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Constantinou G, Ayers S, Mitchell EJ, Moore S, Jones AM, Downe S, Walker KF, Daniels J. The acceptability of group B streptococcal bacteria (GBS) testing to women, including self-swabbing procedures: A qualitative study. Midwifery 2024; 135:104063. [PMID: 38896943 DOI: 10.1016/j.midw.2024.104063] [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: 03/16/2023] [Revised: 02/16/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Group B streptococcus (GBS) is a bacterium carried by 20-25 % of pregnant women in the UK, which can be transmitted from pregnant women to their babies at the time of birth. Women can be tested for GBS in pregnancy using a vaginal-rectal swab, however, this testing is currently not routinely offered in the UK. A large clinical trial is underway to determine the clinical and cost-effectiveness of routine testing (ISRCTN reference number ISRCTN49639731). A crucial part of understanding whether this type of test should be implemented is women's views on the acceptability of being offered GBS tests, their preferences towards testing procedures and their willingness to receive these tests. AIM To explore women's views on the acceptability of different methods of Group B streptococcal bacteria (GBS) testing in pregnancy, including self-swabbing procedures. METHODS A convenience sample of 19 women (5 pregnant and 14 postpartum) were interviewed using a semi-structured interview guide. Interviews were transcribed and analysed using systematic thematic analysis. RESULTS Findings show that many of the women interviewed were not concerned about being offered a GBS test, were willing to provide a sample and felt positive towards samples being taken to detect GBS. Women varied in their preferences on the best time for sampling. Some thought being approached during pregnancy gave them time to understand the purpose of testing, prepare for what may happen next and ask questions about potential treatment if needed. Others thought labour was a good time to provide accurate results on GBS carriage at birth and reduce unnecessary worry during pregnancy. However, women were concerned that they may be unable to make an informed decision in labour due to time, pain and the prospect of birthing quickly. Women perceived clinician swabbing as more accurate than self-sampling; however, many thought clinician swabbing might be embarrassing so self-swabs should be available to increase uptake for some women. CONCLUSIONS Overall, women thought both pregnancy and labour were acceptable times to test for GBS. The majority found both clinician and self-swabbing procedures acceptable; however, many had a preferred swabbing option and thought women should be given the choice of the swabbing procedure most acceptable to them. It is important that women are given information about GBS testing and its procedures in pregnancy regardless of when the GBS swabbing is performed.
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Affiliation(s)
- Georgina Constantinou
- Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, Northampton Square EC1V 0HB, London.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, Northampton Square EC1V 0HB, London
| | | | - Sarah Moore
- Nottingham Clinical Trials Unit, University of Nottingham, London
| | - Anne-Marie Jones
- Nottingham Clinical Trials Unit, University of Nottingham, London
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, London
| | - Kate F Walker
- Population and Lifespan Unit, School of Medicine, University of Nottingham, London
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, London
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Thorn N, Guy RL, Karampatsas K, Powell M, Walker KF, Plumb J, Khalil A, Greening V, Eccleston E, Trotter C, Andrews N, Rush L, Sharkey C, Wallis L, Heath P, Le Doare K. GBS vaccines in the UK: a round table discussion. F1000Res 2024; 13:519. [PMID: 39206274 PMCID: PMC11350325 DOI: 10.12688/f1000research.147555.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 09/04/2024] Open
Abstract
Background Group B streptococcus (GBS) remains a leading cause of infant sepsis, meningitis and death despite intrapartum antibiotic prophylaxis. A vaccine is urgently required, and two candidates are in advanced clinical trials. For successful GBS vaccine implementation, especially if a vaccine is licensed based on an immunological threshold, there must be cross-sector engagement, effective advocacy, robust plans for phase IV studies and equitable access. Meeting A round-table discussion, held at St George's University of London, reviewed the current position of GBS vaccines in the UK context, focusing on phase IV plans, convening a diverse group of stakeholders from across the UK, with a role in GBS vaccine licensure, advocacy, implementation or effectiveness evaluation.Presentations outlined the latest UK epidemiology, noting the rising infant invasive GBS (iGBS) infection rates from 1996 to 2021 for both early and late onset disease, with the highest disease rates in Black infants (1.1/1000 livebirths vs white infants (0.81/1000 livebirths). Potential coverage of the candidate vaccines was high (>95%). Regulatory input suggested that EU regulators would consider waiving the need for a pre-licensure efficacy study if a putative correlate of protection could be adequately justified. Phase IV study methodologies for a GBS vaccine were considered, largely based on previous UK maternal vaccine assessments, such as a nationwide cohort study design using a vaccine register and a maternal services dataset. Other strategies were also discussed such as a cluster or stepped-wedge randomised trial to evaluate implementation outcomes. Opportunities for advocacy, education and engagement with additional key partners were discussed and identified. Conclusions With an approved GBS vaccine a near possibility, planning of phase IV studies and identification of critical barriers to implementation are urgently needed. Cross-sector engagement is essential and will facilitate a successful pathway.
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Affiliation(s)
- Natasha Thorn
- St George's University of London, London, SW17 0RE, UK
| | | | | | - Mair Powell
- Healthcare Products Regulatory Agency, Dublin, Ireland
| | | | - Jane Plumb
- Group B Strep Support (GBSS), Haywards Heath, UK
| | - Asma Khalil
- St George's University of London, London, SW17 0RE, UK
| | | | | | - Caroline Trotter
- Imperial College London, London, England, UK
- University of Cambridge, Cambridge, England, UK
| | | | | | | | - Lauren Wallis
- St George's University of London, London, SW17 0RE, UK
| | - Paul Heath
- St George's University of London, London, SW17 0RE, UK
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3
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Hilpipre G, Furfaro LL, Porter M, Blyth CC, Yeoh DK. Characterization of invasive Group B Streptococcus isolates from Western Australian infants, 2004-2020. J Med Microbiol 2024; 73. [PMID: 38567639 DOI: 10.1099/jmm.0.001822] [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] [Indexed: 04/04/2024] Open
Abstract
Background. Invasive Group B Streptococcus (GBS; Streptococcus agalactiae) remains a leading cause of infant morbidity and mortality. Intrapartum antibiotic prophylaxis (IAP) has been implemented in many countries with a reduction in early-onset disease, but an effective vaccine may further reduce the disease burden. Candidate vaccines targeting capsular polysaccharides and surface proteins are now in clinical trials.Methods. Using whole-genome sequencing and phenotypic antimicrobial susceptibility testing, we characterized sterile-site GBS isolates recovered from Western Australian infants between 2004 and 2020. Characteristics were compared between three time periods: 2004-2008, 2009-2015 and 2016-2020.Results. A total of 135 isolates were identified. The proportion of serotype III (22.7 % in Period 1 to 47.9 % in Period 3, P=0.04) and clonal complex 17 (13.6-39.6 %, P=0.01) isolates increased over time. Overall coverage of vaccines currently being trialled was >95 %. No isolates were penicillin resistant (MIC>0.25 mg l-1), but 21.5 % of isolates had reduced penicillin susceptibility (MIC>0.12 mg l-1) and penicillin MIC increased significantly over time (P=0.04). Clindamycin resistance increased over time to 45.8 % in the latest period.Conclusions. Based on comprehensive characterization of invasive infant GBS in Western Australia, we found that coverage for leading capsular polysaccharide and surface protein vaccine candidates was high. The demonstrated changes in serotype and molecular type highlight the need for ongoing surveillance, particularly with regard to future GBS vaccination programmes. The reduced susceptibility to IAP agents over time should inform changes to antibiotic guidelines.
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Affiliation(s)
- Ginger Hilpipre
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Lucy L Furfaro
- Division of Obstetrics and Gynaecology, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michelle Porter
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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4
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Boureka E, Krasias D, Tsakiridis I, Karathanasi AM, Mamopoulos A, Athanasiadis A, Dagklis T. Prevention of Early-Onset Neonatal Group B Streptococcal Disease: A Comprehensive Review of Major Guidelines. Obstet Gynecol Surv 2023; 78:766-774. [PMID: 38134342 DOI: 10.1097/ogx.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Group B Streptococcus (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often associated with poor screening and management. Objective The aim of this study was to review and compare the most recently published influential guidelines on the screening and management of this clinical entity during antenatal and intrapartum periods. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada on the prevention of early-onset neonatal group B streptococcal disease was carried out. Results There is a consensus among the reviewed guidelines regarding the optimal screening specimen type, indications for intrapartum antibiotic administration such as bacteriuria during pregnancy, clinical signs of chorioamnionitis or maternal pyrexia, and history of GBS-related neonatal disease. There is also agreement on several conditions where no intervention is recommended, that is, antepartum treatment of GBS and GBS-positive women with planned cesarean delivery and intact membranes. Controversy exists regarding the optimal screening time, with the Royal College of Obstetricians and Gynecologists stating against routine screening and on management strategies related to preterm labor and preterm prelabor rupture of membranes. Conclusions The development of consistent international practice protocols for the timely screening of GBS and effective management of this clinical entity both during pregnancy and the intrapartum period seems of paramount importance to safely guide clinical practice and subsequently improve neonatal outcomes.
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Affiliation(s)
| | | | | | | | - Apostolos Mamopoulos
- Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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5
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Gaccioli F, Stephens K, Sovio U, Jessop F, Wong HS, Lager S, Cook E, de Goffau MC, Le Doare K, Peacock SJ, Parkhill J, Charnock-Jones DS, Smith GCS. Placental Streptococcus agalactiae DNA is associated with neonatal unit admission and foetal pro-inflammatory cytokines in term infants. Nat Microbiol 2023; 8:2338-2348. [PMID: 38030897 PMCID: PMC10686823 DOI: 10.1038/s41564-023-01528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Streptococcus agalactiae (Group B Streptococcus; GBS) is a common cause of sepsis in neonates. Previous work detected GBS DNA in the placenta in ~5% of women before the onset of labour, but the clinical significance of this finding is unknown. Here we re-analysed this dataset as a case control study of neonatal unit (NNU) admission. Of 436 infants born at term (≥37 weeks of gestation), 7/30 with placental GBS and 34/406 without placental GBS were admitted to the NNU (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.3-7.8). We then performed a validation study using non-overlapping subjects from the same cohort. This included a further 239 cases of term NNU admission and 686 term controls: 16/36 with placental GBS and 223/889 without GBS were admitted to the NNU (OR 2.4, 95% CI 1.2-4.6). Of the 36 infants with placental GBS, 10 were admitted to the NNU with evidence of probable but culture-negative sepsis (OR 4.8, 95% CI 2.2-10.3), 2 were admitted with proven GBS sepsis (OR 66.6, 95% CI 7.3-963.7), 6 were admitted and had chorioamnionitis (inflammation of the foetal membranes) (OR 5.3, 95% CI 2.0-13.4), and 5 were admitted and had funisitis (inflammation of the umbilical cord) (OR 6.7, 95% CI 12.5-17.7). Foetal cytokine storm (two or more pro-inflammatory cytokines >10 times median control levels in umbilical cord blood) was present in 36% of infants with placental GBS DNA and 4% of cases where the placenta was negative (OR 14.2, 95% CI 3.6-60.8). Overall, ~1 in 200 term births had GBS detected in the placenta, which was associated with infant NNU admission and morbidity.
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Affiliation(s)
- Francesca Gaccioli
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Katie Stephens
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Flora Jessop
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hilary S Wong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Susanne Lager
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Cook
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Marcus C de Goffau
- Wellcome Trust Sanger Institute, Hinxton, UK
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's University of London, London, UK
| | | | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - D Stephen Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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6
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Trotter CL, Alderson M, Dangor Z, Ip M, Le Doare K, Nakabembe E, Procter SR, Sekikubo M, Lambach P. Vaccine value profile for Group B streptococcus. Vaccine 2023; 41 Suppl 2:S41-S52. [PMID: 37951694 DOI: 10.1016/j.vaccine.2023.04.024] [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: 08/05/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 11/14/2023]
Abstract
Group B streptococcus (GBS) is a major global cause of neonatal meningitis, sepsis and pneumonia, with an estimated 91,000 infant deaths per year and an additional 46,000 stillbirths. GBS infection in pregnancy is also associated with adverse maternal outcomes and preterm births. As such, the World Health Organization (WHO) prioritised the development of a GBS vaccine suitable for use in pregnant women and use in LMICs, where the burden of disease is highest. Several GBS vaccines are in clinical development. The WHO Defeating Meningitis by 2030 has set a target of 2026 for vaccine licensure. This 'Vaccine Value Profile' (VVP) for GBS is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations, and in collaboration with stakeholders from the WHO regions of AFR, AMR, EUR, WPR. All contributors have extensive expertise on various elements of the GBS VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Caroline L Trotter
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
| | - Mark Alderson
- PATH, 2201 Westlake Avenue, Suite,200, Seattle, WA 98121, USA.
| | - Ziyaad Dangor
- WITS VIDA Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, 30 Chris Hani Road, Diepkloof, Soweto, 1862 Johannesburg, South Africa.
| | - Margaret Ip
- The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | - Kirsty Le Doare
- St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Eve Nakabembe
- Makerere University School of Medicine, P.O. Box 7072, Kampala, Uganda.
| | - Simon R Procter
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Musa Sekikubo
- Makerere University School of Medicine, P.O. Box 7072, Kampala, Uganda.
| | - Philipp Lambach
- World Health Organization, Avenue Appia, Geneva CH-1211, Switzerland.
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Gibała P, Jarosz-Lesz A, Sołtysiak-Gibała Z, Staniczek J, Stojko R. Multifactorial Colonization of the Pregnant Woman's Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns. J Clin Med 2023; 12:6852. [PMID: 37959317 PMCID: PMC10649208 DOI: 10.3390/jcm12216852] [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: 08/19/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
This retrospective study aimed to investigate the impact of microorganisms identified in the reproductive tract on disorders during the early adaptation period in newborns. A cohort of 823 patients and cervical canal cultures were analyzed to identify the presence of microorganisms. Newborns included in the study were divided into two groups due to the number of pathogens identified in the swab from the cervical canal of the mother. The first group consisted of newborns whose mothers had one pathogen identified (N = 637), while the second group consisted of newborns whose mothers had two or more pathogens identified (N = 186). The analysis of disorders of the early adaptation period included the incidence of respiratory distress syndrome, the number of procedures performed with the use of CPAP, oxygen therapy, antibiotic therapy and parenteral nutrition. Respiratory distress syndrome was more common in group II than in group I (85 vs. 31, p = 0.001). In group II, CPAP (63 vs. 21, p = 0.001), oxygen therapy (15 vs. 8, p = 0.02) and antibiotics were used more frequently (13 vs. 8, p = 0.01). The findings of this study revealed that the number of pathogens colonizing the reproductive tract had a significant influence on the early adaptation period in newborns. Multifactorial colonization of the reproductive tract was associated with an increased incidence of infections in newborns and a higher prevalence of acid-base balance disorders. This study highlights the importance of monitoring and addressing the microbial composition of the reproductive tract during pregnancy.
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Affiliation(s)
- Piotr Gibała
- Chair and Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, 40-211 Katowice, Poland (R.S.)
| | - Anna Jarosz-Lesz
- Neonatology Unit, The Guardian Angels Hospital of the Brothers Hospitallers of St. John of God in Katowice, 40-211 Katowice, Poland
| | - Zuzanna Sołtysiak-Gibała
- Chair and Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, 40-211 Katowice, Poland (R.S.)
| | - Jakub Staniczek
- Chair and Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, 40-211 Katowice, Poland (R.S.)
| | - Rafał Stojko
- Chair and Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, 40-211 Katowice, Poland (R.S.)
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Subbarao S, Ribeiro S, Campbell H, Okike I, Ramsay ME, Ladhani SN. Trends in laboratory-confirmed bacterial meningitis (2012-2019): national observational study, England. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100692. [PMID: 37538400 PMCID: PMC10393823 DOI: 10.1016/j.lanepe.2023.100692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
Background Bacterial meningitis is associated with significant morbidity and mortality worldwide. We aimed to describe the epidemiology, aetiology, trends over time and outcomes of laboratory-confirmed bacterial meningitis in England during 2012-2019. Methods UK Health Security Agency routinely receives electronic notifications of confirmed infections from National Health Service hospital laboratories in England. Data were extracted for positive bacterial cultures, PCR-positive results for Neisseria meningitidis or Streptococcus pneumoniae from cerebrospinal fluid and positive blood cultures in patients with clinical meningitis. Findings During 2012-19, there were 6554 laboratory-confirmed cases. Mean annual incidence was 1.49/100,000, which remained stable throughout the surveillance period (p = 0.745). There were 155 different bacterial species identified, including 68.4% (106/1550) Gram-negative and 31.6% (49/155) Gram-positive bacteria. After excluding coagulase-negative staphylococci (2481/6554, 37.9%), the main pathogens causing meningitis were Streptococcus pneumoniae (811/4073, 19.9%), Neisseria meningitidis (497/4073, 12.2%), Staphylococcus aureus (467/4073, 11.5%), Escherichia coli (314/4073, 7.7%) and group B streptococcus (268/4073, 6.6%). Pneumococcal meningitis incidence increased significantly during 2012-9, while meningococcal, group A streptococcal and tuberculous meningitis declined. Infants aged <3 months had the highest mean incidence (55.6/100,000; 95% CI, 47.7-63.5) driven mainly by group B streptococci, followed by 3-11 month-olds (8.1/100,000; 95% CI 7.1-9.0), where pneumococcal and meningitis predominated. The 30-day case-fatality rate (CFR) was 10.0% (71/6554). Group A streptococcal meningitis had the highest CFR (47/85, 55.3%). The probability of surviving at 30 days was 95.3% (95% CI, 93.4-97.3%) for infants and 80.0% for older adults (77-84%). Interpretation The incidence of bacterial meningitis has remained stable. The high CFR highlights a need for prevention through vaccination. Funding PHE.
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Affiliation(s)
- Sathyavani Subbarao
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
- Department of Infectious Diseases, St George's Hospital, University of London, London, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | | | - Mary E. Ramsay
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
- Paediatric Infectious Diseases Research Group (PIDRG), St George's University of London, London, UK
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9
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Schim van der Loeff I, Tsilifis C, Abdelhafiz K, Williams EJ. Recurrent group B stretococcus infection in an extremely premature infant: as a preterm neonate, infant and toddler. BMJ Case Rep 2023; 16:e255216. [PMID: 37507127 PMCID: PMC10387633 DOI: 10.1136/bcr-2023-255216] [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] [Indexed: 07/30/2023] Open
Abstract
We report five discrete episodes of group B streptococcus (GBS) bacteraemia in an extremely premature infant, extending into early childhood. The first four episodes occurred during infancy despite appropriate treatment. Breastmilk was positive for group B streptococcal 16S DNA by polymerase chain reaction. The fifth episode occurred at 17 months of age, shortly after stopping antimicrobial prophylaxis.Radiological investigations did not identify a focus for recurrence of GBS bacteraemia, and immunological investigations and targeted whole genome sequencing yielded only transient hypogammaglobulinaemia of infancy, which resolved.This case highlights invasive GBS infection as a cause of infant morbidity. Premature infants are at particular risk of invasive as well as recurrent disease. GBS is typically a sensitive organism and each episode of GBS in our patient was effectively treated with penicillin. The role of breastmilk in recurrent GBS is controversial; in this case infant and mother isolated identical GBS serotypes and were concurrently treated with rifampicin.
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Affiliation(s)
- Ina Schim van der Loeff
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christo Tsilifis
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Khalid Abdelhafiz
- Neonatalogy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eleri J Williams
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
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10
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Alotaibi NM, Alroqi S, Alharbi A, Almutiri B, Alshehry M, Almutairi R, Alotaibi N, Althoubiti A, Alanezi A, Alatawi N, Almutairi H, Alhmadi M, Almutairi R, Alshammari M. Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1279. [PMID: 37512090 PMCID: PMC10383037 DOI: 10.3390/medicina59071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Group B streptococcus (GBS) is the leading cause of infections in neonates with high fatality rates. GBS is caused by the streptococcus bacterium known as streptococcus agalactiae, which is highly contagious and can be transmitted from pregnant women to infants. GBS infection can occur as an early onset or late-onset infection and has different treatment strategies. Antibiotics are effective in treating GBS infections at early stages. The aim of this systematic review was to summarize the clinical characteristics and treatment strategies for GBS, with a focus on antibiotics. Material and Methods: The findings of this review were reported in accordance with the PRISMA 2020 guidelines and a flow diagram of the study selection process, a summary of the included studies, a description of the study characteristics, a summary of the results, a discussion of the implications of the findings, and a conclusion are included. Overall, the authors followed a rigorous methodology to ensure that this review is comprehensive and inclusive of relevant studies on GBS infection and its treatment. Results: Overall, 940 studies were reviewed and only the most relevant 22 studies were included in the systematic review. This review describes the characteristics of patients in different studies related to early onset GBS disease and presents various treatment strategies and outcomes for GBS infection in pediatrics. The studies suggest that preventive measures, risk-based intrapartum antibiotic prophylaxis, and maternal vaccination can significantly reduce the burden of GBS disease, but late-onset GBS disease remains a concern, and more strategies are required to decrease its rate. Improvement is needed in the management of the risk factors of GBS. A conjugate vaccine with a serotype (Ia, Ib, II, III, and V) has been proven effective in the prevention of GBS in neonates. Moreover, penicillin is an important core antibiotic for treating early onset GBS (EOD). Conclusions: This systematic review summarizes the treatment comparison for GBS infections in neonates, with a primary focus on antibiotics. IAP (intrapartum antibiotic prophylaxis) according to guidelines, antenatal screening, and the development of a conjugate vaccine may be effective and could lower the incidence of the disease.
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Affiliation(s)
- Nawaf M Alotaibi
- Department of Clinical Pharmacy, Northern Border University, Rafhaa 73213, Saudi Arabia
| | - Sharefa Alroqi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Abdulrahman Alharbi
- Department of Pharmaceutical Care, King Faisal Specialist Hospital & Research Centre, Al Madinah Al Munawwarah 42355, Saudi Arabia
| | | | - Manal Alshehry
- Department of Clinical Pharmacy, King Khalid Hospital in IV & Nutrition TPN, Tabuk 32593, Saudi Arabia
| | - Rinad Almutairi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Nada Alotaibi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Atheer Althoubiti
- Hokmaa Taif Medical Complex, Kingdom of Saudi Arabia, Taif 21944, Saudi Arabia
| | - Ashwaq Alanezi
- College of Clinical Pharmacy, King Faisal University, Al-Ahasa 13890, Saudi Arabia
| | - Nouf Alatawi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hanan Almutairi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Munira Alhmadi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Rawan Almutairi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Mohammed Alshammari
- Department of Pharmaceutical Care, Northern Border Cluster, Arar 73311, Saudi Arabia
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11
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Constantinou G, Ayers S, Mitchell EJ, Walker KF, Daniels J, Moore S, Jones AM, Downe S. Women's knowledge of and attitudes towards group B streptococcus (GBS) testing in pregnancy: a qualitative study. BMC Pregnancy Childbirth 2023; 23:339. [PMID: 37170236 PMCID: PMC10173516 DOI: 10.1186/s12884-023-05651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND 20-25% pregnant women in the UK carry group B streptococcus (GBS) which, if left undetected, is transmitted from pregnant mothers to their babies during birth in 36% of cases. This transmission leads to early onset GBS infection (EOGBS) in 1% of babies which is a significant cause of mortality and morbidity in newborns. The literature available suggests women's knowledge of GBS is low, with many women unaware of the GBS bacterium. In addition, attitudes towards GBS testing have not been widely examined, with research mostly focusing on attitudes towards potential GBS vaccination. AIM To examine women's knowledge of GBS in pregnancy and their attitudes towards GBS testing. METHODS Semi-structured interviews with 19 women (5 pregnant and 14 postpartum). Interviews were transcribed and analysed using systematic thematic analysis. RESULTS Four main theme categories were identified. Participants had varying levels of awareness of GBS, with the information provided by health professionals not being clearly explained or the importance of GBS being downplayed. Participants wanted more information and to feel informed. Overall, the majority had positive attitudes towards being offered and taking up GBS testing, and this study identified some of the key factors influencing their decision. These included: seeing GBS testing as just another routine procedure during pregnancy; that it would lower the risk of their baby becoming unwell; provide reassurance; and allow them to prepare; and provide informed choices. Participants also expressed a few common concerns about GBS testing: questioning the invasiveness of the procedure; risks to themselves and the baby; and the risk of receiving antibiotics. CONCLUSIONS Women need clear, detailed information about GBS and GBS testing, and women's concerns are important to address if routine GBS testing is implemented. The efficacy of implementing routine universal testing in the UK is currently being investigated in a large multi-centre clinical trial; the GBS3trial, further qualitative research is needed to look at the acceptability of different methods of GBS testing, as well as the acceptability of GBS testing to women in specific groups, such as those planning a home birth or those from different ethnic backgrounds.
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Affiliation(s)
- Georgina Constantinou
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Susan Ayers
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Eleanor J Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kate F Walker
- Population and Lifeorgdivision Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sarah Moore
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Anne-Marie Jones
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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12
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Wu J, Song X, Hu Y, Chen J, Jiang L. High-risk factors associated with refractory childhood bacterial meningitis in Southwest China. BMC Pediatr 2023; 23:220. [PMID: 37147568 PMCID: PMC10163699 DOI: 10.1186/s12887-023-04007-z] [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: 09/23/2022] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Refractory bacterial meningitis is acute, develops rapidly, and has higher mortality and morbidity than common bacterial meningitis. This study was undertaken to investigate the high-risk factors related to refractory bacterial meningitis in children with positive pathogens. METHODS We retrospectively analyzed the clinical data of 109 patients who had bacterial meningitis. The patients were divided into a refractory group (96 patients) and nonrefractory group (13 patients) based on the classification criteria. Seventeen clinical variables on risk factors were extracted and evaluated by univariate and multivariate logistic regression analyses. RESULTS There were 64 males and 45 females. The onset age ranged from 1 month old to 12 years old, and the median age was 181 days old. The pathogenic bacteria included 67 cases of gram-positive (G+) bacteria (61.5%) and 42 cases of gram-negative (G-) bacteria. In patients who were 1 to 3 months old, E. coli was the most common (47.5%), followed by Streptococcus agalactiae and Staphylococcus hemolyticus (10.0%); in patients > 3 months old, S. pneumoniae was the most common (55.1%), followed by E. coli (8.7%). The multivariate analysis indicated that consciousness disorder (odds ratio [OR] = 13.050), peripheral blood C-reactive protein (CRP) ≥ 50 mg/L (OR = 29.436), and the isolate bacteria being gram-positive bacteria (OR = 8.227) were independent risk factors for predicting who would progress to refractory bacterial meningitis in this group. CONCLUSION For patients who have pathogenic positive bacterial meningitis along with consciousness disorder, CRP ≥ 50 mg/L, and/or have an isolate bacteria that is a G + bacteria, it is important to be alert to the potential for progression to refractory bacterial meningitis, which demands the physicians' significant attention.
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Affiliation(s)
- JinFeng Wu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - XiaoJie Song
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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13
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Alallah J, Ridnah K, Turkstani BA, Albukhari SN. Late-Onset Group B Streptococcal Sepsis in Preterm Twins. Cureus 2023; 15:e38646. [PMID: 37284404 PMCID: PMC10241549 DOI: 10.7759/cureus.38646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 06/08/2023] Open
Abstract
Group B streptococcal (GBS) infection is one of the leading causes of neonatal sepsis worldwide. Despite a significant decline in early-onset (EOS) sepsis due to intrapartum antibiotic prophylaxis, the incidence of late-onset (LOS) infection has remained unchanged. However, LOS GBS sepsis affecting twins is very rare. We report on preterm twins born at 29 weeks of gestation: Twin B was 31 days old when he developed LOS GBS sepsis and meningitis, and Twin A was 35 days old when he developed LOS GBS sepsis. Tests for maternal GBS colonization in breast milk were negative. Both babies were treated with antibiotics and eventually discharged without complications.
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Affiliation(s)
- Jubara Alallah
- Pediatrics/Neonatology, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, SAU
- Pediatrics, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Neonatology, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Khaild Ridnah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bakur A Turkstani
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Saeed N Albukhari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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14
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Auma E, Hall T, Chopra S, Bilton S, Ramkhelawon L, Amini F, Calvert A, Amirthalingam G, Jones CE, Andrews N, Heath PT, Le Doare K. Using Dried Blood Spots for a Sero-Surveillance Study of Maternally Derived Antibody against Group B Streptococcus. Vaccines (Basel) 2023; 11:vaccines11020357. [PMID: 36851236 PMCID: PMC9966576 DOI: 10.3390/vaccines11020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
Vaccination during pregnancy could protect women and their infants from invasive Group B Streptococcus (GBS) disease. To understand if neonatal dried blood spots (DBS) can be used to determine the amount of maternally derived antibody that protects infants against invasive GBS disease, a retrospective case-control study was conducted in England between 1 April 2014 and 30 April 2015. The DBS of cases with invasive GBS disease (n = 61) were matched with healthy controls (n = 125). The haematocrit, DBS storage temperature, freeze-thaw cycle, and paired serum/DBS studies were set up to optimise the antibody assessment. The samples were analysed using a multiplex immunoassay, and the results were assessed using parametric and nonparametric tests. Antibody concentrations were stable at haematocrits of up to 50% but declined at 75%. DBS storage at room temperature was stable for three months compared with storage from collection at -20 °C and rapidly degraded thereafter. Total IgG levels measured in DBS and paired serum showed a good correlation (r2 = 0.99). However, due to suboptimal storage conditions, no difference was found in the GBS IgG levels between DBS samples from cases and controls. We have demonstrated a proof of concept that assays utilising DBS for assessing GBS serotype-specific antibodies in infants is viable. This method could be used to facilitate future large sero-correlate studies, but DBS samples must be stored at -20 °C for long term preservation of antibody.
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Affiliation(s)
- Erick Auma
- Department of Biology, Université Claude Bernard Lyon, ENS de Lyon, CNRS, UMR, 69100 Villeurbanne, France
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Tom Hall
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Correspondence:
| | - Simran Chopra
- Immunity and Infection, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Sam Bilton
- Neonatal Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Laxmee Ramkhelawon
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Fahimah Amini
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Anna Calvert
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London NW9 5EQ, UK
| | - Christine E. Jones
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London NW9 5EQ, UK
| | - Paul T. Heath
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Makerere University—Johns Hopkins University Research Collaboration, Kampala P.O. Box 23491, Uganda
- Pathogen Immunology Group, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
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15
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van der Linden M, Jaschek M, Junker J, Levina N, Weidenhaupt B. Evaluation of the 'HG Group B Streptococcus' loop-mediated isothermal amplification assay for accurate identification of Streptococcus agalactiae. J Med Microbiol 2022; 71. [PMID: 36748534 DOI: 10.1099/jmm.0.001609] [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: 12/23/2022] Open
Abstract
This study evaluated the HiberGene Group B Streptococcus test, a CE-IVD-approved molecular assay for rapid detection of Streptococcus agalactiae [Group B Streptococcus (GBS)] in human clinical specimens. Performance of the assay in terms of specificity, sensitivity and genotype inclusivity was investigated using an extended specificity panel of 113 human and animal GBS isolates, and eight isolates from other streptococcal species, from the isolate collection of the German National Reference Center for Streptococci. Broth cultures were tested according to the manufacturer's protocol, including lysis, heat denaturation and isothermal amplification. All 104/104 (100 %) human GBS isolates of nine serotypes (Ia, Ib, II, III, IV, V, VI, VII, VIII and non-typeable) were correctly identified by the assay as GBS. Additionally, 7/9 (78 %) GBS isolates from elephants were also correctly identified. Six isolates of other streptococcal species/subspecies (Streptococcus anginosus, S. constellatus, S. castoreus, S. dysgalactiae and S. dysgalactiae equisimilis) were correctly reported as negative. Two S. pyogenes (Group A Streptococcus) isolates gave invalid results. The HG Group B Streptococcus assay identified human GBS isolates in culture with 100 % sensitivity.
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Affiliation(s)
- Mark van der Linden
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany
| | - Mareike Jaschek
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany
| | - Julia Junker
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany
| | - Natascha Levina
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany
| | - Bruno Weidenhaupt
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany
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16
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Maternal Group B Streptococcal Rectovaginal Colonization after Intrapartum Antibiotic Prophylaxis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121848. [PMID: 36553292 PMCID: PMC9776505 DOI: 10.3390/children9121848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Maternal rectovaginal colonization with Group B Streptococcus (GBS) during labor is a prerequisite for neonatal early-onset GBS disease. Intrapartum antibiotic prophylaxis (IAP) has been proven to prevent GBS perinatal infection, while there are few studies on the evaluation of the effectiveness of different antibiotic prophylaxis regimens. This study aimed to assess the maternal rectovaginal GBS colonization status after IAP, antimicrobial susceptibility and maternal and neonatal outcomes among women administered different antibiotic prophylaxis regimens. A prospective study was conducted between June 2018 and June 2022. GBS carriers identified at 35-37 weeks of gestation were provided IAP (penicillin, cefazolin or clindamycin) at delivery based on the local protocol for GBS prevention. Rectovaginal samples were obtained from participants again after delivery. Antimicrobial susceptibility testing in GBS isolates was performed using the broth microdilution method. A total of 295 cases were included in this study. In the postpartum re-examination for GBS, the overall negative rectovaginal culture rate was 90.8% (268/295). Women who received cefazolin prophylaxis had the highest negative culture rate (95.2%, 197/207), which was followed by those who received penicillin (80.7%, 67/83) and clindamycin (80.0%, 4/5) (p = 0.001). All GBS isolates achieved sensitivity to penicillin and cefazolin, whereas resistance to clindamycin was shown in 21.4% of the strains. There were no significant differences in maternal and neonatal outcomes among the IAP groups. The use of IAP is highly effective in reducing the maternal rectovaginal GBS colonization. Cefazolin may offer equivalent efficacy and safety compared to standard penicillin prophylaxis.
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17
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Karampatsas K, Davies H, Mynarek M, Andrews N, Heath PT, Le Doare K. Clinical Risk Factors Associated With Late-Onset Invasive Group B Streptococcal Disease: Systematic Review and Meta-Analyses. Clin Infect Dis 2022; 75:1255-1264. [PMID: 35275986 PMCID: PMC9525091 DOI: 10.1093/cid/ciac206] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Group B streptococcal (GBS) infection remains one of the most significant causes of late-onset sepsis and meningitis (LOGBS) among young infants. However, transmission routes and risk factors for LOGBS are not yet fully understood. METHODS We conducted systematic reviews on clinical risk factors previously reported in the literature (prematurity, low birth weight [<2500 g], antenatal colonization, multiple-gestation pregnancy, maternal age <20 years, male infant sex, intrapartum fever, prolonged rupture of membranes) and meta-analyses to determine pooled estimates of risk. RESULTS We included 27 articles, reporting 5315 cases. Prematurity (odds ratio [OR] 5.66; 95% confidence interval [CI]: 4.43-7.22), low birth weight (OR 6.73; 95% CI: 4.68-9.67), maternal colonization (2.67; [2.07-3.45]), and multiple-gestation pregnancies (OR 8.01; 95% CI: 5.19-12.38) were associated with an increased risk of LOGBS. CONCLUSIONS Prematurity/low birth weight and maternal colonization are major risk factors for LOGBS. Future GBS vaccine studies should try to establish the optimal time for vaccination during pregnancy to protect preterm infants.
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Affiliation(s)
- Konstantinos Karampatsas
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George’s, University of London, London, United Kingdom
| | - Hannah Davies
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George’s, University of London, London, United Kingdom
| | - Maren Mynarek
- Center for Early Brain Development, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George’s, University of London, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George’s, University of London, London, United Kingdom
- MRC/UVRI @LHSTM Uganda Research Unit, Entebbe, Uganda
- Pathogen Immunity Group, Public Health England, Porton Down, United Kingdom
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18
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Li A, Fang M, Hao D, Wu Q, Qian Y, Xu H, Zhu B. Late-Onset Sepsis in a Premature Infant Mediated by Breast Milk: Mother-to-Infant Transmission of Group B Streptococcus Detected by Whole-Genome Sequencing. Infect Drug Resist 2022; 15:5345-5352. [PMID: 36110126 PMCID: PMC9469938 DOI: 10.2147/idr.s381466] [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: 07/15/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Late-onset group B Streptococcus (LOGBS) sepsis is a cause of infection and death in infants. Infected breast milk has been considered a source of neonatal GBS infection and invasive infection. However, mother-to-infant transmission of GBS detected by the high-resolution diagnostic method is rarely reported. Methods This study describes a low-weight premature infant who developed late-onset GBS septicemia 21 days after birth. GBS strains isolated from the mother’s cervical secretion, the mother’s milk, and the baby’s blood were cultured to identify the source of GBS infection. We further confirmed the GBS isolates through matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). Finally, we performed whole-genome sequencing (WGS) and phylogenetic analyses on the GBS strains recovered. Results GBS isolates were cultured from the bloodstream of the premature infant and the mother’s milk, respectively. Subsequently, WGS and phylogenetic analyses on three GBS isolates demonstrated that the GBS strain from the infant’s bloodstream was 100% homologous to that from the mother’s breast milk, which had some different gene fragments from the GBS strain from the mother’s cervical secretion. It provided evidence that this infant’s late-onset GBS septicemia originated from his mother’s breast milk instead of the vertical mother-to-infant transmission. Conclusion Through WGS and phylogenetic analysis of the GBS strains, we proved in this study that the late-onset GBS sepsis in a premature infant was derived from his mother’s breast milk. It indicated that WGS diagnosis is an effective tool for infection tracing. Furthermore, this report provides direction for preventing late-onset GBS infection.
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Affiliation(s)
- Aiyun Li
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Ming Fang
- Institute of Infection Disease Control, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China
| | - Dongjie Hao
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Qiaoai Wu
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yaqi Qian
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Hao Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.,Department of Structure and Morphology, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People's Republic of China
| | - Bo Zhu
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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19
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Freeman M. Investing for population mental health in low and middle income countries-where and why? Int J Ment Health Syst 2022; 16:38. [PMID: 35953845 PMCID: PMC9366832 DOI: 10.1186/s13033-022-00547-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Policy makers intent on improving population mental health are required to make fundamental decisions on where to invest resources to achieve optimal outcomes. While research on the effectiveness and efficiency of interventions is critical to such choices, including clinical outcomes and return on investment, in the "real world" of policy making other concerns invariably also play a role. Politics, history, community awareness and demands for care, understanding of etiology, severity of condition and local circumstances are all critical. Policy makers should not merely rely on previous allocations, but need to take active decisions regarding the proportion of resources that should be allocated to particular interventions to achieve optimum outcomes. Given that scientific evidence is only one of the reasons informing such decisions, it is necessary to have clear and informed reasons for allocations and for making cases for new mental health investments. MAIN BODY Investment allocations are unlikely to ever be an exact science. Alternatives therefore need to be rationally weighed up and reasoned decisions made based on this. Using prevalence data and the distribution of mental health resources in South Africa as a backdrop and proxy, investment proposals are made for LMICs with due consideration given to inter alia the social determinants of mental health, the needs and potential benefits of investments in people with severe verses common mental disorder, mental health promotion and disease prevention and to other areas that may impact on population mental health, such as management. CONCLUSION Based on a range of arguments, it is proposed that mental health investments should follow the following approach. A mental health-in-all-policies method must be adopted. There should be no more than a 20% gap in the humane and human rights oriented care, treatment and rehabilitation of people with severe mental disorder. A minimum additional amount of 10% of the amount spent on severe mental disorder should be allocated to treating people with common mental disorder. Screening for mental disabilities should take place within all chronic care services. A minimum of 3% of the budget spent on severe mental disorder should be spent on promotion and prevention programmes. An additional 1% of the allocation for severe mental disorder should be provided for managing/driving the mental health programme.
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Affiliation(s)
- Melvyn Freeman
- University of Stellenbosch, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa.
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20
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Gilbert PB, Isbrucker R, Andrews N, Goldblatt D, Heath PT, Izu A, Madhi SA, Moulton L, Schrag SJ, Shang N, Siber G, Sobanjo-Ter Meulen A. Methodology for a correlate of protection for group B Streptococcus: Report from the Bill & Melinda Gates Foundation workshop held on 10 and 11 February 2021. Vaccine 2022; 40:4283-4291. [PMID: 35779963 PMCID: PMC11299424 DOI: 10.1016/j.vaccine.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/05/2022] [Indexed: 01/19/2023]
Abstract
Worldwide, childhood mortality has declined significantly, with improvements in hygiene and vaccinations against common childhood illnesses, yet newborn mortality remains high. Group B Streptococcus (GBS) disease significantly contributes to newborn mortality and is the leading cause of meningitis in infants. Many years of research have demonstrated the potential for maternal vaccination against GBS to confer protection to the infant, and at least three vaccine candidates are currently undergoing clinical trials. Given the relatively low disease incidence, any clinical vaccine efficacy study would need to include at least 40,000 to 60,000 participants. Therefore, a path to vaccine licensure based on a correlate of protection (CoP) would be the preferred route, with post-approval effectiveness studies demonstrating vaccine impact on reduction of disease burden likely to be required as part of conditional marketing approval. This workshop, hosted by the Bill & Melinda Gates Foundation on 10 and 11 February 2021, discussed considerations and potential statistical methodologies for establishing a CoP for GBS disease. Consensus was reached that an antibody marker with global threshold predictive of a high level of vaccine protection would be most beneficial for licensure assessments. IgG binding antibody in cord blood would likely serve as the CoP, with additional studies needed to confirm a high correlation with functional antibody and to demonstrate comparable kinetics of natural versus vaccine-induced antibody. Common analyses of ongoing seroepidemiological studies include estimation of absolute and relative disease risk as a function of infant antibody concentration, with adjustment for confounders of the impact of antibody concentration on infant GBS disease including gestational age and maternal age. Estimation of an antibody concentration threshold indicative of high protection should build in margin for uncertainties from sources including unmeasured confounders, imperfect causal mediation, and variability in point and confidence interval estimates across regions and/or serotypes.
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Affiliation(s)
- Peter B Gilbert
- Vaccine and Infectious Disease and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center and Department of Biostatistics, University of Washington, USA
| | | | - Nick Andrews
- UK Health Security Agency, Colindale, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Paul T Heath
- Vaccine Institute, St George's, University of London, London, UK
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Moulton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nong Shang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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21
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Chaguza C, Jamrozy D, Bijlsma MW, Kuijpers TW, van de Beek D, van der Ende A, Bentley SD. Population genomics of Group B Streptococcus reveals the genetics of neonatal disease onset and meningeal invasion. Nat Commun 2022; 13:4215. [PMID: 35864107 PMCID: PMC9304382 DOI: 10.1038/s41467-022-31858-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Group B Streptococcus (GBS), or Streptococcus agalactiae, is a pathogen that causes preterm births, stillbirths, and acute invasive neonatal disease burden and mortality. Here, we investigate bacterial genetic signatures associated with disease onset time and meningeal tissue infection in acute invasive neonatal GBS disease. We carry out a genome-wide association study (GWAS) of 1,338 GBS isolates from newborns with acute invasive disease; the isolates had been collected annually, for 30 years, through a national bacterial surveillance program in the Netherlands. After controlling for the population structure, we identify genetic variation within noncoding and coding regions, particularly the capsule biosynthesis locus, statistically associated with neonatal GBS disease onset time and meningeal invasion. Our findings highlight the impact of integrating microbial population genomics and clinical pathogen surveillance, and demonstrate the effect of GBS genetics on disease pathogenesis in neonates and infants.
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Affiliation(s)
- Chrispin Chaguza
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Amsterdam Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Stephen D Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.
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22
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Haeusler IL, Daniel O, Isitt C, Watts R, Cantrell L, Feng S, Cochet M, Salloum M, Ikram S, Hayter E, Lim S, Hall T, Athaide S, Cosgrove CA, Tregoning JS, Le Doare K. Group B Streptococcus (GBS) colonisation is dynamic over time, whilst GBS capsular polysaccharides-specific antibody remains stable. Clin Exp Immunol 2022; 209:188-200. [PMID: 35802786 PMCID: PMC9390841 DOI: 10.1093/cei/uxac066] [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: 03/31/2022] [Revised: 06/08/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Group B Streptococcus (GBS) is a leading cause of adverse pregnancy outcomes due to invasive infection. This study investigated longitudinal variation in GBS rectovaginal colonization, serum and vaginal GBS capsular polysaccharide (CPS)-specific antibody levels. Non-pregnant women were recruited in the UK and were sampled every 2 weeks over a 12-week period. GBS isolates were taken from recto-vaginal swabs and serotyped by polymerase chain reaction. Serum and vaginal immunoglobulin G (IgG) and nasal immunoglobulin A (IgA) specific to CPS were measured by Luminex, and total IgG/A by ELISA. Seventy women were enrolled, of median age 26. Out of the 66 participants who completed at least three visits: 14/47 (29.8%) women that were GBS negative at screening became positive in follow-up visits and 16/19 (84.2%) women who were GBS positive at screening became negative. There was 50% probability of becoming negative 36 days after the first positive swab. The rate of detectable GBS carriage fluctuated over time, although serum, vaginal, and nasal CPS-specific antibody levels remained constant. Levels of CPS-specific antibodies were higher in the serum of individuals colonized with GBS than in non-colonized, but similar in the vaginal and nasal mucosa. We found correlations between antibody levels in serum and the vaginal and nasal mucosa. Our study demonstrates the feasibility of elution methods to retrieve vaginal and nasal antibodies, and the optimization of immunoassays to measure GBS-CPS-specific antibodies. The difference between the dynamics of colonization and antibody response is interesting and further investigation is required for vaccine development.
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Affiliation(s)
- I L Haeusler
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom
| | - O Daniel
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom
| | - C Isitt
- St George's University of London, The Vaccine Institute, London, United Kingdom
| | - R Watts
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom
| | - L Cantrell
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
| | - S Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford
| | - M Cochet
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom
| | - M Salloum
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom.,UnivLyon, Claude Bernard University Lyon I, France
| | - S Ikram
- St George's University of London, The Vaccine Institute, London, United Kingdom
| | - E Hayter
- St George's University of London, The Vaccine Institute, London, United Kingdom
| | - S Lim
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom
| | - T Hall
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom
| | - S Athaide
- St George's University of London, The Vaccine Institute, London, United Kingdom
| | - C A Cosgrove
- St George's University of London, The Vaccine Institute, London, United Kingdom
| | - J S Tregoning
- Imperial College London, Department of Infectious Disease, London, United Kingdom
| | - K Le Doare
- St George's University of London, Paediatric Infectious Diseases Research Group, London, United Kingdom.,Makerere University John Hopkins Research Collaboration, Kampala, Uganda.,Pathogen Immunology Group, United Kingdom Health Security Agency, Porton Down, United Kingdom
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23
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Gonçalves BP, Procter SR, Paul P, Chandna J, Lewin A, Seedat F, Koukounari A, Dangor Z, Leahy S, Santhanam S, John HB, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Sánchez Yanotti C, Horváth-Puhó E, Sørensen HT, van de Beek D, Bijlsma MW, Gardner WM, Kassebaum N, Trotter C, Bassat Q, Madhi SA, Lambach P, Jit M, Lawn JE. Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden. Lancet Glob Health 2022; 10:e807-e819. [PMID: 35490693 PMCID: PMC9090904 DOI: 10.1016/s2214-109x(22)00093-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets. METHODS We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and estimated the burden for 183 countries in 2020 regarding: maternal GBS colonisation, iGBS cases and deaths in infants younger than 3 months, children surviving iGBS affected by NDI, and maternal iGBS cases. We analysed the proportion of stillbirths with GBS and applied this to the UN-estimated stillbirth risk per country. Excess preterm births associated with maternal GBS colonisation were calculated using meta-analysis and national preterm birth rates. FINDINGS Data from the seven systematic reviews, published in 2017, that informed the previous burden estimation (a total of 515 data points) were combined with new data (17 data points) from large multicountry studies on neurodevelopmental impairment (two studies) and stillbirths (one study). A posterior median of 19·7 million (95% posterior interval 17·9-21·9) pregnant women were estimated to have rectovaginal colonisation with GBS in 2020. 231 800 (114 100-455 000) early-onset and 162 200 (70 200-394 400) late-onset infant iGBS cases were estimated to have occurred. In an analysis assuming a higher case fatality rate in the absence of a skilled birth attendant, 91 900 (44 800-187 800) iGBS infant deaths were estimated; in an analysis without this assumption, 58 300 (26 500-125 800) infant deaths from iGBS were estimated. 37 100 children who recovered from iGBS (14 600-96 200) were predicted to develop moderate or severe NDI. 40 500 (21 500-66 200) maternal iGBS cases and 46 200 (20 300-111 300) GBS stillbirths were predicted in 2020. GBS colonisation was also estimated to be potentially associated with considerable numbers of preterm births. INTERPRETATION Our analysis provides a comprehensive assessment of the pregnancy-related GBS burden. The Bayesian approach enabled coherent propagation of uncertainty, which is considerable, notably regarding GBS-associated preterm births. Our findings on both the acute and long-term consequences of iGBS have public health implications for understanding the value of investment in maternal GBS immunisation and other preventive strategies. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Bronner P Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, Kenyan Medical Research Institute, Wellcome Trust, Kilifi, Kenya; Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, Kenyan Medical Research Institute, Wellcome Trust, Kilifi, Kenya
| | | | | | | | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - William M Gardner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Departments of Global Health and Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology and National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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24
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Abstract
Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.
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Affiliation(s)
- Teresa Tavares
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Liliana Pinho
- Centro Hospitalar Universitário do Porto, Centro Materno Infantil do Norte, Porto, Portugal
| | - Elva Bonifácio Andrade
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
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25
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Pangerl S, Sundin D, Geraghty S. Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy. J Adv Nurs 2022; 78:3247-3260. [PMID: 35429021 PMCID: PMC9546437 DOI: 10.1111/jan.15249] [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: 11/06/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022]
Abstract
Aims To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non‐midwifery led). Design This retrospective quantitative study has employed a descriptive design using administrative health data. Methods Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis. Results The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to screening was found in the midwifery led model of care (MMC, 68.76%, n = 7232) when compared with the non‐midwifery led model of care (NMMC, 90.49%, n = 10,767). Over the 5 years, screening rates trended down in the MMC with stable numbers in the counterpart. Adherence in relation to intrapartum antibiotic prophylaxis revealed discrepant findings between the study groups. Conclusion Adherence to screening and management guidelines of maternal GBS colonization in pregnancy is lower within the MMC when compared with the NMMC. Impact This is the first cohort study to describe the adherence to the recommended Western Australian GBS screening guidelines in the two different models of care. Findings may assist in the guidance and improvement of clinical protocols as well as the planning of clinical care in relation to GBS screening to reduce the risk of neonatal GBS infection.
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Affiliation(s)
- Sabine Pangerl
- King Edward Memorial Hospital Perth Western Australia Australia
| | - Deborah Sundin
- Edith Cowan University Perth Western Australia Australia
| | - Sadie Geraghty
- The University of Notre Dame Australia Fremantle Western Australia Australia
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26
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Furuta A, Brokaw A, Manuel G, Dacanay M, Marcell L, Seepersaud R, Rajagopal L, Adams Waldorf K. Bacterial and Host Determinants of Group B Streptococcal Infection of the Neonate and Infant. Front Microbiol 2022; 13:820365. [PMID: 35265059 PMCID: PMC8899651 DOI: 10.3389/fmicb.2022.820365] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Group B streptococci (GBS) are Gram-positive β-hemolytic bacteria that can cause serious and life-threatening infections in neonates manifesting as sepsis, pneumonia, meningitis, osteomyelitis, and/or septic arthritis. Invasive GBS infections in neonates in the first week of life are referred to as early-onset disease (EOD) and thought to be acquired by the fetus through exposure to GBS in utero or to vaginal fluids during birth. Late-onset disease (LOD) refers to invasive GBS infections between 7 and 89 days of life. LOD transmission routes are incompletely understood, but may include breast milk, household contacts, nosocomial, or community sources. Invasive GBS infections and particularly meningitis may result in significant neurodevelopmental injury and long-term disability that persists into childhood and adulthood. Globally, EOD and LOD occur in more than 300,000 neonates and infants annually, resulting in 90,000 infant deaths and leaving more than 10,000 infants with a lifelong disability. In this review, we discuss the clinical impact of invasive GBS neonatal infections and then summarize virulence and host factors that allow the bacteria to exploit the developing neonatal immune system and target organs. Specifically, we consider the mechanisms known to enable GBS invasion into the neonatal lung, blood vessels and brain. Understanding mechanisms of GBS invasion and pathogenesis relevant to infections in the neonate and infant may inform the development of therapeutics to prevent or mitigate injury, as well as improve risk stratification.
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Affiliation(s)
- Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Gygeria Manuel
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Matthew Dacanay
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Lauren Marcell
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Ravin Seepersaud
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Kristina Adams Waldorf
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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27
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Xu X, Marffy ALL, Keightley A, McCarthy AJ, Geisbrecht BV. Group B Streptococcus Surface Protein β: Structural Characterization of a Complement Factor H-Binding Motif and Its Contribution to Immune Evasion. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:1232-1247. [PMID: 35110419 PMCID: PMC8881398 DOI: 10.4049/jimmunol.2101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022]
Abstract
The β protein from group B Streptococcus (GBS) is a ∼132-kDa, cell-surface exposed molecule that binds to multiple host-derived ligands, including complement factor H (FH). Many details regarding this interaction and its significance to immune evasion by GBS remain unclear. In this study, we identified a three-helix bundle domain within the C-terminal half of the B75KN region of β as the major FH-binding determinant and determined its crystal structure at 2.5 Å resolution. Analysis of this structure suggested a role in FH binding for a loop region connecting helices α1 and α2, which we confirmed by mutagenesis and direct binding studies. Using a combination of protein cross-linking and mass spectrometry, we observed that B75KN bound to complement control protein (CCP)3 and CCP4 domains of FH. Although this binding site lies within a complement regulatory region of FH, we determined that FH bound by β retained its decay acceleration and cofactor activities. Heterologous expression of β by Lactococcus lactis resulted in recruitment of FH to the bacterial surface and a significant reduction of C3b deposition following exposure to human serum. Surprisingly, we found that FH binding by β was not required for bacterial resistance to phagocytosis by neutrophils or killing of bacteria by whole human blood. However, loss of the B75KN region significantly diminished bacterial survival in both assays. Although our results show that FH recruited to the bacterial surface through a high-affinity interaction maintains key complement-regulatory functions, they raise questions about the importance of FH binding to immune evasion by GBS as a whole.
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Affiliation(s)
- Xin Xu
- Department of Biochemistry & Molecular Biophysics, Kansas State University; Manhattan, KS U.S.A
| | - Alexander L. Lewis Marffy
- Department of Infectious Diseases, Section of Molecular Microbiology, MRC Centre for Molecular Bacteriology & Infection, Imperial College London; London, U.K
| | - Andrew Keightley
- Department of Opthamology, School of Medicine, University of Missouri-Kansas City; Kansas City, MO U.S.A
| | - Alex J. McCarthy
- Department of Infectious Diseases, Section of Molecular Microbiology, MRC Centre for Molecular Bacteriology & Infection, Imperial College London; London, U.K
| | - Brian V. Geisbrecht
- Department of Biochemistry & Molecular Biophysics, Kansas State University; Manhattan, KS U.S.A.,To whom correspondence should be addressed: Brian V. Geisbrecht, Ph.D., Kansas State University, 141 Chalmers Hall, 1711 Claflin Road, Manhattan, KS 66506, PH: 785.532.3154,
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Juliana NCA, Deb S, Juma MH, Poort L, Budding AE, Mbarouk A, Ali SM, Ouburg S, Morré SA, Sazawal S, Ambrosino E. The Vaginal Microbiota Composition and Genital Infections during and after Pregnancy among Women in Pemba Island, Tanzania. Microorganisms 2022; 10:microorganisms10030509. [PMID: 35336085 PMCID: PMC8951098 DOI: 10.3390/microorganisms10030509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023] Open
Abstract
We investigated the vaginal microbiota (VMB) composition, prevalence of genital pathogens and their association among pregnant and post-delivery women in Pemba Island, Tanzania. Vaginal swabs were collected from 90 women, at two time points during pregnancy (<20 weeks of gestational age [GA] and ≥20 weeks GA) and once after delivery, when possible. IS-pro assay was used for VMB characterization. Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and human papillomavirus (HPV) were detected by qPCRs. VMB were mostly Lactobacillus dominant during pregnancy and non-Lactobacillus dominant post-delivery. A significant decrease in VMB richness was observed during pregnancy among paired and unpaired samples. Shannon diversity was significantly lower during pregnancy than post-delivery among unpaired samples. Klebsiella species and Streptococcus anginosus were the most commonly identified pathobionts at all timepoints. A high abundance of pathobionts was mostly seen in women with non-Lactobacillus dominant VMB. At ≥20 weeks GA timepoint during pregnancy, 63.0% of the women carrying one or more genital pathogen (either HPV, CT, TV, or MG) had L. iners dominant VMB. NG was not detected pre-delivery. This study contributes evidence on VMB composition, its changes during pregnancy and post-delivery, and their association with pathobionts and genital pathogens.
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Affiliation(s)
- Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
| | - Saikat Deb
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
- Centre for Public Health Kinetics, New Delhi 110024, India;
| | - Mohamed H. Juma
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Linda Poort
- inBiome, 1098 Amsterdam, The Netherlands; (L.P.); (A.E.B.)
| | | | - Abdalla Mbarouk
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Said M. Ali
- Public Health Laboratory—Ivo de Carneri, Chake Chake 74201, Pemba Island, Tanzania; (S.D.); (M.H.J.); (A.M.); (S.M.A.)
| | - Sander Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Amsterdam UMC, Location AMC, 1105 Amsterdam, The Netherlands;
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
| | - Sunil Sazawal
- Centre for Public Health Kinetics, New Delhi 110024, India;
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Reproduction), Faculty of Health, Medicine & Life Sciences, University of Maastricht, 6200 Maastricht, The Netherlands; (N.C.A.J.); (S.A.M.)
- Correspondence: ; Tel.: +31-04-3388-4081
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Daniels J, Dixon EF, Gill A, Bishop J, D'Amico M, Ahmed K, Dodds J, Tryposkiadis K, Wilks M, Millar M, Husain S, Gray J, Whiley A, Moore PV, Munetsi RL, Hemming K, Roberts T, Plumb J, Deeks J, Khan KS, Thangaratinam S. A rapid intrapartum test for group B Streptococcus to reduce antibiotic usage in mothers with risk factors: the GBS2 cluster RCT. Health Technol Assess 2022; 26:1-82. [PMID: 35195519 DOI: 10.3310/bicf1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mother-to-baby transmission of group B Streptococcus (Streptococcus agalactiae) is the main cause of early-onset infection. OBJECTIVES We investigated if intrapartum antibiotic prophylaxis directed by a rapid intrapartum test reduces maternal and neonatal antibiotic use, compared with usual care (i.e. risk factor-directed antibiotics), among women with risk factors for vertical group B Streptococcus transmission, and examined the accuracy and cost-effectiveness of the rapid test. DESIGN An unblinded cluster randomised controlled trial with a nested test accuracy study, an economic evaluation and a microbiology substudy. SETTING UK maternity units were randomised to either a strategy of rapid test or usual care. PARTICIPANTS Vaginal and rectal swabs were taken from women with risk factors for vertical group B Streptococcus transmission in established term labour. The accuracy of the GeneXpert® Dx IV GBS rapid testing system (Cepheid, Maurens-Scopont, France) was compared with the standard of selective enrichment culture in diagnosing maternal group B Streptococcus colonisation. MAIN OUTCOME MEASURES Primary outcomes were rates of intrapartum antibiotic prophylaxis administered to prevent early-onset group B Streptococcus infection and accuracy estimates of the rapid test. Secondary outcomes were maternal antibiotics for any indication, neonatal antibiotic exposure, maternal antibiotic duration, neonatal group B Streptococcus colonisation, maternal and neonatal antibiotic resistance, neonatal morbidity and mortality, and cost-effectiveness of the strategies. RESULTS Twenty-two maternity units were randomised and 20 were recruited. A total of 722 mothers (749 babies) participated in rapid test units and 906 mothers (951 babies) participated in usual-care units. There were no differences in the rates of intrapartum antibiotic prophylaxis for preventing early-onset group B Streptococcus infection in the rapid test units (41%, 297/716) compared with the usual-care units (36%, 328/906) (risk ratio 1.16, 95% confidence interval 0.83 to 1.64). There were no differences between the groups in intrapartum antibiotic administration for any indication (risk ratio 0.99, 95% confidence interval 0.81 to 1.21). Babies born in the rapid test units were 29% less likely to receive antibiotics (risk ratio 0.71, 95% confidence interval 0.54 to 0.95) than those born in usual-care units. The sensitivity and specificity of the rapid test were 86% (95% confidence interval 81% to 91%) and 89% (95% confidence interval 85% to 92%), respectively. In 14% of women (99/710), the rapid test was invalid or the machine failed to provide a result. In the economic analysis, the rapid test was shown to be both less effective and more costly and, therefore, dominated by usual care. Sensitivity analysis indicated potential lower costs for the rapid test strategy when neonatal costs were included. No serious adverse events were reported. CONCLUSIONS The Group B Streptococcus 2 (GBS2) trial found no evidence that the rapid test reduces the rates of intrapartum antibiotic prophylaxis administered to prevent early-onset group B Streptococcus infection. The rapid test has the potential to reduce neonatal exposure to antibiotics, but economically is dominated by usual care. The accuracy of the test is within acceptable limits. FUTURE WORK The role of routine testing for prevention of neonatal infection requires evaluation in a randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN74746075. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jane Daniels
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily F Dixon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alicia Gill
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Maria D'Amico
- Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Khaled Ahmed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Julie Dodds
- Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kostas Tryposkiadis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mark Wilks
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael Millar
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shahid Husain
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angela Whiley
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Patrick V Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruvimbo L Munetsi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Khalid S Khan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and System Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Dietz J, Plumb J, Banfield P, Soe A, Chehadah F, Chang-Douglass S, Rogers G. Immediate birth for women between 34 and 37 weeks of gestation with prolonged preterm prelabour rupture of membranes and detection of vaginal or urine group B streptococcus: an economic evaluation. BJOG 2022; 129:1779-1789. [PMID: 35137528 PMCID: PMC9543209 DOI: 10.1111/1471-0528.17119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Objective What are the costs, benefits and harms of immediate birth compared with expectant management in women with prolonged preterm prelabour rupture of membranes (PPROM) at 34+0–36+6 weeks of gestation and detection of vaginal or urine group B streptococcus (GBS)? Design Mathematical decision model comprising three independent decision trees. Setting UK National Health Service (NHS) and personal social services perspective. Population Women testing positive for GBS with PPROM at 34+0–36+6 weeks of gestation. Methods The model estimates lifetime costs and quality‐adjusted life years (QALYs) using evidence from randomised trials, UK NHS data sources and further observational studies. Simulated events include neonatal infections, morbidity associated with preterm birth and consequences of caesarean birth. Deterministic and probabilistic sensitivity analyses (PSAs) were performed. Main outcome measures QALYs, costs and incremental cost‐effectiveness ratio (ICER). Results In this population, immediate birth dominates expectant management: it is more effective (average lifetime QALYs, 24.705 versus 24.371) and it is cheaper (average lifetime costs, £14,372 versus £19,311). In one‐way sensitivity analysis, results are robust to all but the odds ratio estimating the relative effect on incidence of infections. Threshold analysis shows that the odds of infection only need to be >1.5% with expectant management for the benefit of avoiding infections to outweigh the disadvantages of immediate birth. In PSA, immediate birth is the preferred option in >80% of simulations. Conclusions Neonatal GBS infections are expensive to treat and may result in substantial adverse health consequences. Therefore, immediate birth, which is associated with a reduced risk of neonatal infection compared with expectant management, is expected to generate better health outcomes and decreased lifetime costs. Tweetable abstract For women with preterm prelabour rupture of membranes and group B streptococcus in vaginal or urine samples, immediate birth is associated with improved health in their babies and reduced costs, compared with expectant management. For women with preterm prelabour rupture of membranes and group B streptococcus in vaginal or urine samples, immediate birth is associated with improved health in their babies and reduced costs, compared with expectant management.
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Affiliation(s)
- Jeremy Dietz
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), London, UK
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, West Sussex, UK
| | | | - Aung Soe
- Oliver Fisher Neonatal Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Fadi Chehadah
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Stacey Chang-Douglass
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), London, UK
| | - Gabriel Rogers
- Division of Population Health, Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Li J, Xia S, Liu Y, Zhang S, Jin Z. Bacteriological Profile and Antibiotic Susceptibility Pattern of Neonatal Septicemia and Associated Factors of ICU Hospitalization Days. Infect Drug Resist 2022; 15:427-438. [PMID: 35177910 PMCID: PMC8846624 DOI: 10.2147/idr.s341536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the microorganisms involved in neonatal septicemia and its antibiotic susceptibility pattern and to further investigate the factors associated with the length of intensive care unit (ICU) stay in neonatal septicemia. Patients and Methods A total of 297 infants with septicemia at neonatal ICU (NICU), Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from 2016 to 2020 were enrolled. Identification of bacterial species was done using the standard positive blood culture. Data included demographics, signs at time of septicemia, laboratory values, patient sources, complications, microbiologic characteristics, and the duration of ICU stay. Univariate and multivariate gamma regression analyses were applied to determine the variables associated with ICU stay. Results The result demonstrated that the main causative pathogens of neonatal septicemia in our hospital were Gram-positive bacteria, among which Staphylococcus epidermidis (100 isolates, 47.17%) was the main conditional pathogens; Escherichia coli (27 isolates, 49.09%) was most frequently isolated among Gram-negative pathogens. Gram-positive bacteria had higher susceptibility to vancomycin, tigecycline and linezolid. Escherichia coli was susceptive to piperacillin (27/27, 100.00%), cefotetan (27/27, 100.00%), meropenem and imipenem (27/27, 100.00%). Streptococcus agalactiae (95% CI: 0.140–0.539), for patients who were transferred from other hospital (95% CI: 0.016 to 0.354), septicemia during hospitalization (95% CI: 0.411 to 0.825), the use of antibacterial drug during pregnancy (95% CI: 0.362 to 2.136), feeding intolerance (95% CI: 0.127 to 0.437), bradycardia (95% CI: 0.196 to 0.838), septicemia newborns have complications (95% CI: 0.063 to 0.291), the onset age (95% CI: 0.006 to 0.023), TRIPS score (95% CI: 0.005 to 0.016), and CRP level (95% CI: 0.002 to 0.005) were related to prolonged ICU stay days. Conclusion This study summarized common pathogens and associated drug sensitivity, and factors influencing ICU stay length. Prevention and control policy in the NICU should be strengthened.
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Affiliation(s)
- Jinchun Li
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Shiwen Xia
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
- Correspondence: Shiwen Xia, Tel +86 027-65395034, Fax +86 027-87163133, Email ;
| | - Yong Liu
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Shasha Zhang
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Zhengjiang Jin
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
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van Kassel MN, Gonçalves BP, Snoek L, Sørensen HT, Bijlsma MW, Lawn JE, Horváth-Puhó E. Sex Differences in Long-term Outcomes After Group B Streptococcal Infections During Infancy in Denmark and the Netherlands: National Cohort Studies of Neurodevelopmental Impairments and Mortality. Clin Infect Dis 2022; 74:S54-S63. [PMID: 34725694 PMCID: PMC8775649 DOI: 10.1093/cid/ciab822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Male infants have a higher incidence of invasive group B Streptococcus disease (iGBS) compared with female infants; however, data on sex differences in mortality and long-term outcomes after iGBS are lacking. We assessed whether a child's sex influences the effects of iGBS on mortality and risk of neurodevelopmental impairments (NDIs). METHODS We used Danish and Dutch registry data to conduct a nationwide cohort study of infants with a history of iGBS. A comparison cohort, children without a history of iGBS, was randomly selected and matched on relevant factors. Effect modification by sex was assessed on additive and multiplicative scales. RESULTS Our analyses included data from children with a history of iGBS in Denmark (period 1997 -2017; n = 1432) and the Netherlands (2000 -2017; n = 697) and from 21 172 children without iGBS. There was no clear evidence of between-sex heterogeneity in iGBS-associated mortality. Boys had a higher risk of NDI, with evidence for effect modification on additive scale at the age of 5 years for any NDI (relative excess risk due to interaction = 1.28; 95% confidence interval [CI], -0.53 to 3.09 in Denmark and 1.14; 95% CI, -5.13 to 7.41 in the Netherlands). A similar pattern was observed for moderate/severe NDI at age 5 years in Denmark and age 10 years in the Netherlands. CONCLUSION Boys are at higher risk of NDI ; our results suggest this is disproportionally increased in those who develop iGBS. Future studies should investigate mechanisms of this effect modification by sex.
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Affiliation(s)
- Merel N van Kassel
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bronner P Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Linde Snoek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Daniels JP, Dixon E, Gill A, Bishop J, Wilks M, Millar M, Gray J, Roberts TE, Plumb J, Deeks JJ, Hemming K, Khan KS, Thangaratinam S. Rapid intrapartum test for maternal group B streptococcal colonisation and its effect on antibiotic use in labouring women with risk factors for early-onset neonatal infection (GBS2): cluster randomised trial with nested test accuracy study. BMC Med 2022; 20:9. [PMID: 35027057 PMCID: PMC8759240 DOI: 10.1186/s12916-021-02202-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mother-to-baby transmission of group B Streptococcus (GBS) is the main cause of early-onset infection. We evaluated whether, in women with clinical risk factors for early neonatal infection, the use of point-of-care rapid intrapartum test to detect maternal GBS colonisation reduces maternal antibiotic exposure compared with usual care, where antibiotics are administered due to those risk factors. We assessed the accuracy of the rapid test in diagnosing maternal GBS colonisation, against the reference standard of selective enrichment culture. METHODS We undertook a parallel-group cluster randomised trial, with nested test accuracy study and microbiological sub-study. UK maternity units were randomised to a strategy of rapid test (GeneXpert GBS system, Cepheid) or usual care. Within units assigned to rapid testing, vaginal-rectal swabs were taken from women with risk factors for vertical GBS transmission in established term labour. The trial primary outcome was the proportion of women receiving intrapartum antibiotics to prevent neonatal early-onset GBS infection. The accuracy of the rapid test was compared against the standard of selective enrichment culture in diagnosing maternal GBS colonisation. Antibiotic resistance profiles were determined in paired maternal and infant samples. RESULTS Twenty-two maternity units were randomised and 20 were recruited. A total of 722 mothers (749 babies) participated in rapid test units; 906 mothers (951 babies) were in usual care units. There was no evidence of a difference in the rates of intrapartum antibiotic prophylaxis (relative risk 1.16, 95% CI 0.83 to 1.64) between the rapid test (41%, 297/716) and usual care (36%, 328/906) units. No serious adverse events were reported. The sensitivity and specificity measures of the rapid test were 86% (95% CI 81 to 91%) and 89% (95% CI 85 to 92%), respectively. Babies born to mothers who carried antibiotic-resistant Escherichia coli were more likely to be colonised with antibiotic-resistant strains than those born to mothers with antibiotic-susceptible E. coli. CONCLUSION The use of intrapartum rapid test to diagnose maternal GBS colonisation did not reduce the rates of antibiotics administered for preventing neonatal early-onset GBS infection than usual care, although with considerable uncertainty. The accuracy of the rapid test is within acceptable limits. TRIAL REGISTRATION ISRCTN74746075 . Prospectively registered on 16 April 2015.
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Affiliation(s)
- Jane P Daniels
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Emily Dixon
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alicia Gill
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mark Wilks
- Barts Health NHS Trust, London, UK.,Queen Mary University of London, London, UK
| | | | - Jim Gray
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Tracy E Roberts
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Plumb
- Group B Strep Support, JYW House, Bridge Road, Haywards Heath, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Shakila Thangaratinam
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and System Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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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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McLeod E, Mason C, Swainston K. Parents experiences of having an infant with early onset group B streptococcus infection. Br J Health Psychol 2021; 27:777-788. [PMID: 34806260 DOI: 10.1111/bjhp.12572] [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: 12/02/2020] [Revised: 10/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study explores parents lived experience of having an infant with early onset group B streptococcus (GBS). DESIGN The study adopts a qualitative approach and a phenomenological framework with written autobiographical accounts as the method of data collection. METHODS Twenty-seven parents wrote first-hand accounts of their experience of having an infant with early onset GBS. Participants documented their experiences in their own way, reporting their thoughts and feelings, experiences, and events that were meaningful to them. RESULTS Four themes were developed from data analysis: 'bonding'; 'grief'; 'communication and information provision'; and 'future family'. CONCLUSIONS The study findings demonstrate the complexity of emotions within parent's experiences and highlight grief and loss as a core component of these experiences. Medical intervention, while acknowledged as being vital and in many cases lifesaving, was viewed as a disruption to early bonding experiences resulting in sadness and guilt. Variation in information provision, communication about this infection, and feeling that their infant's illness and/or death were preventable added to the sense of loss. Breakdowns in interpersonal communications with partners and family were commonly described and experiences of early onset GBS had implications for decision-making around future pregnancies.
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Affiliation(s)
- Emma McLeod
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Celia Mason
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Katherine Swainston
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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AlZuheiri STS, Dube R, Menezes G, Qasem S. Clinical Profile and Outcome of Group B Streptococcal Colonization in Mothers and Neonates in Ras Al Khaimah, United Arab Emirates: A Prospective Observational Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:235-240. [PMID: 34667470 PMCID: PMC8474000 DOI: 10.4103/sjmms.sjmms_213_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35–37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cultures for GBS colonization. The carriage rate was higher in women without any risk factors for early-onset GBS disease (EOGBS) (P < 0.01). The GBS isolates were about 97% susceptible to linezolid and vancomycin, 90% to benzyl penicillin and 95% to ampicillin. Resistance to trimethoprim/sulfamethoxazole, clindamycin, erythromycin, and levofloxacin were about 77%, 57%, 57%, and 10%, respectively. Urinary tract infection in GBS colonized women were more common in those aged ≤30 years (P = 0.009). Fetal outcome was favorable in women receiving IAP for GBS colonization. No neonate had culture proven EOGBS. Conclusion: The prevalence of GBS colonization in pregnant women as well as the overall maternal and neonatal complications is low in Ras Al Khaimah, UAE. IAP is effective in preventing early-onset sepsis in newborn, and thus should be initiated in those with GBS colonization. The cultured GBS showed sensitivity to most antibiotics.
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Affiliation(s)
- Shatha Taher Salman AlZuheiri
- Department of Obstetrics and Gynecology, Abdulla Bin Omran Hospital for Obstetrics and Gynecology, Ras Al-Khaimah, UAE
| | - Rajani Dube
- Department of Obstetrics and Gynecology, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Godfred Menezes
- Department of Microbiology, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Samar Qasem
- Department of Obstetrics and Gynecology, Abdulla Bin Omran Hospital for Obstetrics and Gynecology, Ras Al-Khaimah, UAE
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Werter DE, Dehaene I, Gurney L, Vargas Buján M, Kazemier BM. Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey. Eur J Obstet Gynecol Reprod Biol 2021; 266:83-88. [PMID: 34600189 DOI: 10.1016/j.ejogrb.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE An association between infections in pregnancy and increased risk of preterm birth (PTB) is described in the literature. We anticipated that differences may exist in screening and treatment approaches for infections associated with PTB, within and between European countries. The aim of this study was to examine and analyse these differences in clinical practice in greater detail. STUDY DESIGN We created a descriptive survey examining the screening and treatment of infections in pregnancy. The survey was sent to European representatives of the International Spontaneous Preterm Birth Young Investigators (I-SPY) group in Europe, who sent it to their network. Finally, we had 50 respondents from ten European countries. RESULTS We found substantial differences in screening for bacterial vaginosis and asymptomatic bacteriuria, administration of antibiotics to women with preterm prelabour rupture of membranes (PPROM), and timing of induction of labour after PPROM. These differences in clinical practice were present both within, and between countries. CONCLUSIONS Approaches for screening and treatment of infections associated with PTB differ between European countries. There is a lack of robust evidence, which is reflected in a lack of uniformity in international guidelines. International collaboration is paramount to enlarge sample sizes in obstetric studies and to facilitate the process of developing, updating, and implementing consistent guidelines across Europe and beyond.
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Affiliation(s)
- Dominique E Werter
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Isabelle Dehaene
- Ghent University Hospital, Department of Obstetrics and Gynaecology, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Leo Gurney
- Birmingham Women's Hospital, Fetal Medicine Department, Mendelsohn Road, Edgbaston, Birmingham, United Kingdom.
| | - Mireia Vargas Buján
- Hospital Universitari Vall d'Hebron, Department of Obstetrics and Gynaecology, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
| | - Brenda M Kazemier
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands.
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Takahashi K, Sato Y, Ikeda K. Group B streptococcus neonatal umbilical colonization managed by dry cord care in nurseries: A retrospective cohort study. Pediatr Neonatol 2021; 62:506-511. [PMID: 34088650 DOI: 10.1016/j.pedneo.2021.05.003] [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: 12/07/2020] [Revised: 03/19/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Screening-based intrapartum antibiotic prophylaxis (IAP) has reduced the prevalence of early-onset group B Streptococcus (GBS) infection in newborns. Nevertheless, early-onset disease still occurs despite IAP, and IAP is not effective in preventing late-onset disease. This study aimed to determine the prevalence and risk factors of GBS neonatal umbilical colonization managed by dry cord care in Japan. METHODS Of 735 healthy newborns in the well-baby nursery at Saitama City Hospital, 353 from whom umbilical bacterial swabs were obtained before discharge were included in the analysis. Maternal and neonatal clinical characteristics were retrospectively reviewed. RESULTS GBS was detected in 4.2% (15/353) of umbilical swabs; 13/15 (86.8%) were born to GBS-negative mothers. The median (IQR) age at umbilical swab collection was 4.0 (4.0-5.0) days. Comparison of clinical characteristics between GBS-positive and negative neonates revealed a significant difference in the proportion of vaginal deliveries (15/15 [100%] in GBS-positive neonates vs. 115/338 [34.0%] in GBS-negative neonates, p < 0.0001). Of 15 GBS-positive neonates, 10 (66.7%) were also co-colonized with other enteric bacteria such as Escherichia coli. CONCLUSION Vaginal delivery was a risk factor associated with GBS neonatal umbilical colonization in Japanese neonates. Co-colonization with multiple enteric bacterial species implicates vertical transmission of GBS from undetected carrier mothers during passage through the birth canal.
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Affiliation(s)
- Keigo Takahashi
- Division of Neonatology, Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Yuka Sato
- Department of Central Clinical Laboratory, Saitama City Hospital, Saitama, Japan
| | - Kazushige Ikeda
- Division of Neonatology, Department of Pediatrics, Saitama City Hospital, Saitama, Japan.
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Berardi A, Trevisani V, Di Caprio A, Bua J, China M, Perrone B, Pagano R, Lucaccioni L, Fanaro S, Iughetti L, Lugli L, Creti R. Understanding Factors in Group B Streptococcus Late-Onset Disease. Infect Drug Resist 2021; 14:3207-3218. [PMID: 34429620 PMCID: PMC8380284 DOI: 10.2147/idr.s291511] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
Group B streptococcus (GBS) infection remains a leading cause of sepsis, pneumonia, and meningitis in infants. Rates of GBS early onset disease have declined following the widcespread use of intrapartum antibiotic prophylaxis; hence, late-onset infections (LOGBS) are currently a common presentation of neonatal GBS dicsease. The pathogenesis, mode of transmission, and risk factors associated with LOGBS are unclear, which interfere with effective prevention efforts. GBS may be transmitted from the mother to the infant at the time of delivery or during the postpartum period via contaminated breast milk, or as nosocomial or community-acquired infection. Maternal GBS colonization, prematurity, young maternal age, HIV exposure, and ethnicity (Black) are identified as risk factors for LOGBS disease; however, further studies are necessary to confirm additional risk factors, if any, for the implementation of effective prevention strategies. This narrative review discusses current and previous studies that have reported LOGBS. Few well-designed studies have described this condition; therefore, reliable assessment of maternal GBS colonization, breastfeeding, and twin delivery as risk factors for LOGBS remains limited.
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Affiliation(s)
- Alberto Berardi
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Viola Trevisani
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy
| | - Antonella Di Caprio
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy
| | - Jenny Bua
- Terapia Intensiva Neonatale, IRCCS Azienda Ospedaliero Universitaria "Burlo Garofalo", Trieste, Italy
| | | | - Barbara Perrone
- Terapia Intensiva Neonatale, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Rossella Pagano
- Unità Operativa di Pediatria, Civile Sassuolo, Sassuolo, Italy
| | - Laura Lucaccioni
- Unità Operativa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Silvia Fanaro
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Lorenzo Iughetti
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy.,Unità Operativa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Licia Lugli
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Roberta Creti
- Reparto di Antibiotico Resistenza e Patogeni Speciali (AR-PS), Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
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Kadambari S, Trotter CL, Heath PT, Goldacre MJ, Pollard AJ, Goldacre R. Group B Streptococcal Disease in England (1998 - 2017): A Population-based Observational Study. Clin Infect Dis 2021; 72:e791-e798. [PMID: 32989454 DOI: 10.1093/cid/ciaa1485] [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: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Group B Streptococcus (GBS) is the leading cause of sepsis and meningitis in infants <90 days. In this study, the burden of GBS disease and mortality in young infants in England was assessed. METHODS Using linked hospitalization records from every National Health Service (NHS) hospital from April 1, 1998 to March 31, 2017, we calculated annual GBS incidence in infants aged <90 days and, using regression models, compared their perinatal factors, rates of hospital-recorded disease outcomes, and all-cause infant mortality rates with those of the general infant population. RESULTS 15 429 infants aged <90 days had a hospital-recorded diagnosis of GBS, giving an average annual incidence of 1.28 per 1000 live births (95% CI 1.26-1.30) with no significant trend over time. GBS-attributable mortality declined significantly from 0.044 (95% CI .029-.065) per 1000 live births in 2001 to 0.014 (95% CI .010-.026) in 2017 (annual percentage change -6.6, 95% CI -9.1 to -4.0). Infants with GBS had higher relative rates of visual impairment (HR 7.0 95% CI 4.1-12.1), cerebral palsy (HR 9.3 95% CI 6.6-13.3), hydrocephalus (HR 17.3 95% CI 13.8-21.6), and necrotizing enterocolitis (HR 18.8 95% CI 16.7-21.2) compared with those without GBS. CONCLUSIONS Annual rates of GBS disease in infants have not changed over 19 years. The reduction in mortality is likely multifactorial and due to widespread implementation of antibiotics in at-risk mothers and babies, as well as advances in managing acutely unwell infants. New methods for prevention, such as maternal vaccination, must be prioritized.
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Affiliation(s)
- Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group & Vaccine Institute, St George's, University of London, and St George's University Hospitals NHS Trust, London, United Kingdom
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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41
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Oligbu G, Ahmed L, Ferraras-Antolin L, Ladhani S. Retrospective analysis of neonatal deaths secondary to infections in England and Wales, 2013-2015. Arch Dis Child Fetal Neonatal Ed 2021; 106:363-369. [PMID: 33239280 DOI: 10.1136/archdischild-2020-319093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/28/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations. DESIGN Retrospective analysis of national electronic death registrations data. SETTING England and Wales. PATIENTS Neonates aged <28 days. MAIN OUTCOME MEASURES Overall and infection-related mortality rate per 1000 live births in term, preterm (28-36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003-2005. RESULTS The neonatal mortality rate during 2013-2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003-2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013-2015 (0.32/1000; n=669) was 20% lower compared with 2003-2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013-2015 and 11.5% (768/6700) during 2003-2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013-2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths. CONCLUSIONS Overall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.
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Affiliation(s)
- Godwin Oligbu
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK.,Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Leila Ahmed
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Laura Ferraras-Antolin
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, Colindale, London, UK .,Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
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42
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Gonçalves BP, Procter SR, Clifford S, Koukounari A, Paul P, Lewin A, Jit M, Lawn J. Estimation of country-level incidence of early-onset invasive Group B Streptococcus disease in infants using Bayesian methods. PLoS Comput Biol 2021; 17:e1009001. [PMID: 34125829 PMCID: PMC8202927 DOI: 10.1371/journal.pcbi.1009001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/25/2021] [Indexed: 01/30/2023] Open
Abstract
Neonatal invasive disease caused by Group B Streptococcus (GBS) is responsible for much acute mortality and long-term morbidity. To guide development of better prevention strategies, including maternal vaccines that protect neonates against GBS, it is necessary to estimate the burden of this condition globally and in different regions. Here, we present a Bayesian model that estimates country-specific invasive GBS (iGBS) disease incidence in children aged 0 to 6 days. The model combines different types of epidemiological data, each of which has its own limitations: GBS colonization prevalence in pregnant women, risk of iGBS disease in children born to GBS-colonized mothers and direct estimates of iGBS disease incidence where available. In our analysis, we present country-specific maternal GBS colonization prevalence after adjustment for GBS detection assay used in epidemiological studies. We then integrate these results with other epidemiological data and estimate country-level incidence of iGBS disease including in countries with no studies that directly estimate incidence. We are able to simultaneously estimate two key epidemiological quantities: the country-specific incidence of early-onset iGBS disease, and the risk of iGBS disease in babies born to GBS-colonized women. Overall, we believe our method will contribute to a more comprehensive quantification of the global burden of this disease, inform cost-effectiveness assessments of potential maternal GBS vaccines and identify key areas where data are necessary. Invasive disease caused by Group B Streptococcus (GBS) in young infants continues to be a major public health problem in both developed and developing countries. However, data on the incidence of this infection during the first week of life are only available for a small number of countries, which has complicated the quantification of the burden of this disease globally. In this paper, we develop a Bayesian framework to estimate the incidence of invasive GBS infection that combines data from multiple types of epidemiological studies, with adjustment for relevant factors such as diagnostic methods used in the studies. We present estimates from a series of models, and our results highlight the potential weaknesses of different types of studies and the importance to consider the entire evidence when estimating global burden of invasive neonatal infections. We believe this model is a step toward better quantification of the number of cases in different regions.
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Affiliation(s)
- Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sam Clifford
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Freudenhammer M, Karampatsas K, Le Doare K, Lander F, Armann J, Acero Moreno D, Boyle M, Buxmann H, Campbell R, Chalker V, Cunney R, Doherty L, Davies E, Efstratiou A, Elling R, Endmann M, Essers J, Hentschel R, Jones CE, Kallsen S, Kapatai G, Krüger M, Ladhani S, Lamagni T, Lindsay D, Meehan M, O'Sullivan CP, Patel D, Reynolds AJ, Roll C, Schulzke S, Smith A, Stein A, von der Wense A, Voss E, Wieg C, Härtel C, Heath PT, Henneke P. Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS Late-Onset Sepsis. Front Immunol 2021; 12:617925. [PMID: 34149682 PMCID: PMC8208644 DOI: 10.3389/fimmu.2021.617925] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/04/2021] [Indexed: 01/30/2023] Open
Abstract
Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
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Affiliation(s)
- Mirjam Freudenhammer
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,IMM-PACT Clinician Scientist Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konstantinos Karampatsas
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Fabian Lander
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Jakob Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Daniel Acero Moreno
- Department of Neonatology, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | - Margaret Boyle
- Department of Health Northern Ireland, Belfast, United Kingdom
| | - Horst Buxmann
- Department of Pediatric and Adolescent Medicine, Division for Neonatology at the University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Ruth Campbell
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Victoria Chalker
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Robert Cunney
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | | | | | | | - Roland Elling
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Endmann
- Department of Pediatric and Adolescent Medicine, St. Franziskus Hospital Ahlen, Ahlen, Germany
| | - Jochen Essers
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Roland Hentschel
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Steffen Kallsen
- Department of Paediatrics and Youth Medicine, Klinikum Friedrichshafen, Friedrichshafen, Germany
| | - Georgia Kapatai
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Marcus Krüger
- Department of Neonatology, München Klinik Harlaching and Schwabing, Munich, Germany
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom.,Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, United Kingdom
| | - Diane Lindsay
- Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | - Catherine P O'Sullivan
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Darshana Patel
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | | | - Claudia Roll
- Department of Neonatology, Vest Children's Hospital Datteln, University Witten-Herdecke, Witten-Herdecke, Germany
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Andrew Smith
- Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.,Glasgow Dental Hospital and School, University of Glasgow, Glasgow, United Kingdom
| | - Anja Stein
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Axel von der Wense
- Neonatology and Pediatric Intensive Care, Altonaer Children's Hospital, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Egbert Voss
- Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Germany
| | - Christian Wieg
- Department of Neonatology, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Freiburg/Lübeck, Germany
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Philipp Henneke
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Freiburg/Lübeck, Germany
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Collin SM, Groves N, O'Sullivan C, Jauneikaite E, Patel D, Cunney R, Meehan M, Reynolds A, Smith A, Lindsay D, Doherty L, Davies E, Chalker V, Lamb P, Afshar B, Balasegaram S, Coelho J, Ready D, Brown CS, Efstratiou A, Le Doare K, Sriskandan S, Heath PT, Lamagni T. Uncovering Infant Group B Streptococcal (GBS) Disease Clusters in the United Kingdom and Ireland Through Genomic Analysis: A Population-based Epidemiological Study. Clin Infect Dis 2021; 72:e296-e302. [PMID: 32766850 DOI: 10.1093/cid/ciaa1087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The true frequency of hospital outbreaks of invasive group B streptococcal (iGBS; Streptococcus agalactiae) disease in infants is unknown. We used whole genome sequencing (WGS) of iGBS isolates collected during a period of enhanced surveillance of infant iGBS disease in the UK and Ireland to determine the number of clustered cases. METHODS Potentially linked iGBS cases from infants with early (<7 days of life) or late-onset (7-89 days) disease were identified from WGS data (HiSeq 2500 platform, Illumina) from clinical sterile site isolates collected between 04/2014 and 04/2015. We assessed time and place of cases to determine a single-nucleotide polymorphism (SNP) difference threshold for clustered cases. Case details were augmented through linkage to national hospital admission data and hospital record review by local microbiologists. RESULTS Analysis of sequences indicated a cutoff of ≤5 SNP differences to define iGBS clusters. Among 410 infant iGBS isolates, we identified 7 clusters (4 genetically identical pairs with 0 SNP differences, 1 pair with 3 SNP differences, 1 cluster of 4 cases with ≤1 SNP differences) of which 4 clusters were uncovered for the first time. The clusters comprised 16 cases, of which 15 were late-onset (of 192 late-onset cases with sequenced isolates) and 1 an early-onset index case. Serial intervals between cases ranged from 0 to 59 (median 12) days. CONCLUSIONS Approximately 1 in 12 late-onset infant iGBS cases were part of a hospital cluster. Over half of the clusters were previously undetected, emphasizing the importance of routine submission of iGBS isolates to reference laboratories for cluster identification and genomic confirmation.
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Affiliation(s)
- Simon M Collin
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom
| | - Natalie Groves
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Elita Jauneikaite
- NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, United Kingdom
| | - Darshana Patel
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Robert Cunney
- Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
| | | | - Andrew Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom.,Scottish Microbiology Reference Laboratory, Glasgow, United Kingdom
| | - Diane Lindsay
- Scottish Microbiology Reference Laboratory, Glasgow, United Kingdom
| | | | | | - Victoria Chalker
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom.,NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom
| | - Peter Lamb
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom
| | - Baharak Afshar
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Sooria Balasegaram
- Field Service, National Infection Service, Public Health England, London, United Kingdom
| | - Juliana Coelho
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Derren Ready
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Colin S Brown
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom
| | - Androulla Efstratiou
- NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom.,WHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections, National Infection Service, Public Health England, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom.,Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Pathogen Immunity Group, Public Health England, Porton Down, United Kingdom
| | - Shiranee Sriskandan
- NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom.,MRC Centre for Molecular Bacteriology & Infection, Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Theresa Lamagni
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI & AMR) Division, National Infection Service, Public Health England, London, United Kingdom.,NIHR Health Protection Unit in Healthcare-associated Infections and Antimicrobial Resistance, Imperial College, London, United Kingdom
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45
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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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46
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Walker KF, Plumb J, Gray J, Thornton JG, Avery AJ, Daniels JP. Should all pregnant women be offered testing for group B streptococcus? BMJ 2021; 373:n882. [PMID: 33903125 DOI: 10.1136/bmj.n882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, UK
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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47
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Horváth-Puhó E, van Kassel MN, Gonçalves BP, de Gier B, Procter SR, Paul P, van der Ende A, Søgaard KK, Hahné SJM, Chandna J, Schrag SJ, van de Beek D, Jit M, Sørensen HT, Bijlsma MW, Lawn JE. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a national matched cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:398-407. [PMID: 33894156 PMCID: PMC8131199 DOI: 10.1016/s2352-4642(21)00022-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
Background Group B Streptococcus (GBS) disease is a leading cause of neonatal death, but its long-term effects have not been studied after early childhood. The aim of this study was to assess long-term mortality, neurodevelopmental impairments (NDIs), and economic outcomes after infant invasive GBS (iGBS) disease up to adolescence in Denmark and the Netherlands. Methods For this cohort study, children with iGBS disease were identified in Denmark and the Netherlands using national medical and administrative databases and culture results that confirmed their diagnoses. Exposed children were defined as having a history of iGBS disease (sepsis, meningitis, or pneumonia) by the age of 89 days. For each exposed child, ten unexposed children were randomly selected and matched by sex, year and month of birth, and gestational age. Mortality data were analysed with the use of Cox proportional hazards models. NDI data up to adolescence were captured from discharge diagnoses in the National Patient Registry (Denmark) and special educational support records (the Netherlands). Health care use and household income were also compared between the exposed and unexposed cohorts. Findings 2258 children—1561 in Denmark (born from Jan 1, 1997 to Dec 31, 2017) and 697 in the Netherlands (born from Jan 1, 2000 to Dec 31, 2017)—were identified to have iGBS disease and followed up for a median of 14 years (IQR 7–18) in Denmark and 9 years (6–11) in the Netherlands. 366 children had meningitis, 1763 had sepsis, and 129 had pneumonia (in Denmark only). These children were matched with 22 462 children with no history of iGBS disease. iGBS meningitis was associated with an increased mortality at age 5 years (adjusted hazard ratio 4·08 [95% CI 1·78–9·35] for Denmark and 6·73 [3·76–12·06] for the Netherlands). Any iGBS disease was associated with an increased risk of NDI at 10 years of age, both in Denmark (risk ratio 1·77 [95% CI 1·44–2·18]) and the Netherlands (2·28 [1·64–3·17]). A history of iGBS disease was associated with more frequent outpatient clinic visits (incidence rate ratio 1·93 [95% CI 1·79–2·09], p<0·0001) and hospital admissions (1·33 [1·27–1·38], p<0·0001) in children 5 years or younger. No differences in household income were observed between the exposed and unexposed cohorts. Interpretation iGBS disease, especially meningitis, was associated with increased mortality and a higher risk of NDIs in later childhood. This previously unquantified burden underlines the case for a maternal GBS vaccine, and the need to track and provide care for affected survivors of iGBS disease. Funding The Bill & Melinda Gates Foundation. Translations For the Dutch and Danish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Merel N van Kassel
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bronner P Gonçalves
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Simon R Procter
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arie van der Ende
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; The National Institute for Public Health and the Environment, University of Amsterdam, Amsterdam, Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam, Netherlands
| | - Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Susan J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Jit
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
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Meehan M, Eogan M, McCallion N, Cunney R, Bray JE, Jolley KA, Unitt A, Maiden MCJ, Harrison OB, Drew RJ. Genomic epidemiology of group B streptococci spanning 10 years in an Irish maternity hospital, 2008-2017. J Infect 2021; 83:37-45. [PMID: 33862060 DOI: 10.1016/j.jinf.2021.04.003] [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] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The genomic epidemiology of group b streptococcal (GBS) isolates from the Rotunda maternity hospital, Dublin, 2008-2017, was investigated. METHODS Whole genome sequences of isolates (invasive, n = 114; non-invasive, n = 76) from infants and women were analysed using the PubMLST database (https://pubmlst.org/sagalactiae/). RESULTS Serotypes III (36%), Ia (18%), V (17%), II (11%) and Ib, (9%) and sequence types (ST) 17 (23%), ST-23 (14%), ST-1 (12%) and ST-19 (7%) were most common. Core genome MLST (cgMLST) differentiated isolates of the same ST, grouped STs into five lineages congruent with known clonal complexes and identified known mother-baby pairs and suspected linked infant cases. Clonal complex (CC) 17 accounted for 40% and 22% of infant and maternal invasive cases, respectively and 21% of non-invasive isolates. CC23 and CC19 were associated with maternal disease (30%) and carriage (24%), respectively. Erythromycin (26%) and clindamycin (18%) resistance increased over the study period and was associated with presence of the erm(B) gene (55%), CC1 (33%) and CC19 (24%). A multi-resistant integrative conjugative element incorporated in the PI-1 locus was detected in CC17, an ST-12 and ST-23 isolate confirming the global dissemination of this element. All isolates possessed one or more pilus islands. Genes encoding other potential protective proteins including Sip, C5a peptidase and Srr1 were present in 100%, 99.5% and 65.8% of isolates, respectively. The srr2 gene was unique to CC17. CONCLUSIONS The PubMLST.org website provides a valuable framework for genomic GBS surveillance to inform on local and global GBS epidemiology, preventive and control measures.
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Affiliation(s)
- Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Maeve Eogan
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Naomi McCallion
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Paediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James E Bray
- Department of Zoology, University of Oxford, Peter Medawar Building, Oxford OX1 3SY, UK
| | - Keith A Jolley
- Department of Zoology, University of Oxford, Peter Medawar Building, Oxford OX1 3SY, UK
| | - Anastasia Unitt
- Department of Zoology, University of Oxford, Peter Medawar Building, Oxford OX1 3SY, UK
| | - Martin C J Maiden
- Department of Zoology, University of Oxford, Peter Medawar Building, Oxford OX1 3SY, UK
| | - Odile B Harrison
- Department of Zoology, University of Oxford, Peter Medawar Building, Oxford OX1 3SY, UK
| | - Richard J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland; Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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49
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Zhu N, Zhang C, Prakash A, Hou Z, Liu W, She W, Morris A, Sik Kim K. Therapeutic development of group B Streptococcus meningitis by targeting a host cell signaling network involving EGFR. EMBO Mol Med 2021; 13:e12651. [PMID: 33474818 PMCID: PMC7933950 DOI: 10.15252/emmm.202012651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS) remains the most common Gram-positive bacterium causing neonatal meningitis and GBS meningitis continues to be an important cause of mortality and morbidity. In this study, we showed that GBS penetration into the brain occurred initially in the meningeal and cortex capillaries, and exploits a defined host cell signaling network comprised of S1P2 , EGFR, and CysLT1. GBS exploitation of such network in penetration of the blood-brain barrier was demonstrated by targeting S1P2 , EGFR, and CysLT1 using pharmacological inhibition, gene knockout and knockdown cells, and gene knockout animals, as well as interrogation of the network (up- and downstream of each other). More importantly, counteracting such targets as a therapeutic adjunct to antibiotic therapy was beneficial in improving the outcome of animals with GBS meningitis. These findings indicate that investigating GBS penetration of the blood-brain barrier provides a novel approach for therapeutic development of GBS meningitis.
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Affiliation(s)
- Ningyu Zhu
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Chengxian Zhang
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Atish Prakash
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Zheng Hou
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Wei Liu
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Weifeng She
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Andrew Morris
- Division of Cardiovascular MedicineThe Gill Heart InstituteUniversity of KentuckyLexingtonKYUSA
| | - Kwang Sik Kim
- Division of Pediatric Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMDUSA
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50
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Invasive Bacterial Infections in Subjects with Genetic and Acquired Susceptibility and Impacts on Recommendations for Vaccination: A Narrative Review. Microorganisms 2021; 9:microorganisms9030467. [PMID: 33668334 PMCID: PMC7996259 DOI: 10.3390/microorganisms9030467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/18/2022] Open
Abstract
The WHO recently endorsed an ambitious plan, “Defeating Meningitis by 2030”, that aims to control/eradicate invasive bacterial infection epidemics by 2030. Vaccination is one of the pillars of this road map, with the goal to reduce the number of cases and deaths due to Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus agalactiae. The risk of developing invasive bacterial infections (IBI) due to these bacterial species includes genetic and acquired factors that favor repeated and/or severe invasive infections. We searched the PubMed database to identify host risk factors that increase the susceptibility to these bacterial species. Here, we describe a number of inherited and acquired risk factors associated with increased susceptibility to invasive bacterial infections. The burden of these factors is expected to increase due to the anticipated decrease in cases in the general population upon the implementation of vaccination strategies. Therefore, detection and exploration of these patients are important as vaccination may differ among subjects with these risk factors and specific strategies for vaccination are required. The aim of this narrative review is to provide information about these factors as well as their impact on vaccination against the four bacterial species. Awareness of risk factors for IBI may facilitate early recognition and treatment of the disease. Preventive measures including vaccination, when available, in individuals with increased risk for IBI may prevent and reduce the number of cases.
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