dPCR shows that GBS DNA copy numbers are positively correlated with the incidence of PROM and neonatal infection, suggesting that dPCR is a promising method for detection of GBS colonization during pregnancy.
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Affiliation(s)
- Yanqing Lin
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China.,Affiliated Shenzhen Maternity & Healthcare Hospital , Southern Medical University , Shenzhen 518028 , People's Republic of China
| | - Jianbin Ye
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China.,Zhuhai SMU Biomedicine Public Service Platform LLC , Zhuhai 519040 , People's Republic of China
| | - Meiqun Luo
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China
| | - Bingxin Hu
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China
| | - Danlin Wu
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China
| | - Junjie Wen
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China
| | - Chuanzhong Yang
- Affiliated Shenzhen Maternity & Healthcare Hospital , Southern Medical University , Shenzhen 518028 , People's Republic of China
| | - Yan Li
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China
| | - Yunshan Ning
- School of Laboratory Medicine and Biotechnology , Southern Medical University , Guangzhou 510515 , People's Republic of China
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24
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Neonatal Group B Streptococcal Infection in a Tertiary Care Hospital in Saudi Arabia: A 13-year Experience. Pediatr Infect Dis J 2019; 38:731-734. [PMID: 31192978 DOI: 10.1097/inf.0000000000002269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Group B streptococcus (GBS) is a leading cause of neonatal bacterial sepsis and meningitis globally. Studies concerning the incidence and burden of neonatal GBS disease in Saudi Arabia are lacking. This study determined the incidence and burden of GBS infection among neonates in association with maternal GBS screening. METHODS A retrospective cohort chart review study included all neonatal GBS disease cases identified through microbiology lab records within the first 90 days of life in the hospital from January 2004 to December 2016. Charts were reviewed to collect maternal and neonatal characteristics using a standardized form. RESULTS Over 13 years, of 108,609 live births, 55 GBS disease cases were identified (overall incidence, 0.51/1000 live births), 69.1% (n = 38) of those had early onset disease (EOD). The annual incidence in 2015 and 2016 was significantly higher than in any previous year (P < 0.0001), coinciding with the discontinuation of routine universal maternal GBS screening. Median age at presentation was 1 day (range, 0-54 days). We found that 67.3% (n = 37) of mothers were not screened antenatally, 72.9% (n = 27) of whom had neonates present with EOD. Neonates of unscreened mothers were more likely to have GBS disease (P = 0.01) and to present with EOD (P = 0.005). Urinary tract infection was the most common manifestation (47.3%, n = 26), followed by sepsis (43.6%, n = 24). Mortality rate was 3.6% (n = 2). CONCLUSIONS The incidence of neonatal GBS infection in Saudi Arabia is similar to the worldwide incidence. Universal antenatal screening discontinuation was significantly associated with an increase in EOD incidence.
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25
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Streptococcus agalactiae Strains with Chromosomal Deletions Evade Detection with Molecular Methods. J Clin Microbiol 2019; 57:JCM.02040-18. [PMID: 30760532 DOI: 10.1128/jcm.02040-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/03/2019] [Indexed: 01/28/2023] Open
Abstract
Surveillance of circulating microbial populations is critical for monitoring the performance of a molecular diagnostic test. In this study, we characterized 31 isolates of Streptococcus agalactiae (group B Streptococcus [GBS]) from several geographic locations in the United States and Ireland that contain deletions in or adjacent to the region of the chromosome that encodes the hemolysin gene cfb, the region targeted by the Xpert GBS and GBS LB assays. PCR-negative, culture-positive isolates were recognized during verification studies of the Xpert GBS assay in 12 laboratories between 2012 and 2018. Whole-genome sequencing of 15 GBS isolates from 11 laboratories revealed four unique deletions of chromosomal DNA ranging from 181 bp to 49 kb. Prospective surveillance studies demonstrated that the prevalence of GBS isolates containing deletions in the convenience sample was <1% in three geographic locations but 7% in a fourth location. Among the 15 isolates with chromosomal deletions, multiple pulsed-field gel electrophoresis types were identified, one of which appears to be broadly dispersed across the United States.
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26
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Esposito S, Rinaldi VE, Argentiero A, Farinelli E, Cofini M, D'Alonzo R, Mencacci A, Principi N. Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection. Mediators Inflamm 2018; 2018:4869329. [PMID: 30581369 PMCID: PMC6287153 DOI: 10.1155/2018/4869329] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/07/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Among neonates and infants <3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clinical parameters have been developed. The aim of this review is to describe the management of young infants with FWS and to discuss the impact of recent knowledge regarding FWS management on clinical practice. MATERIALS AND METHODS PubMed was used to search for all of the studies published over the last 35 years using the keywords: "fever without source" or "fever of unknown origin" or "meningitis" or "sepsis" or "urinary tract infection" and "neonate" or "newborn" or "infant <90 days of life" or "infant <3 months". RESULTS AND DISCUSSION The selection of neonates and young infants who are <3 months old with FWS who are at risk for SBI remains a problem without a definitive solution. The old Rochester criteria remain effective for identifying young infants between 29 and 60 days old who do not have severe bacterial infections (SBIs). However, the addition of laboratory tests such as C-reactive protein (CRP) and procalcitonin (PCT) can significantly improve the identification of children with SBI. The approach in evaluating neonates is significantly more complicated, as their risk of SBIs, including bacteremia and meningitis, remains relevant and none of the suggested approaches can reduce the risk of dramatic mistakes. In both groups, the best antibiotic must be carefully selected considering the clinical findings, the laboratory data, the changing epidemiology, and increasing antibiotic resistance of the most common infectious bacteria.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Victoria Elisa Rinaldi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Edoardo Farinelli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Renato D'Alonzo
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Antonella Mencacci
- Microbiology Unit, Department of Medicine, Università degli Studi di Perugia, Perugia, Italy
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27
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Madhi SA, Koen A, Cutland CL, Jose L, Govender N, Wittke F, Olugbosi M, Sobanjo-Ter Meulen A, Baker S, Dull PM, Narasimhan V, Slobod K. Antibody Kinetics and Response to Routine Vaccinations in Infants Born to Women Who Received an Investigational Trivalent Group B Streptococcus Polysaccharide CRM197-Conjugate Vaccine During Pregnancy. Clin Infect Dis 2018; 65:1897-1904. [PMID: 29029127 PMCID: PMC5848233 DOI: 10.1093/cid/cix666] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/22/2017] [Indexed: 11/27/2022] Open
Abstract
Background Maternal vaccination against group B Streptococcus (GBS) might provide protection against invasive GBS disease in infants. We investigated the kinetics of transplacentally transferred GBS serotype-specific capsular antibodies in the infants and their immune response to diphtheria toxoid and pneumococcal vaccination. Methods This phase 1b/2, observer-blind, single-center study (NCT01193920) enrolled infants born to women previously randomized (1:1:1:1) to receive either GBS vaccine at dosages of 0.5, 2.5, or 5.0 μg of each of 3 CRM197-glycoconjugates (serotypes Ia, Ib, and III), or placebo. Infants received routine immunization: combination diphtheria vaccine (diphtheria-tetanus-acellular pertussis–inactivated poliovirus/Haemophilus influenzae type b vaccine; age 6/10/ 14 weeks) and 13-valent pneumococcal CRM197-conjugate vaccine (PCV13; age 6/14 weeks and 9 months). Antibody levels were assessed at birth, day (D) 43, and D91 for GBS serotypes; 1 month postdose 3 (D127) for diphtheria; and 1 month postprimary (D127) and postbooster (D301) doses for pneumococcal serotypes. Results Of 317 infants enrolled, 295 completed the study. In infants of GBS vaccine recipients, GBS serotype-specific antibody geometric mean concentrations were significantly higher than in the placebo group at all timepoints and predictably decreased to 41%–61% and 26%–76% of birth levels by D43 and D91, respectively. Across all groups, ≥95% of infants were seroprotected against diphtheria at D127 and ≥91% of infants had seroprotective antibody levels against each PCV13 pneumococcal serotype at D301. Conclusions Maternal vaccination with an investigational CRM197-glycoconjugate GBS vaccine elicited higher GBS serotype-specific antibody levels in infants until 90 days of age, compared with a placebo group, and did not affect infant immune responses to diphtheria toxoid and pneumococcal vaccination. Clinical Trials Registration NCT01193920.
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Affiliation(s)
- 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.,National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa
| | - Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand
| | - Lisa Jose
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand
| | - Niresha Govender
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand
| | | | | | | | - Sherryl Baker
- GSK and Novartis Vaccines Division, Cambridge, Massachusetts
| | - Peter M Dull
- GSK and Novartis Vaccines Division, Cambridge, Massachusetts
| | - Vas Narasimhan
- GSK and Novartis Vaccines Division, Cambridge, Massachusetts
| | - Karen Slobod
- GSK and Novartis Vaccines Division, Cambridge, Massachusetts
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28
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Liu J, Xu R, Zhong H, Zhong Y, Xie Y, Li L, Li B, Chen D, Xu Z. RETRACTED: Prevalence of GBS serotype III and identification of a ST 17-like genotype from neonates with invasive diseases in Guangzhou, China. Microb Pathog 2018; 120:213-218. [DOI: 10.1016/j.micpath.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/27/2018] [Accepted: 05/02/2018] [Indexed: 10/25/2022]
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29
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Otaguiri ES, Morguette AEB, Morey AT, Tavares ER, Kerbauy G, de Almeida Torres RSL, Chaves Júnior M, Tognim MCB, Góes VM, Krieger MA, Perugini MRE, Yamauchi LM, Yamada-Ogatta SF. Development of a melting-curve based multiplex real-time PCR assay for simultaneous detection of Streptococcus agalactiae and genes encoding resistance to macrolides and lincosamides. BMC Pregnancy Childbirth 2018; 18:126. [PMID: 29724169 PMCID: PMC5934892 DOI: 10.1186/s12884-018-1774-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/25/2018] [Indexed: 01/25/2023] Open
Abstract
Background Streptococcus agalactiae or Group B Streptococcus (GBS) remains the leading cause of infections in newborns worldwilde. Prenatal GBS screening of pregnant women for vaginal-rectal colonization is recommended in many countries to manage appropriate intrapartum antimicrobial prophylaxis for those identified as carriers. In this study, a novel melting-curve based multiplex real-time PCR assay for the simultaneous detection of GBS and macrolide and lincosamide resistance markers was developed. The usefulness of the assay was evaluated for rapid and accurate prenatal GBS screening. Methods One hundred two pregnant women who were at 35–37 weeks of gestation were enrolled in this study. The analytical performance of the multiplex real-time PCR was first tested using a panel of reference and clinical bacterial and fungal strains. To test the clinical performance, vaginal-rectal swabs were obtained from pregnant women who were seen at the teaching hospital for regular prenatal care. The results of real-time were compared with those obtained from microbiological analyses. Results The real-time PCR assay showed 100% specificity and a limit of detection of 104 colony forming units equivalent per reaction. The prevalence of GBS colonization among the population studied was 15.7% (16/102) based on a positive culture and the real-time PCR results. Agreement between the two assays was found for 11 (68.75%) GBS colonized women. Using the culture-based results as a reference, the multiplex real-time PCR had a sensitivity of 91.7% (11/12, CI 59.7–99.6%), a specificity of 95.5% (86/90, CI 89.8–98.7%), a positive predictive value of 73.3% (11/15, CI 44.8–91.1%) and a negative predictive value of 98.9% (86/87, CI 92.9–99.9%). Conclusion The multiplex real-time PCR is a rapid, affordable and sensitive assay for direct detection of GBS in vaginal-rectal swabs. Electronic supplementary material The online version of this article (10.1186/s12884-018-1774-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eliane Saori Otaguiri
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Ana Elisa Belotto Morguette
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Alexandre Tadachi Morey
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Eliandro Reis Tavares
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Gilselena Kerbauy
- Departamento de Enfermagem, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Rosângela S L de Almeida Torres
- Laboratory of Bacteriology, Epidemiology Laboratory and Disease Control Division, Laboratório Central do Estado do Paraná - LACEN, Curitiba, PR, Brazil
| | - Mauricio Chaves Júnior
- Departamento de Medicina, Hospital Universitário de Maringá, Universidade Estadual de Maringá, Maringá, Brazil
| | | | | | | | - Marcia Regina Eches Perugini
- Departamento de Patologia, Análises Clínicas e Toxicológicas, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Lucy Megumi Yamauchi
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Sueli Fumie Yamada-Ogatta
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Paraná, Brazil. .,Departamento de Microbiologia, Universidade Estadual de Londrina, Centro de Ciências Biológicas, Rodovia Celso Garcia Cid, PR 445, km 380. CEP, Londrina, 86057-970, Brazil.
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30
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Seedat F, Cooper JA, Uthman OA, Takwoingi Y, Robinson ER, Kandala NB, Stranges S, Taylor-Phillips S. Real-time polymerase chain reaction tests versus antenatal culture tests for the screening of maternal group B Streptococcus colonisation in labour. Hippokratia 2018. [DOI: 10.1002/14651858.cd013016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Farah Seedat
- University of Warwick; Division of Health Sciences, Warwick Medical School; Coventry UK CV4 7AL
| | - Jennifer A Cooper
- University of Warwick; Division of Health Sciences, Warwick Medical School; Coventry UK CV4 7AL
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of Warwick; Warwick Centre for Applied Health Research and Delivery (WCAHRD); Coventry UK CV4 7AL
| | - Yemisi Takwoingi
- University of Birmingham; Institute of Applied Health Research; Edgbaston Birmingham UK B15 2TT
| | - Esther R Robinson
- Heartlands Hospital; Birmingham Public Health Laboratory; Birmingham UK
| | - Ngianga-Bakwin Kandala
- Northumbria University; Department of Mathematics, Physics & Electrical Engineering (MPEE), Faculty of Engineering and Environment; Ellison Building (EBD) Room 2018 Newcastle upon Tyne UK NE1 8ST
| | - Saverio Stranges
- Schulich School of Medicine and Dentistry, Western University; Department of Epidemiology and Biostatistics; London Canada
| | - Sian Taylor-Phillips
- University of Warwick; Division of Health Sciences, Warwick Medical School; Coventry UK CV4 7AL
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31
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Khalil MR, Thorsen PB, Møller JK, Uldbjerg N. Number of colony forming units in urine at 35–37 weeks’ gestation as predictor of the vaginal load of Group B Streptococci at birth. Eur J Obstet Gynecol Reprod Biol 2018; 223:68-71. [DOI: 10.1016/j.ejogrb.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/15/2018] [Indexed: 01/31/2023]
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32
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Ding T, Lambert LA, Aronoff DM, Osteen KG, Bruner-Tran KL. Sex-Dependent Influence of Developmental Toxicant Exposure on Group B Streptococcus-Mediated Preterm Birth in a Murine Model. Reprod Sci 2017; 25:662-673. [PMID: 29153057 DOI: 10.1177/1933719117741378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infectious agents are a significant risk factor for preterm birth (PTB); however, the simple presence of bacteria is not sufficient to induce PTB in most women. Human and animal data suggest that environmental toxicant exposures may act in concert with other risk factors to promote PTB. Supporting this "second hit" hypothesis, we previously demonstrated exposure of fetal mice (F1 animals) to the environmental endocrine disruptor 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) leads to an increased risk of spontaneous and infection-mediated PTB in adult animals. Surprisingly, adult F1males also confer an enhanced risk of PTB to their control partners. Herein, we used a recently established model of ascending group B Streptococcus (GBS) infection to explore the impact of a maternal versus paternal developmental TCDD exposure on infection-mediated PTB in adulthood. Group B Streptococcus is an important contributor to PTB in women and can have serious adverse effects on their infants. Our studies revealed that although gestation length was reduced in control mating pairs exposed to low-dose GBS, dams were able to clear the infection and bacterial transmission to pups was minimal. In contrast, exposure of pregnant F1females to the same GBS inoculum resulted in 100% maternal and fetal mortality. Maternal health and gestation length were not impacted in control females mated to F1males and exposed to GBS; however, neonatal survival was reduced compared to controls. Our data revealed a sex-dependent impact of parental TCDD exposure on placental expression of Toll-like receptor 2 and glycogen production, which may be responsible for the differential impact on fetal and maternal outcomes in response to GBS infection.
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Affiliation(s)
- Tianbing Ding
- 1 Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren A Lambert
- 1 Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David M Aronoff
- 1 Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Vanderbilt University Medical Center, Nashville, TN, USA.,2 Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin G Osteen
- 1 Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Vanderbilt University Medical Center, Nashville, TN, USA.,3 Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA.,4 VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Kaylon L Bruner-Tran
- 1 Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Role of HIV exposure and infection in relation to neonatal GBS disease and rectovaginal GBS carriage: a systematic review and meta-analysis. Sci Rep 2017; 7:13820. [PMID: 29062060 PMCID: PMC5653843 DOI: 10.1038/s41598-017-13218-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/20/2017] [Indexed: 12/31/2022] Open
Abstract
Streptococcus agalactiae (GBS) is the leading cause worldwide of neonatal sepsis. We sought to assess to which extent HIV exposure of neonates is associated with GBS neonatal disease. Furthermore, we assessed to which extent HIV infection in women is associated with maternal rectovaginal GBS carriage, the single most important risk factor for GBS neonatal disease. We searched Pubmed, Embase, and Web of Science for studies assessing the association between neonatal GBS disease and HIV-status of the mother and studies that assessed the association between rectovaginal GBS colonization and HIV status in women. HIV-exposed uninfected neonates were more than twice as likely to have neonatal GBS disease compared to unexposed neonates. HIV-exposed neonates were not at increased risk for early-onset neonatal disease, but were 4.43 times more likely to have late-onset neonatal GBS disease. There was no significant association between HIV infection status and rectovaginal GBS carriage. Public health interventions preventing neonatal GBS disease are urgently needed for the increasing group of HIV-exposed neonates. A framework integrating and explaining our findings highlights opportunities for the clinical practice and global health policy to prevent disease. Well-designed studies should clarify the relation between HIV-status and GBS carriage.
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Group B Streptococcus causes severe sepsis in term neonates: 8 years experience of a major Chinese neonatal unit. World J Pediatr 2017; 13:314-320. [PMID: 28560649 DOI: 10.1007/s12519-017-0034-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/24/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND In contrast to industrialized countries, the clinical characteristics of neonatal sepsis caused by Group B Streptococcus (GBS) are largely unexplored in China. METHODS A retrospective case series study was performed at a high-capacity neonatal unit in Shanghai, China from January 2008 to December 2015. Clinical characteristics of neonates with culture-proven GBS sepsis and antibiotic susceptibility of isolated strains were analyzed. RESULTS Forty-three term neonates were included during the study period. The majority (74.4%) had early-onset sepsis with symptoms of respiratory distress. Meningitis was significantly more common in lateonset sepsis than in early-onset sepsis (81.5% vs. 18.8%, P<0.0001). Approximately one third of all patients (n=16) developed severe sepsis, defined as sepsis with organ dysfunctions, and respiratory dysfunction/failure was the most common (32.6%). The in-hospital mortality rate of GBS sepsis was 4.7%. Neonates who progressed to severe sepsis had significantly lower pH level at the onset of symptoms than those who did not (7.26±0.12 vs. 7.39±0.05, P=0.006). Treatment of severe GBS sepsis required lots of medical resources including extracorporeal membrane oxygenation. All tested GBS strains were susceptible to penicillin, but the rate of resistance to clindamycin (84.0%) and erythromycin (88.0%) was high. CONCLUSIONS GBS as a pathogen for neonatal sepsis has been receiving little attention in China. Our data demonstrated that GBS sepsis was likely to be fulminant. Early recognition followed by antibiotics and adequate supportive therapies was critical for successful treatment. Chinese clinicians should be aware of GBS infection when treating neonatal sepsis, especially in the absence of universal maternal GBS screening.
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Erythromycin or Clindamycin - is it Still an Empirical Therapy against Streptococcus agalactiae in Patients Allergic to Penicillin? Pol J Microbiol 2017; 66:265-268. [PMID: 28735311 DOI: 10.5604/01.3001.0010.7878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Retrospective analysis of Streptococcus agalactiae antibiotic susceptibility isolated in 2010-2013 was performed. Penicillin was still the first-line antibiotic. Due to the high percentage of strains resistant to erythromycin and clindamycin empirical treatment with these antibiotics may not be effective. Lower resistance rate to erythromycin and clindamycin among strains isolated from infected pregnant women and newborns were observed than among strains isolated from samples from patients hospitalized in other departments (29% and 47% v. 46% and 63%). The increasing resistance rate might give a rise to a new epidemiological situation.
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Intrapartum PCR assay versus antepartum culture for assessment of vaginal carriage of group B streptococci in a Danish cohort at birth. PLoS One 2017; 12:e0180262. [PMID: 28678829 PMCID: PMC5497980 DOI: 10.1371/journal.pone.0180262] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/13/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to compare the performances of two strategies for predicting intrapartum vaginal carriage of group B streptococci (GBS). One strategy was based on an antepartum culture and the other on an intrapartum polymerase chain reaction (PCR). We conducted a prospective observational study enrolling 902 pregnant women offered GBS screening before delivery by two strategies. The Culture-strategy was based on vaginal and rectal cultures at 35–37 weeks’ gestation, whereas the PCR-strategy was based on PCR assay on intrapartum vaginal swab samples. An intrapartum vaginal culture for GBS was used as the reference standard from which the performances of the 2 strategies were evaluated. The reference standard showed a GBS-prevalence of 12%. The culture-strategy performed with a sensitivity of 82%, specificity of 91%, positive predictive value (PPV) of 55%, negative predictive value (NPV) of 98%, and Likelihood ratio (LH+) of 9.2. The PCR-strategy showed corresponding values as sensitivity of 83%, specificity of 97%, PPV of 78%, NPV of 98%, and LH+ of 27.5. We conclude that in a Danish population with a low rate of early-onset neonatal infection with GBS, the intrapartum PCR assay performs better than the antepartum culture for identification of GBS vaginal carriers during labor.
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Lazzarin M, Mu R, Fabbrini M, Ghezzo C, Rinaudo CD, Doran KS, Margarit I. Contribution of pilus type 2b to invasive disease caused by a Streptococcus agalactiae ST-17 strain. BMC Microbiol 2017; 17:148. [PMID: 28673237 PMCID: PMC5496222 DOI: 10.1186/s12866-017-1057-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 06/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background Group B Streptococcus (GBS) is a major cause of invasive disease especially in neonates. In GBS three structurally distinct pilus polymers have been identified as important virulence factors and promising vaccine candidates. The vast majority of Group B Streptococci belonging to the hypervirulent serotype III ST-17 lineage bear pilus types 1 and 2b. The purpose of this study was to investigate the relative contribution of these two pilus types to the pathogenesis of a ST-17 strain. Results We performed in vivo and in vitro analysis of isogenic knockout mutants derived from the GBS COH1 ST-17 strain deprived of either pilus type 1 or 2b. We compared the two pilus mutants with the wild type strain in a mouse model of invasive disease, in vitro survival in macrophages, and adherence/invasion assays using human brain endothelial and lung epithelial cell lines. Significantly less of the pilus 2b mutant was recovered from the blood, lungs and brain tissue of infected mice compared to the wild-type and pilus 1 mutant strains. Further, while the pilus 2b mutant survived similarly in murine macrophages, it exhibited a lower capacity to adhere and invade human brain epithelial and lung endothelial cell lines. Conclusions The data suggest an important role of pilus 2b in mediating GBS infection and host cell interaction of strains belonging to the hypervirulent GBS ST-17 lineage.
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Affiliation(s)
| | - Rong Mu
- Department of Biology and Center for Microbial Sciences, San Diego State University, 5500 Campanile Dr., NLS 317, San Diego, CA, 92182, USA
| | | | | | | | - Kelly S Doran
- Department of Biology and Center for Microbial Sciences, San Diego State University, 5500 Campanile Dr., NLS 317, San Diego, CA, 92182, USA.,Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
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Abstract
PURPOSE OF REVIEW The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics. RECENT FINDINGS There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection. SUMMARY The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.
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Ellem JA, Kovacevic D, Olma T, Chen SCA. Rapid detection of Group B streptococcus directly from vaginal-rectal specimens using liquid swabs and the BD Max GBS assay. Clin Microbiol Infect 2017; 23:948-951. [PMID: 28487166 DOI: 10.1016/j.cmi.2017.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/23/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We adapted the BD Max GBS assay, an automated platform for the detection of Group B streptococcus (GBS) DNA in vaginal-rectal swab specimens after LIM broth enrichment, to directly detect GBS in specimens collected using cellular foam swabs in Amies liquid medium. We compared the BD Max GBS assay performance to that of enriched culture and the BD GeneOhm StrepB assay. METHODS Seventy-two reference vaginal-rectal specimens were employed to determine the limit of GBS detection and the preferred test volume for direct detection of GBS. A total of 304 clinical specimens were then tested by the optimized BD Max GBS assay, both by direct testing and following broth enrichment. RESULTS The limit of GBS detection was 75 CFU/mL and the preferred test volume was 100 μL. Of 304 clinical specimens tested, GBS was detected in 62 specimens by enriched culture (20.4%); 61 of these yielded GBS by the BD Max GBS assay when performed directly from the liquid swab (sensitivity 98.4%). All 242 culture-negative specimens also yielded negative results by the BD Max GBS assay (specificity 100%). When this assay was performed following broth enrichment, GBS was detected in all 62 culture-positive specimens (100% sensitivity). The sensitivity and specificity of the BD GeneOhm StrepB assay was 90.3% and 99%, respectively. CONCLUSIONS The BD Max GBS assay is highly sensitive, requires minimal technical skill with <2 min required to set-up, and results are available in under 80 min (versus 24-48 h for culture). It is configured for 'on demand' testing and vaginal-rectal specimens can be rapidly screened for GBS without the need for enrichment. The results obtained in this study demonstrate that rapid GBS screening using the BD Max GBS assay at the time of delivery is a viable alternative to the current recommended screening at 35-37 weeks of gestation with pre-enrichment testing methods.
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Affiliation(s)
- J A Ellem
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Westmead Hospital, Westmead NSW, Australia.
| | - D Kovacevic
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Westmead Hospital, Westmead NSW, Australia
| | - T Olma
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Westmead Hospital, Westmead NSW, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Westmead Hospital, Westmead NSW, Australia; Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead NSW, Australia
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Groff SM, Fallatah W, Yang S, Murphy J, Crutchfield C, Marzinke M, Kurtzberg J, Lee CKK, Burd I, Farzin A. Effect of Maternal Obesity on Maternal-Fetal Transfer of Preoperative Cefazolin at Cesarean Section. J Pediatr Pharmacol Ther 2017. [PMID: 28638306 DOI: 10.5863/1551-6776-22.3.227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES American Congress of Obstetricians and Gynecologists recommends a single dose of antibiotic prophylaxis before all cesarean sections (C/S). This recommendation is based on pharmacokinetic studies that include only non-obese patients. We sought to evaluate 1) cefazolin plasma concentrations among obese and non-obese patients after administration of a 2-g cefazolin dose for prevention of surgical wound infections, and 2) whether cefazolin concentration in fetal circulation may be protective against pathogens that cause early onset neonatal sepsis. METHODS Maternal and fetal cefazolin plasma concentrations were compared between obese (body mass index [BMI] ≥ 30 kg/m2) and non-obese (BMI < 25 kg/m2) healthy, term pregnant women undergoing scheduled C/S. Liquid chromatographic-tandem mass spectrometric (LC-MS/MS) methods were used for quantification of total and free cefazolin concentrations in maternal blood (MB) and umbilical cord blood (UCB). RESULTS Eight women were screened and consented. There was no difference between groups in MB total and free cefazolin concentrations. All MB samples had total and free cefazolin concentrations greater than the minimum inhibitory concentration 90 (MIC90) for Group B Streptococcus (GBS), Staphylococcus aureus, and Escherichia coli. All UCB samples had total and free cefazolin concentrations greater than MIC90 for GBS and S aureus, even when administered as briefly as 18 minutes before delivery. A lower concentration of total cefazolin was detected in UCB of neonates of obese women compared to non-obese women (p > 0.05). CONCLUSIONS Administration of 2 g of cefazolin to women undergoing scheduled C/S might be an adequate prophylactic dose for surgical wound infection in both non-obese and obese patients; and cefazolin concentration in fetal circulation may be protective against GBS and S aureus.
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Cools P, Melin P. Group B Streptococcus and perinatal mortality. Res Microbiol 2017; 168:793-801. [PMID: 28435137 DOI: 10.1016/j.resmic.2017.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
The World Health Organization estimates that every year, one million neonatal deaths occur because of neonatal infection. Furthermore, an equal number of stillbirths are thought to be caused by infections. Here we discuss the role of Streptococcus agalactiae (group B Streptococcus, GBS) in neonatal disease and stillbirth.
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Affiliation(s)
- Piet Cools
- Laboratory Bacteriology Research, Department of Microbiology, Immunology and Clinical Chemistry, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Pierrette Melin
- Clinical Microbiology, National Reference Centre for Streptococcus agalactiae, University Hospital of Liège, Faculty of Medicine, Liege University, Liège, Belgium
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Parente V, Clark RH, Ku L, Fennell C, Johnson M, Morris E, Romaine A, Utin U, Benjamin DK, Messina JA, Smith PB, Greenberg R. Risk factors for group B streptococcal disease in neonates of mothers with negative antenatal testing. J Perinatol 2017; 37:157-161. [PMID: 27853322 PMCID: PMC5280520 DOI: 10.1038/jp.2016.201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to identify risk factors for early-onset group B Streptococcus (EOGBS) disease in neonates of mothers with negative antenatal screening. STUDY DESIGN We performed a retrospective cohort study of neonates born to mothers with negative antenatal GBS screening between 2002 and 2012. Our primary outcome was EOGBS infection. We used multivariable logistic regression to assess factors associated with EOGBS. RESULTS EOGBS was confirmed in 492 of the 179 818 neonates that met the study inclusion criteria. Risk factors for EOGBS included black race (reference: white, odds ratio (OR) =1.81 (95% confidence interval: 1.43, 2.31)), maternal age <18 years (reference: >35 years, OR=2.63 (1.54, 4.51)) and maternal age 18 to 35 years (reference: >35 years, OR=1.94 (1.30, 2.88)). CONCLUSION Maternal age <18 years and black race were the strongest predictors of EOGBS. Further research investigating contributors to the discordance between screening results and neonatal outcomes in these populations is needed.
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Affiliation(s)
- Victoria Parente
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Lawrence Ku
- Department of Pediatrics, Duke University, Durham, North Carolina
| | | | | | - Emma Morris
- Duke Clinical Research Institute, Durham, North Carolina
| | - Andrew Romaine
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Daniel K. Benjamin
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - P. Brian Smith
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Rachel Greenberg
- Department of Pediatrics, Duke University, Durham, North Carolina
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Sullivan MJ, Carey AJ, Leclercq SY, Tan CK, Ulett GC. Increased Age, but Not Parity Predisposes to Higher Bacteriuria Burdens Due to Streptococcus Urinary Tract Infection and Influences Bladder Cytokine Responses, Which Develop Independent of Tissue Bacterial Loads. PLoS One 2016; 11:e0167732. [PMID: 27936166 PMCID: PMC5147962 DOI: 10.1371/journal.pone.0167732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/18/2016] [Indexed: 12/18/2022] Open
Abstract
Streptococcus agalactiae causes urinary tract infection (UTI) in pregnant adults, non-pregnant adults, immune-compromised individuals and the elderly. The pathogenesis of S. agalactiae UTI in distinct patient populations is poorly understood. In this study, we used murine models of UTI incorporating young mice, aged and dam mice to show that uropathogenic S. agalactiae causes bacteriuria at significantly higher levels in aged mice compared to young mice and this occurs coincident with equivalent levels of bladder tissue colonisation at 24 h post-infection (p.i.). In addition, aged mice exhibited significantly higher bacteriuria burdens at 48 h compared to young mice, confirming a divergent pattern of bacterial colonization in the urinary tract of aged and young mice. Multiparous mice, in contrast, exhibited significantly lower urinary titres of S. agalactiae compared to age-matched nulliparous mice suggesting that parity enhances the ability of the host to control S. agalactiae bacteriuria. Additionally, we show that both age and parity alter the expression levels of several key regulatory and pro-inflammatory cytokines, which are known to be important the immune response to UTI, including Interleukin (IL)-1β, IL-12(p40), and Monocyte Chemoattractant Protein-1 (MCP-1). Finally, we demonstrate that other cytokines, including IL-17 are induced significantly in the S. agalactiae-infected bladder regardless of age and parity status. Collectively, these findings show that the host environment plays an important role in influencing the severity of S. agalactiae UTI; infection dynamics, particularly in the context of bacteriuria, depend on age and parity, which also affect the nature of innate immune responses to infection.
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Affiliation(s)
- Matthew J. Sullivan
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Alison J. Carey
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sophie Y. Leclercq
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Research and Development Center, Ezequiel Dias Foundation (Funed), Belo Horizonte, MG, Brazil
| | - Chee K. Tan
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Glen C. Ulett
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- * E-mail:
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Rapid Detection of Streptococcus agalactiae Infection Using a Loop-Mediated Isothermal Amplification Method. Jundishapur J Microbiol 2016. [DOI: 10.5812/jjm.37171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
INTRODUCTION The success of the vaccines available on the market has significantly increased interest in vaccine development. Areas covered: The main aim of this paper is to discuss the most important vaccines of pediatric interest that are currently being developed. New pneumococcal vaccines and vaccines against group B Streptococcus, Staphylococcus aureus and respiratory syncytial virus are analyzed in detail. Expert commentary: Advances in understanding human immunology, including human monoclonal antibody identification, sequencing technology, and the ability to solve atomic level structures of vaccine targets have provided tools to guide the rational design of future vaccines. It is likely that some of these vaccines will reach the market in the future and will thus partially contribute to the prevention of very severe diseases that significantly affect the morbidity and mortality of children. However, further studies in animals and several clinical trials in children must be performed before new vaccines become licensed.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Kobayashi M, Vekemans J, Baker CJ, Ratner AJ, Le Doare K, Schrag SJ. Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries. F1000Res 2016; 5:2355. [PMID: 27803803 PMCID: PMC5070600 DOI: 10.12688/f1000research.9363.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/07/2023] Open
Abstract
Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.
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Affiliation(s)
- Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA
| | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Carol J. Baker
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, USA
- Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, USA
| | - Adam J. Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, USA
| | - Kirsty Le Doare
- Centre for International Child Health, Imperial College, London, UK
| | - Stephanie J. Schrag
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Fabbrini M, Rigat F, Rinaudo CD, Passalaqua I, Khacheh S, Creti R, Baldassarri L, Carboni F, Anderloni G, Rosini R, Maione D, Grandi G, Telford JL, Margarit I. The Protective Value of Maternal Group B Streptococcus Antibodies: Quantitative and Functional Analysis of Naturally Acquired Responses to Capsular Polysaccharides and Pilus Proteins in European Maternal Sera. Clin Infect Dis 2016; 63:746-753. [PMID: 27402816 DOI: 10.1093/cid/ciw377] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/02/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is a major cause of neonatal sepsis and meningitis. A vaccine targeting pregnant women could protect infants through placentally transferred antibodies. The association between GBS maternal antibody concentrations and the risk of neonatal infection has been investigated in US and African populations. Here we studied naturally acquired immunoglobulin G (IgG) responses to GBS capsular polysaccharides (CPS) and pilus proteins in European pregnant women. METHODS Maternal sera were prospectively collected in 8 EU countries from 473 GBS non-colonized and 984 colonized pregnant women who delivered healthy neonates and from 153 mothers of infants with GBS disease. GBS strains from these colonized women and infected infants were obtained in parallel and their capsular and pilus types were identified by serological and molecular methods. Maternal serum concentrations of IgG anti- Ia, -Ib, -III and -V polysaccharides and anti-BP-1, -AP1-2a and -BP-2b pilus proteins were determined by enzyme-linked immunosorbent assay. Antibody functional activity was quantified by Opsonophagocytic Killing Assay. RESULTS Antibody levels against CPS and pilus proteins were significantly higher in GBS colonized women delivering healthy babies than in mothers of neonates with GBS disease or non-colonized women. Moreover, maternal anti-capsular IgG concentrations showed a significant correlation with functional titers measured by Opsonophagocytic Killing Assay. CONCLUSIONS Maternal anti-capsular IgG concentrations above 1 µg/mL mediated GBS killing in vitro and were predicted to respectively reduce by 81% (95% confidence interval, 40%-100%) and 78% (45%-100%) the risk of GBS Ia and III early-onset disease in Europe.
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Bowker RM, Farrow KN. Sick or Fussy? Normal and Abnormal Findings in the First Week of Life. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Madhi SA, Cutland CL, Jose L, Koen A, Govender N, Wittke F, Olugbosi M, Meulen AST, Baker S, Dull PM, Narasimhan V, Slobod K. Safety and immunogenicity of an investigational maternal trivalent group B streptococcus vaccine in healthy women and their infants: a randomised phase 1b/2 trial. THE LANCET. INFECTIOUS DISEASES 2016; 16:923-34. [PMID: 27139805 DOI: 10.1016/s1473-3099(16)00152-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Maternal group B streptococcus (GBS) serotype-specific capsular antibody concentrations are correlated with susceptibility to neonatal GBS invasive disease. Maternal immunisation against GBS during pregnancy might protect infants across the period of susceptibility to invasive disease, but no licensed vaccine exists. This study assessed the safety and immunogenicity of a CRM197-conjugated trivalent GBS vaccine in non-pregnant and pregnant women, and antibody transfer to their infants. METHODS We did a phase 1b/2, randomised, observer-blind single-centre study of an investigational trivalent GBS vaccine in healthy non-pregnant women (cohort 1), and a dose-ranging study in healthy pregnant women (cohort 2). The study was done at the Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. Participants were healthy non-pregnant or pregnant (28-35 weeks' gestation) women aged 18-40 years. In cohort 1, non-pregnant women were randomly assigned (2:1) to receive the investigational vaccine (two injections, 1 month apart, of a 20 μg dose [of each serotype] of aluminium hydroxide-adjuvanted investigational vaccine) or placebo. In cohort 2, pregnant women were randomly assigned (1:1:1:1) to receive one injection at 28-35 weeks' gestation of 0·5 μg, 2·5 μg, or 5·0 μg of the non-adjuvanted investigational vaccine (for each serotype), or placebo. All study participants and study staff not involved with vaccine preparation were masked to the randomisation group. The vaccine contained an equal dose (0·5 μg, 2·5 μg, 5·0 μg, or 20 μg) of each of three glycoconjugates (serotypes Ia, Ib and III). Reactogenicity was monitored to day 7 and unsolicited adverse events (adverse events) and infant safety were recorded throughout the study. The primary outcomes were tolerability and GBS-specific antibody response (measured as geometric mean concentrations [GMCs] in μg/mL) following the two injections for cohort 1, and selection of one vaccine dose based on analysis of serotype-specific antibody responses at delivery (+72 h) for use in subsequent studies. These outcomes were assessed in participants or infants of participants who correctly received the study vaccine with no major protocol deviations, and provided evaluable serum samples at day 1 and the scheduled timepoints throughout the study. This study is registered with ClinicalTrials.gov, NCT01193920. FINDINGS Between Oct 5, 2010, and Sept 21, 2011, we screened 75 non-pregnant and 417 pregnant healthy South African women. Of these, 60 non-pregnant women were enrolled in cohort 1 (40 randomly assigned to the GBS 20 μg group and 40 randomly assigned to the placebo group) and 320 pregnant women were enrolled in cohort 2 (80 in each of the four groups). Among the randomised groups of pregnant women, 33-40% experienced at least one local and 54-71% one systemic solicited adverse event, less than 4% of which were severe, and the rate did not differ by study group. Also, 2% of the pregnancies resulted in stillbirth and 3·5% of the liveborn babies died by 12 months age, none of these deaths were attributed to vaccination. There was one death in a GBS-vaccine recipient, which too was unrelated to vaccination. For cohort 1, serotype-specific antibody concentrations were significantly higher, as evident by no overlap of the 95% CIs of GMCs against all three serotypes in the vaccinated group than the placebo group. For cohort 2, pregnant women in all vaccine groups had significantly higher GMCs than did those in the placebo group at delivery (eg, GMCs against serotype Ia were 11 μg/mL [95% CI 7·0-18] for the GBS vaccine 0·5 μg group, 18 μg/mL [11-29] for the GBS vaccine 2·5 μg group, 22 μg/mL [13-35] for the GBS vaccine 5·0 μg group, and 0·64 μg/mL [0·42-0·98] for the placebo group) and at all measured timepoints. GMCs did not differ significantly between the vaccine doses at any of the measured timepoints (p>0·05). INTERPRETATION The vaccine was well tolerated and induced capsular-specific antibody responses, in non-pregnant and pregnant women. Maternal vaccination led to higher GBS serotype-specific antibody concentrations in infants than did placebo, with both interventions resulting in similar safety profiles. FUNDING Novartis Vaccines and Diagnostics division, now part of the GlaxoSmithKline group of companies.
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Affiliation(s)
- Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; National Institute for Communicable Diseases: a Division of National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa.
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Jose
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Niresha Govender
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med 2016; 8:39. [PMID: 27074706 PMCID: PMC4831151 DOI: 10.1186/s13073-016-0294-z] [Citation(s) in RCA: 528] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The widespread use of antibiotics in the past 80 years has saved millions of human lives, facilitated technological progress and killed incalculable numbers of microbes, both pathogenic and commensal. Human-associated microbes perform an array of important functions, and we are now just beginning to understand the ways in which antibiotics have reshaped their ecology and the functional consequences of these changes. Mounting evidence shows that antibiotics influence the function of the immune system, our ability to resist infection, and our capacity for processing food. Therefore, it is now more important than ever to revisit how we use antibiotics. This review summarizes current research on the short-term and long-term consequences of antibiotic use on the human microbiome, from early life to adulthood, and its effect on diseases such as malnutrition, obesity, diabetes, and Clostridium difficile infection. Motivated by the consequences of inappropriate antibiotic use, we explore recent progress in the development of antivirulence approaches for resisting infection while minimizing resistance to therapy. We close the article by discussing probiotics and fecal microbiota transplants, which promise to restore the microbiota after damage of the microbiome. Together, the results of studies in this field emphasize the importance of developing a mechanistic understanding of gut ecology to enable the development of new therapeutic strategies and to rationally limit the use of antibiotic compounds.
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Affiliation(s)
- Amy Langdon
- Center for Genome Sciences, Washington University School of Medicine, Campus Box 8510, 4515 McKinley Research Building, St. Louis, MO, 63108, USA
- Clinical Research Training Center, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO, 63110-1093, USA
| | - Nathan Crook
- Center for Genome Sciences, Washington University School of Medicine, Campus Box 8510, 4515 McKinley Research Building, St. Louis, MO, 63108, USA
- Department of Pathology & Immunology, Washington University School of Medicine, Campus Box 8118, 660 South Euclid Ave, St. Louis, MO, 63110, USA
| | - Gautam Dantas
- Center for Genome Sciences, Washington University School of Medicine, Campus Box 8510, 4515 McKinley Research Building, St. Louis, MO, 63108, USA.
- Department of Pathology & Immunology, Washington University School of Medicine, Campus Box 8118, 660 South Euclid Ave, St. Louis, MO, 63110, USA.
- Department of Biomedical Engineering, Washington University in Saint Louis, Campus Box 1097, 1 Brookings Drive, Saint Louis, MO, 63130, USA.
- Department of Molecular Microbiology, Washington University School of Medicine, Campus Box 8230, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
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