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Motallebirad T, Fazeli H, Ghahiri A, Shokri D, Jalalifar S, Moghim S, Esfahani BN. Prevalence, population structure, distribution of serotypes, pilus islands and resistance genes among erythromycin-resistant colonizing and invasive Streptococcus agalactiae isolates recovered from pregnant and non-pregnant women in Isfahan, Iran. BMC Microbiol 2021; 21:139. [PMID: 33947330 PMCID: PMC8096152 DOI: 10.1186/s12866-021-02186-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 01/31/2023] Open
Abstract
Background The information on antibiotic resistance and molecular features of Group B Streptococcus (GBS) are essential for epidemiological purposes as well as vaccine development. Therefore, we aimed to assess the antimicrobial resistance profiles and molecular characteristics of GBS isolates in Isfahan, Iran. A total number of 72 colonizing and invasive GBS were collected from pregnant and non-pregnant women. The GBS isolates were analyzed for resistance profiles, capsular genotyping, and detection of PI-1, PI-2a, PI-2b, hvgA, ermB, ermTR, lnuB and, mefA genes. Besides, erythromycin-resistant strains were subjected to multilocus sequence typing (MLST). Results The prevalence of colonizing and invasive GBS were 11 and 0.05%, respectively. The frequency of capsular serotypes was as follows: III (26.3%), Ia (20.83%), Ib and V (each 15.2%), IV (9.7%), II (8.3%), VII (2.7%), and VI (1.3%). Overall frequencies of PIs were as follows: PI-1, 37.5%, PI-1 + PI-2a, 30.5%, PI-1 + PI-2b, 29.1% and PI-2b, 2.7%. Two maternal colonizing GBS (2.6%) were hvgA positive and were belonged to ST-17/CPS-III/PI-1 + PI-2b lineage. Among 30(41.6%) erythromycin resistant GBS, 21 isolates (70%) harbored ermB gene, followed by ermTR (23.3%) and mefA (10%). One clindamycin-resistant isolate harbored the lnuB gene. MLST analysis revealed the following five clonal complexes (CCs) and nine STs: (CC-19/ST-335, ST-19, and ST-197), (CC-12/ST-43, ST-12), (CC-23/ST-163, ST-23), (CC-17/ST-17) and (CC-4/ST-16). Conclusion The study shows an alarmingly high prevalence of erythromycin-resistant GBS in Iran. In addition, we report dissemination of ST-335/CPS-III clone associated with tetracycline and erythromycin resistance in our region. The distribution of capsular and pilus genotypes varies between invasive and colonizing GBS that could be helpful for vaccine development.
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Affiliation(s)
- Tahereh Motallebirad
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Street, Isfahan, Iran
| | - Hossein Fazeli
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Street, Isfahan, Iran
| | - Ataollah Ghahiri
- Department of Gynecology and Obstetrics, Al-Zahra university Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Dariush Shokri
- Infectious disease and tropical medicine research center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Jalalifar
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Street, Isfahan, Iran
| | - Sharareh Moghim
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Street, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Street, Isfahan, Iran.
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Baldan R, Droz S, Casanova C, Knabben L, Huang DJ, Brülisauer C, Kind AB, Krause E, Mauerer S, Spellerberg B, Sendi P. Group B streptococcal colonization in elderly women. BMC Infect Dis 2021; 21:408. [PMID: 33941088 PMCID: PMC8091692 DOI: 10.1186/s12879-021-06102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background In non-pregnant adults, the incidence of invasive Group B Streptococcus (GBS) disease is continuously increasing. Elderly and immunocompromised persons are at increased risk of infection. GBS commonly colonizes the vaginal tract, though data on colonization in the elderly are scarce. It is unknown whether the prevalence of GBS colonization is increasing in parallel to the observed rise of invasive infection. We conducted a three-year (2017–2019) prospective observational cross-sectional study in two teaching hospitals in Switzerland to determine the rate of GBS vaginal colonization in women over 60 years and i) to compare the proportions of known risk factors associated with invasive GBS diseases in colonized versus non-colonized women and ii) to evaluate the presence of GBS clusters with specific phenotypic and genotypic patterns in this population. Methods GBS screening was performed by using vaginal swabs collected during routine examination from women willing to participate in the study and to complete a questionnaire for risk factors. Isolates were characterized for antibiotic resistance profile, serotype and sequence type (ST). Results The GBS positivity rate in the elderly was 17% (44/255 positive samples), and similar to the one previously reported in pregnant women (around 20%). We could not find any association between participants’ characteristics, previously published risk factors and GBS colonization. All strains were susceptible to penicillin, 22% (8/36) were not susceptible to erythromycin, 14% (5/36) were not susceptible to clindamycin and 8% (3/36) showed inducible clindamycin resistance. Both M and L phenotypes were each detected in one isolate. The most prevalent serotypes were III (33%, 12/36) and V (31%, 11/36). ST1 and ST19 accounted for 11% of isolates each (4/36); ST175 for 8% (3/36); and ST23, ST249 and ST297 for 6% each (2/36). Significantly higher rates of resistance to macrolides and clindamycin were associated with the ST1 genetic background of ST1. Conclusions Our findings indicate a similar colonization rate for pregnant and elderly women. Trial registration Current Controlled Trial ISRCTN15468519; 06/01/2017 Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06102-x.
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Affiliation(s)
- Rossella Baldan
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3010, Bern, Switzerland
| | - Sara Droz
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3010, Bern, Switzerland
| | - Carlo Casanova
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3010, Bern, Switzerland
| | - Laura Knabben
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Dorothy J Huang
- Outpatient Department & Colposcopy Unit, University Women's Hospital Basel, Basel, Switzerland
| | - Christine Brülisauer
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3010, Bern, Switzerland
| | - André B Kind
- Outpatient Department & Colposcopy Unit, University Women's Hospital Basel, Basel, Switzerland
| | - Elke Krause
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stefanie Mauerer
- Institute of Medical Microbiology and Hygiene, University Hospital Ulm, Ulm, Germany
| | - Barbara Spellerberg
- Institute of Medical Microbiology and Hygiene, University Hospital Ulm, Ulm, Germany
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3010, Bern, Switzerland. .,Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland.
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Prevalence of group B streptococcal colonization in the healthy non-pregnant population: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:968-980. [PMID: 33813109 DOI: 10.1016/j.cmi.2021.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/17/2021] [Accepted: 03/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Colonization and transmission precede invasive group B streptococcal (GBS) disease. Data on GBS colonization prevalence, detection methods and risk factors for carriage are relevant for vaccine development and to understand GBS pathogenesis. OBJECTIVES To evaluate GBS colonization prevalence after the first week of life in the healthy non-pregnant population. DATA SOURCES Pubmed/Medline, Embase, Latin American and Caribbean Health Sciences Literature, World Health Organization Library Information System, and Scopus. Search performed 12 January 2021 with search terms related to 'GBS' and 'colonization, epidemiology, prevalence or screening' without restrictions. STUDY ELIGIBILITY CRITERIA All studies that reported prevalence of GBS colonization (any site) in the healthy population. PARTICIPANTS All individuals (>6 days of age), with no indication of pregnancy, invasive disease or severe underlying immunological co-morbidities. METHODS Logit transformation and a random effects model (DerSimonian and Laird) were used to pool colonization estimates. Subgroup analysis and meta-regression on a priori determined subgroups were performed. RESULTS We included 98 studies with 43 112 participants. Our search identified 9309 studies of which 8831 were excluded based on title and abstract and 380 after reading the full text. Colonization rates varied considerably between studies (I2 = 97%), which could be partly explained by differences in culture methods (R2 = 27%), culture sites (R2 = 24%), continent (R2 = 10%) and participant's age (R2 = 6%). Higher prevalence was found with selective culture methods (19%, 95% CI 16%-23% versus non-selective methods 8%, 95% CI 6%-9%; p < 0.0001). Colonization rates were highest in rectum (19%, 95% CI 15%-24%), vagina (14%, 95% CI 12%-17%) and urethra (9%, 95% CI 5%-18%). In participants with negative rectal cultures, 7% (95% CI 5%-9%) had GBS cultured from another niche. Colonization prevalence was lower in children (6 months to 16 years; 3%, 95% CI 2%-5%) compared with adults (16%, 95% CI 14%-20%; p < 0.0001). Using selective culture methods in adults resulted in a prevalence of 26% (95% CI 19%-33%) rectal, 21% (95% CI 17%-25%) vaginal and 9% (95% CI 6%-14%) urethral colonization. CONCLUSION The rectum is the most common body site colonized by GBS. The best approach to screen for any GBS colonization is to screen multiple body sites using selective culture methods.
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Molecular Characterization of Streptococcus agalactiae Isolates from Pregnant Women in Kathmandu City. J Trop Med 2020; 2020:4046703. [PMID: 32908547 PMCID: PMC7474781 DOI: 10.1155/2020/4046703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Group B streptococci (GBS) are globally recognized as one of the leading causes of neonatal sepsis and meningitis and is also known to cause adverse pregnancy outcomes such as stillbirths and miscarriages. Thus, detailed investigation of GBS in pregnant women has special significance in public health related researches. Objectives The present study is aimed at evaluating the prevalence of GBS colonization among pregnant women in Kathmandu city. Methods The study was carried out among 125 pregnant women at their trimester (35-37 weeks) (during the time period between January and June in 2018). The prevalence was determined by the culture method in HiCrome Strep B Selective Agar Base and then by using the PCR technique. The serotypes were evaluated by multiplex PCR analysis, while the antibiotics susceptibility tests were performed using the disk diffusion method. Results Among 125 samples studied, GBS were recorded in 24 samples (implying a prevalence of 19.2%). Furthermore, using the multiplex PCR, among 24 GBS-positive samples, 13 (54.17%) were found to be typeable while 11 (45.83%) were nontypeable. The most abundant serotype recorded in this study was type III (33.33) while the serotypes IV, V, VI, VII, and VIII were not found. Conclusion The isolates were sensitive towards some antibiotics such as linezolid and ceftriaxone 100%, whereas penicillin 50% and vancomycin 75% but were resistant to tetracycline and ertapenem. Serotype III was found to be predominant in the samples collected during the study period. The observed prevalence was significantly associated with the gestational period, whereas no relationship was found for other risk factors.
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Kardos S, Tóthpál A, Laub K, Kristóf K, Ostorházi E, Rozgonyi F, Dobay O. High prevalence of group B streptococcus ST17 hypervirulent clone among non-pregnant patients from a Hungarian venereology clinic. BMC Infect Dis 2019; 19:1009. [PMID: 31779587 PMCID: PMC6883650 DOI: 10.1186/s12879-019-4626-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022] Open
Abstract
Background Although Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults. The relation between its presence in the genitourinary tract and manifested clinical symptoms of STD patients remains an open question. In this study, a complex epidemiological investigation of GBS isolates from a venerology clinic was performed. Methods Ninety-six GBS isolates were serotyped and their genetic relatedness determined by PFGE. MLST was also performed for a subset of 20 isolates. The antibiotic susceptibility was tested with agar dilution. Surface proteins and the ST-17 hypervirulent clone was detected by PCR. Results The serotype prevalence was the following: V (29.2%), III (27.1%), Ia (22.9%), IV (10.4%), II (5.2%) and Ib (4.2%). A strong association was demonstrated between surface protein genes and serotypes. All isolates were fully susceptible to penicillin, but erythromycin and clindamycin resistance was high (41.7 and 35.4%, respectively), and 8 phenotypically macrolide sensitive isolates carried the ermB gene. 21.9% of all strains belonged to the hypervirulent ST17 clone, most being of serotype III and all were rib +. We found a few serotype IV isolates belonging to several STs and one serotype V/ST110 strain, containing a 44-bp deletion in the atr allele. Conclusions The presence of silent ermB genes is of worry, as their expression upon macrolide exposure could lead to unforeseen therapeutic failure, while clindamycin is used for intrapartum antibiotic prophylaxis, in case of penicillin allergy. The other alarming result is the high prevalence of ST17 among these strains from STD patients, who could be sources of further infections. This is the first report from Hungary providing both serotyping and genotyping data of GBS isolates. These results could be helpful for vaccine production as the major vaccine candidates are capsular antigens or surface proteins.
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Affiliation(s)
- Szilvia Kardos
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Adrienn Tóthpál
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Krisztina Laub
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Katalin Kristóf
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Eszter Ostorházi
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, H-1089, Hungary.,Department of Dermatology, Dermatooncology and Venerology, Semmelweis University, Budapest, Hungary
| | - Ferenc Rozgonyi
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Dermatooncology and Venerology, Semmelweis University, Budapest, Hungary
| | - Orsolya Dobay
- Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, Budapest, H-1089, Hungary.
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Whole-Genome Sequences and Classification of Streptococcus agalactiae Strains Isolated from Laboratory-Reared Long-Evans Rats (Rattus norvegicus). GENOME ANNOUNCEMENTS 2017; 5:5/1/e01435-16. [PMID: 28057750 PMCID: PMC5255911 DOI: 10.1128/genomea.01435-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In collaboration with the CDC's Streptococcus Laboratory, we report here the whole-genome sequences of seven Streptococcus agalactiae bacteria isolated from laboratory-reared Long-Evans rats. Four of the S. agalactiae isolates were associated with morbidity accompanied by endocarditis, metritis, and fatal septicemia, providing an opportunity for comparative genomic analysis of this opportunistic pathogen.
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Molecular Characteristics of Group B Streptococci Isolated from Adults with Invasive Infections in Japan. J Clin Microbiol 2016; 54:2695-2700. [PMID: 27558182 DOI: 10.1128/jcm.01183-16] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/15/2016] [Indexed: 01/18/2023] Open
Abstract
Streptococcus agalactiae (group B streptococcus) isolates (n = 443) obtained from Japanese adults with invasive infections between April 2010 and March 2013 were analyzed for capsular serotype, multilocus sequence type (ST), antibiotic susceptibility, and resistance genes. Among these cases, bacteremia without primary focus was the most common variety of infection (49.9%), followed by cellulitis (12.9%) and pneumonia (9.0%). Concerning patient age (18 to 59, 60 to 69, 70 to 79, 80 to 89, and 90 years old or older), the incidence of pneumonia increased in patients in their 70s and 80s (P < 0.001), while younger patients (18 to 59 and 60 to 69 years old) were more likely to have abscesses (P < 0.05). The mortality rate was 10.2% for all ages. The most common capsular serotype was Ib (39.5%), followed by V (16.0%), III (13.8%), VI (9.5%), and Ia (8.6%). The main ST of serotype Ib strains was ST10, which belonged to clonal complex 10 (88.0%). The predominant clonal complexes of serotypes V and III, respectively, were 1 (78.9%) and 19 (75.4%). Among these isolates, 9 strains (2.0%) were identified as group B streptococci with reduced penicillin susceptibility, reflecting amino acid substitutions in penicillin-binding protein 2X (PBP2X). In addition, 19.2% of all strains possessed mef(A/E), erm(A), or erm(B) genes, which mediate macrolide resistance, while 40.2% of strains were resistant to quinolones resulting from amino acid substitutions in GyrA and ParC. Our data argue strongly for the continuous surveillance of microbial characteristics and judicious antibiotic use in clinical practice.
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