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Chen Y, Liu L, Liu J, Ji T, Gao Y, Yang D, Zhao M, Zhai Y, Cao Z. Serotype distribution, antimicrobial resistance, and molecular characterization of group B Streptococcus isolates from Chinese pregnant woman. J Matern Fetal Neonatal Med 2024; 37:2295805. [PMID: 38124302 DOI: 10.1080/14767058.2023.2295805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study was aimed to investigate the serotypes, antibiotic susceptibilities, and multi-locus sequence type (MLST) profiles of group B Streptococcus (GBS) in the Beijing area. METHODS Lower vaginal and rectal swabs were obtained from pregnant women of 35-37 gestational weeks (GWs) who attended the Beijing Obstetrics and Gynecology Hospital. All GBS isolates were identified with Gram staining, catalase reaction assays, and CAMP tests, followed by antibiotic susceptibility testing, serotype identification, multilocus sequence typing and erythromycin resistance gene analysis (ermB and mefE). RESULTS From July 2020 to June 2022, 311 (5.17%) of 6012 pregnant women that were screened for GBS colonization were detected positive. Of the eight serotypes identified (III, Ia, Ib, IV, II, VIII, V, and NT), serotypes III (43.09%), Ia (34.08%) and Ib (17.04%) were the predominant species. In the antimicrobial susceptibility experiments, the resistant rates measured for erythromycin, clindamycin, levofloxacin, and tetracycline were 76.21%, 63.99%, 50.80%, and 81.03%, respectively, and 7.6% of GBS isolates showed inducible clindamycin in resistance (D-test phenotype). Meanwhile, the multilocus sequence typing analysis showed that sequence type 19 (ST19) (30.34%) and ST10 (18.62%) were the dominant sequence types. Among the 237 erythromycin-resistant isolates, 176 harbored ermB (128, 54.00%) or mefE (48, 20.30%) gene alone. CONCLUSION The infection rates, serotypes or MSLT distribution, and antimicrobial resistance of GBS in Beijing area were investigated, which may be applied in analyses of the epidemiological characteristics of GBS. This contributes to the basic knowledge required for successful GBS vaccine development suited for disease prevention and treatment in China, as well as the implementation of effective clinical antimicrobials.
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Affiliation(s)
- Yifei Chen
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Lin Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jing Liu
- Laboratory Department of Tsinghua University Hospital, Beijing, China
| | - Tongzhen Ji
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yang Gao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Dongmei Yang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Mohan Zhao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Center of Clinical Mass Spectrometry, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
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Litman E, Young B, Spiel M. Novel Insights on Group B Streptococcus in Pregnancy. Clin Obstet Gynecol 2024:00003081-990000000-00164. [PMID: 38902963 DOI: 10.1097/grf.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Group B Streptococcus (GBS) is a frequent colonizer of the human genital and gastrointestinal tract. In pregnant or postpartum persons, colonization is often asymptomatic and can contribute to infectious morbidity in both the parturient and the newborn. The prevalence of invasive GBS disease has dramatically decreased over the past 3 decades. However, despite standardized clinical algorithms, GBS disease remains a public health concern. Our review summarizes the GBS bacteria pathophysiology, morbidity, management guidelines, and summarizes ongoing research. While novel testing and parturient vaccination are being explored, barriers exist, preventing guideline updates and widespread implementation.
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Affiliation(s)
- Ethan Litman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Brett Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Melissa Spiel
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
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3
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Pena JMS, Lannes-Costa PS, Nagao PE. Vaccines for Streptococcus agalactiae: current status and future perspectives. Front Immunol 2024; 15:1430901. [PMID: 38947337 PMCID: PMC11211565 DOI: 10.3389/fimmu.2024.1430901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024] Open
Abstract
A maternal vaccine to protect newborns against invasive Streptococcus agalactiae infection is a developing medical need. The vaccine should be offered during the third trimester of pregnancy and induce strong immune responses and placental transfer of protective antibodies. Polysaccharide vaccines against S. agalactiae conjugated to protein carriers are in advanced stages of development. Additionally, protein-based vaccines are also in development, showing great promise as they can provide protection regardless of serotype. Furthermore, safety concerns regarding a new vaccine are the main barriers identified. Here, we present vaccines in development and identified safety, cost, and efficacy concerns, especially in high-need, low-income countries.
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Affiliation(s)
| | | | - Prescilla Emy Nagao
- Laboratory of Molecular Biology and Physiology of Streptococci, Institute of Biology Roberto Alcantara Gomes, Rio de Janeiro State University - UERJ, Rio de Janeiro, Brazil
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4
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Gong X, Jin Y, Han X, Jiang X, Miao B, Meng S, Zhang J, Zhou H, Zheng H, Feng J, Li J. Genomic Characterization and Resistance Features of Streptococcus agalactiae Isolated from Non-pregnant Adults in Shandong, China. J Glob Antimicrob Resist 2024:S2213-7165(24)00111-5. [PMID: 38866137 DOI: 10.1016/j.jgar.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/04/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Streptococcus agalactiae is a recognized pathogen that primarily affects infants and pregnant women. However, its increasingly important role in causing invasive infections among non-pregnant adults has become a significant health concern due to the severity and variety of its clinical impacts. METHODS Nonduplicate S. agalactiae clinical strains associated with clinical infections (n=139) were isolated from non-pregnant adults in Shandong, China. Antibiotic susceptibility testing, whole-genome sequencing, and genomic analyses were conducted to characterize the genome and identify resistance features of these strains. RESULTS The strains exhibited universal susceptibility to penicillin, ampicillin, cefotaxime, meropenem, linezolid, and vancomycin. Notably, high resistance rates were observed for erythromycin (91.4%), clindamycin (89.2%), levofloxacin (84.2%), tetracycline (54.0%) and, to a lesser extent, chloramphenicol (12.9%). Serotyping revealed seven serotypes and one non-typeable strain. Serotypes Ia, Ib, III, and V predominated, representing 95.7% of the strains. Nineteen sequence types were categorized into seven clonal complexes, with CC10 being the most prevalent at 48.9%. The resistance genes mreA (100%), ermB (70.5%), and tetM (46.0%) were commonly detected. All the isolates carried at least one pilus backbone determinant and one alpha-like protein gene, with the PI-1+PI-2a and the bca gene being the most frequent at 84.2% and 54.7%, respectively. CONCLUSIONS While S. agalactiae strains in non-pregnant adults retain sensitivity to β-lactam antibiotics, the elevated resistance to erythromycin, clindamycin, levofloxacin, and tetracycline is concerning. Given the growing elderly population worldwide, the burden of S. agalactiae infections is significant. Continuous surveillance of serotype distribution and antibiotic resistance patterns is imperative for targeted prevention and therapeutic strategies.
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Affiliation(s)
- Xinyi Gong
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Jin
- Clinical Laboratories of Shandong Provincial Hospital
| | - Xiao Han
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xueqi Jiang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Beibei Miao
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuang Meng
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingyi Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haijian Zhou
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Han Zheng
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Feng
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Juan Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Caballero Méndez A, Reynoso de la Rosa RA, Abreu Bencosme ME, Sosa Ortiz MN, Pichardo Beltré E, de la Cruz García DM, Piñero Santana NJ, Bacalhau de León JC. Development and performance evaluation of a qPCR-based assay for the fully automated detection of group B Streptococcus (GBS) on the Panther Fusion Open Access system. Microbiol Spectr 2024; 12:e0005724. [PMID: 38682931 DOI: 10.1128/spectrum.00057-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Streptococcus agalactiae [group B Streptococcus (GBS)] poses a major threat as the primary cause of early-onset neonatal invasive disease, particularly when mothers are colonized rectovaginally. Although culture remains the gold standard for antepartum GBS screening, quantitative polymerase chain reaction (qPCR) offers advantages in terms of sensitivity and turnaround time. The aim of this study was to validate the clinical utility of an automated qPCR laboratory-developed test (LDT) for antepartum GBS screening using the Panther Fusion Open Access system (Hologic, California, USA). The LDT targeted a conserved region of the GBS surface immunogenic protein gene, demonstrating no cross-reactivity and high coverage (99.82%-99.99%). The limit of detection (LoD) was 118 CFU/mL. Comparison with commercial qPCR assays (Panther Fusion GBS and VIASURE Streptococcus B Real-Time) revealed an overall agreement of 99.7%, with a robust Cohen's kappa coefficient of 0.992. Testing of 285 rectovaginal swabs from pregnant women and 15 external quality assessment samples demonstrated exceptional diagnostic performance of the LDT, achieving a diagnostic sensitivity and specificity of 100%, underscoring its accuracy. Prevalence and predictive values were also determined to reinforce test reliability. Our research highlights the limitations of culture-based screening and supports the suitability of our qPCR-based LDT for GBS detection in a clinical setting.IMPORTANCERectovaginal colonization by GBS is a major risk factor for early-onset invasive neonatal disease. The most effective approach to reducing the incidence of early-onset disease (EOD) has been described as universal screening, involving assessment of GBS colonization status in late pregnancy and intrapartum antibiotic prophylaxis. Despite its turnaround time and sensitivity limitations, culture remains the gold standard method for GBS screening. However, nucleic acid amplification-based tests, such as qPCR, have been utilized due to their speed and high sensitivity and specificity. This study validated the clinical usefulness of an automated qPCR-LDT for antepartum GBS screening through the Panther Fusion Open Access system (Hologic). Our study addresses the critical need for more robust, sensitive, and rapid strategies for GBS screening in pregnant women that could favorably impact the incidence of EOD.
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Affiliation(s)
- Andy Caballero Méndez
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Roberto A Reynoso de la Rosa
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Miguel E Abreu Bencosme
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Mayeline N Sosa Ortiz
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Eliezel Pichardo Beltré
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Darah M de la Cruz García
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Nelson J Piñero Santana
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Joana C Bacalhau de León
- Microbiology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
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Lee KW, Yap SF, Murdan S, Zainudin Z, Abdul Hamid H, Emamjomeh M, Mohd Desa MN, Sither Joseph NM, Azmai Amal MN, Amin-Nordin S. Maternal and neonatal group B streptococcus colonisation: A systematic review and the meta-analysis of matched-pair studies. Acta Paediatr 2024; 113:892-911. [PMID: 38351491 DOI: 10.1111/apa.17152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 04/11/2024]
Abstract
AIM To determine the prevalence of group B Streptococcus (GBS) carriage among parturient women and neonates, and the relative risk of vertical transmission, the relative risk of early and late-onset GBS and the pooled incidence of early-late-onset GBS infection. METHODS A systematic search of relevant cohort studies from three electronic databases to identify all relevant studies published up to 7 November 2022. The review was conducted in accordance with PRISMA guidelines. Estimates were pooled using random-effects meta-analyses. RESULTS A total of 54 articles with 355 787 matched pairs of parturient women and neonates from 30 countries were included in the analysis. The pooled prevalence of GBS colonisation was 17.1% among the pregnant women and 1.0% among neonates. The pooled prevalence of vertical transmission of GBS was 4.5% and the pooled relative risk of GBS colonisation of neonates born to mothers with GBS was 9.9. CONCLUSION We support the implementation of targeted intrapartum antibiotic prophylaxis for all women who are positive for GBS as well as women with risks factors for early onset GBS in their infants regardless of their GBS colonisation status.
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Affiliation(s)
- Kai Wei Lee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sook Fan Yap
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Centre for Research on Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, UK
| | - Zurina Zainudin
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Obstetric and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohsen Emamjomeh
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Nasir Mohd Desa
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Narcisse Mary Sither Joseph
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohammad Noor Azmai Amal
- Department of Biology, Faculty of Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Tonen-Wolyec S, Otuli NL, Otsatre-Okuti M, Atenyi-Kasemire R, Dupont R, Bélec L. Analytical performances of a point-of-care loop-mediated isothermal amplification assay to detect Group B Streptococcus in intrapartum pregnant women living in the Democratic Republic of the Congo. Int J Infect Dis 2024; 142:106972. [PMID: 38387704 DOI: 10.1016/j.ijid.2024.02.015] [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: 11/07/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Group B Streptococcus (GBS) is the leading infectious cause of stillbirth and neonatal morbidity and mortality in sub-Saharan Africa. METHODS Vaginal and rectovaginal swab samples were obtained from 274 intrapartum pregnant women in the Democratic Republic of the Congo to be analyzed for GBS DNA detection in parallel by the point-of-care BIOSYNEX AMPLIFLASH® GBS assay (Biosynex SA, Illkirch-Graffenstaden, France) and by reference quantitative polymerase chain reaction (qPCR). RESULTS Rectovaginal swabbing, nearly two-fold more positive for GBS than vaginal swabbing alone, showed a high prevalence of GBS DNA positivity in 20.1% of eligible intrapartum pregnant women. In the event of significant bacterial carriage (i.e., cycle threshold ≤33 by reference qPCR), the AMPLIFLASH® GBS assay with rectovaginal swabbing showed high sensitivity (98.1%) and specificity (100.0%) for GBS DNA detection, with excellent concordance, reliability, and accuracy with the reference qPCR, and positive predictive values and negative predictive values above 99.0%. CONCLUSIONS The study demonstrates a high rate of female rectogenital GBS colonization in pregnant Congolese women. The AMPLIFLASH® GBS assay harbored excellent analytical performances in the field, which makes it suitable to be used as point-of-care molecular assay in various hospital and non-hospital settings where rapid diagnosis of GBS is necessary.
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Affiliation(s)
- Serge Tonen-Wolyec
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo; Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo.
| | - Noel Labana Otuli
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - Monde Otsatre-Okuti
- Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo
| | | | - Raphael Dupont
- Laboratoire d'analyses médicales, Centre Cardiologique du Nord (CCN), Saint-Denis, France
| | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France
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Dilrukshi N, Kottahachchi J, Dissanayake T, Weerasekera M, Sampath A, Fernando N. Unravelling Streptococcus agalactiae: Serotype distribution, virulence factors, obstetrics history and clinical presentation correlations in tertiary care hospitals of the western province of Sri Lanka. Indian J Med Microbiol 2024; 49:100617. [PMID: 38763381 DOI: 10.1016/j.ijmmb.2024.100617] [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: 10/06/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE This study investigated to detect serotypes and virulence genes of Group B Streptococcus (GBS) isolated from pregnant women. METHODS Forty-five samples of GBS isolates from January to August 2019 at antenatal clinics of 4 teaching hospitals in Western Province, Sri Lanka were included. Isolated GBS were carried to identify 9 serotypes by multiplex PCR. Different virulence determinants, including bac, rib and scp(B) have been detected by PCR. RESULTS Among GBS-positive culture isolates most abundant serotype detected was type III 12/45 (26.7%) while serotype VII, VIII and IX were not seen. Furthermore, serotype Ia (15.6%); II (20%); V (17.8%); VI (15.6%); Ib (2.2%) and IV (2.2%) were identified. Among 5 rectal isolates, 1 isolate was serotype Ia, 2 isolates were serotype II and 2 isolates were serotype III. Forty (40/45) isolates expressed scpB gene (88.8%). Presence of rib gene was confirmed in 17.8%, bac in 13.3% isolates. ScpB, rib and bac were identified in 4.4% isolates, 8.9% isolates were scpB, rib positive and bac negative, 8.9% isolates were scpB, bac positive and rib negative. These three-virulence genes did not express in 8.9% isolates. ScpB gene was found once in serotype Ib and IV and all serotype VI expressed scpB gene. Rib gene was more common among serotype II and it was not found in serotype Ib, IV and VI. Bac gene was more common in serotype V and it was not found in serotype Ia, Ib and IV. There was not significant association between serotypes and virulence gene (p > 0.05). CONCLUSION Serotype III is the most abundant serotype. In formulation of vaccine against GBS for Sri Lanka, serotype III should be targeted. Prevalence of vaccine candidate virulence protein such as β antigens of the C protein (bac) and surface protein Rib (rib) genes were low in this study.
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Affiliation(s)
- Niluka Dilrukshi
- University of Sri Jayewardenepura, Faculty of Medical Sciences, Department of Microbiology, Nugegoda, Gangodawila, Sri Lanka; University of Sri Jayewardenepura, Faculty of Graduate Studies, Nugegoda, Gangodawila, Sri Lanka; Faculty of Health Sciences, Department of Medical Laboratory Sciences, The Open University, Sri Lanka.
| | - Jananie Kottahachchi
- University of Sri Jayewardenepura, Faculty of Medical Sciences, Department of Microbiology, Nugegoda, Gangodawila, Sri Lanka.
| | - Thushari Dissanayake
- University of Sri Jayewardenepura, Faculty of Medical Sciences, Department of Microbiology, Nugegoda, Gangodawila, Sri Lanka.
| | - Manjula Weerasekera
- University of Sri Jayewardenepura, Faculty of Medical Sciences, Department of Microbiology, Nugegoda, Gangodawila, Sri Lanka.
| | - Asanga Sampath
- University of Sri Jayewardenepura, Faculty of Medical Sciences, Department of Microbiology, Nugegoda, Gangodawila, Sri Lanka.
| | - Neluka Fernando
- University of Sri Jayewardenepura, Faculty of Medical Sciences, Department of Microbiology, Nugegoda, Gangodawila, Sri Lanka.
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de Oliveira LMA, Simões LC, Crestani C, Costa NS, Pantoja JCDF, Rabello RF, Teixeira LM, Khan UB, Bentley S, Jamrozy D, Pinto TDCA, Zadoks RN. Long-Term Co-Circulation of Host-Specialist and Host-Generalist Lineages of Group B Streptococcus in Brazilian Dairy Cattle with Heterogeneous Antimicrobial Resistance Profiles. Antibiotics (Basel) 2024; 13:389. [PMID: 38786118 PMCID: PMC11117364 DOI: 10.3390/antibiotics13050389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Group B Streptococcus (GBS) is a major cause of contagious bovine mastitis (CBM) in Brazil. The GBS population is composed of host-generalist and host-specialist lineages, which may differ in antimicrobial resistance (AMR) and zoonotic potential, and the surveillance of bovine GBS is crucial to developing effective CBM control and prevention measures. Here, we investigated bovine GBS isolates (n = 156) collected in Brazil between 1987 and 2021 using phenotypic testing and whole-genome sequencing to uncover the molecular epidemiology of bovine GBS. Clonal complex (CC) 61/67 was the predominant clade in the 20th century; however, it was replaced by CC91, with which it shares a most common recent ancestor, in the 21st century, despite the higher prevalence of AMR in CC61/67 than in CC91, and high selection pressure for AMR from indiscriminate antimicrobial use in the Brazilian dairy industry. CC103 also emerged as a dominant CC in the 21st century, and a considerable proportion of herds had two or more GBS strains, suggesting poor biosecurity and within-herd evolution due to the chronic nature of CBM problems. The majority of bovine GBS belonged to serotype Ia or III, which was strongly correlated with CCs. Ninety-three isolates were resistant to tetracycline (≥8 μg/mL; tetO = 57, tetM = 34 or both = 2) and forty-four were resistant to erythromycin (2.0 to >4 μg/mL; ermA = 1, ermB = 38, mechanism unidentified n = 5). Only three isolates were non-susceptible to penicillin (≥8.0 μg/mL), providing opportunities for improved antimicrobial stewardship through the use of narrow-spectrum antimicrobials for the treatment of dairy cattle. The common bovine GBS clades detected in this study have rarely been reported in humans, suggesting limited risk of interspecies transmission of GBS in Brazil. This study provides new data to support improvements to CBM and AMR control, bovine GBS vaccine design, and the management of public health risks posed by bovine GBS in Brazil.
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Affiliation(s)
- Laura Maria Andrade de Oliveira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.C.S.); (N.S.C.); (L.M.T.); (T.d.C.A.P.)
| | - Leandro Correia Simões
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.C.S.); (N.S.C.); (L.M.T.); (T.d.C.A.P.)
| | | | - Natália Silva Costa
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.C.S.); (N.S.C.); (L.M.T.); (T.d.C.A.P.)
| | | | | | - Lucia Martins Teixeira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.C.S.); (N.S.C.); (L.M.T.); (T.d.C.A.P.)
| | - Uzma Basit Khan
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK; (U.B.K.); (S.B.); (D.J.)
| | - Stephen Bentley
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK; (U.B.K.); (S.B.); (D.J.)
| | - Dorota Jamrozy
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK; (U.B.K.); (S.B.); (D.J.)
| | - Tatiana de Castro Abreu Pinto
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (L.C.S.); (N.S.C.); (L.M.T.); (T.d.C.A.P.)
| | - Ruth N. Zadoks
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camden, NSW 2570, Australia
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10
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Malloy E, Kates AE, Dixon J, Riley C, Safdar N, Hanson L. Vaginal and Rectal microbiome changes following administration of a multi-species antenatal probiotic: A randomized control trial. GUT MICROBES REPORTS 2024; 1:1-10. [PMID: 38708373 PMCID: PMC11065196 DOI: 10.1080/29933935.2024.2334311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/14/2024] [Indexed: 05/07/2024]
Abstract
The gut and vaginal microbiome undergo changes during pregnancy which may be protective or harmful to the birthing person. Probiotics have been found to cause protective changes to the gut and vaginal microbiomes, with the potential to improve perinatal outcomes. This randomized control trial compares the vaginal and rectal microbiomes before and after an antenatal probiotic or placebo intervention, with a diverse group of pregnant people and a special focus on racial disparities. The vaginal and rectal microbiomes reveal non-significant increased Lactobacillus in the probiotics group, with a greater increase in participants who identified as Black. Potential implications and future study are discussed.
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Affiliation(s)
- Emily Malloy
- Aurora UW Medical Group Midwifery & Wellness, Advocate Aurora Healthcare Milwaukee, USA
- College of Nursing, Marquette University, Milwaukee, USA
| | - Ashley E. Kates
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Jonah Dixon
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Colleen Riley
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Disease, University of Wisconsin-Madison, Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | - Lisa Hanson
- College of Nursing, Marquette University, Milwaukee, USA
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11
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Bei J, Wu J, Liu J. Re-N-acetylation of group B Streptococcus type Ia capsular polysaccharide improves the immunogenicity of glycoconjugate vaccines. Carbohydr Polym 2024; 330:121848. [PMID: 38368118 DOI: 10.1016/j.carbpol.2024.121848] [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: 11/16/2023] [Revised: 12/28/2023] [Accepted: 01/19/2024] [Indexed: 02/19/2024]
Abstract
The capsular polysaccharides (CPS) of Group B Streptococcus play a crucial role as virulence determinants and are potential candidates for antigenic components in vaccine formulations. Alkaline treatments are commonly used to extract polysaccharides owing to their efficiency and cost-effectiveness; however, they may induce the removal of N-acetyl groups from CPS. This study involved re-N-acetylation of CPS Ia to improve its biological functionality. The structural modifications and enhanced antigenicity of CPS Ia were observed after re-N-acetylation. The tetanus toxoid (TT) was conjugated with either partially de-N-acetylated or fully re-N-acetylated CPS. As a result, the conjugate containing re-N-acetylated CPS (IaReN-TT) enhanced the induction of IgG antibody levels and functional antibodies in mice. Both passive and active protection assays substantiated the superior protective efficacy of IaReN-TT, suggesting that the re-N-acetylation of CPS Ia could be a critical step in refining the immunogenic profile of glycoconjugate vaccines.
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Affiliation(s)
- Jiaming Bei
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education; School of Biotechnology, Jiangnan University, Wuxi 214122, China; Suzhou Juwei Biotech Co., Ltd, Suzhou 215000, China
| | - Jianrong Wu
- Key Laboratory of Carbohydrate Chemistry and Biotechnology, Ministry of Education; School of Biotechnology, Jiangnan University, Wuxi 214122, China.
| | - Jia Liu
- Suzhou Juwei Biotech Co., Ltd, Suzhou 215000, China
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12
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[A cross-sectional study on the pathogen composition and antimicrobial resistance in neonates with sepsis in Hebei Province, China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:350-357. [PMID: 38660898 PMCID: PMC11057296 DOI: 10.7499/j.issn.1008-8830.2309107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To study the pathogen composition and antimicrobial resistance characteristics in neonates with sepsis in the Hebei area, providing a basis for optimizing the management strategies for neonatal sepsis in the region. METHODS The medical data of neonates with sepsis confirmed by blood culture from 23 hospitals in Hebei Province were collected prospectively from November 1, 2021 to December 31, 2022. The pathogen composition and antimicrobial resistance characteristics were analyzed in early-onset sepsis (EOS), community-acquired late-onset sepsis (CALOS), and hospital-acquired late-onset sepsis (HALOS) cases. RESULTS A total of 289 neonates were included, accounting for 292 infection episodes, with 117 (40.1%) EOS, 95 (32.5%) CALOS, and 80 (27.4%) HALOS cases. A total of 294 pathogens were isolated, with 118 (40.1%) from the EOS group, where Escherichia coli (39 strains, 33.0%) and coagulase-negative staphylococci (13 strains, 11.0%) were the most common. In the CALOS group, 95 pathogens were isolated (32.3%), with Escherichia coli (35 strains, 36.8%) and group B Streptococcus (14 strains, 14.7%) being predominant. The HALOS group yielded 81 isolates (27.6%), with Klebsiella pneumoniae (24 strains, 29.6%) and Escherichia coli (21 strains, 25.9%) as the most frequent. Coagulase-negative staphylococci showed over 80% resistance to penicillin antibiotics. Escherichia coli and Klebsiella pneumoniae showed a resistance rate of 2.2% to 75.0% to common β-lactam antibiotics. The resistance rates of predominant Gram-negative bacteria in the HALOS group to common β-lactam antibiotics were higher than those in the CALOS group. CONCLUSIONS In the Hebei region, Escherichia coli is the most common pathogen in both EOS and LOS. There are differences in the composition and antimicrobial resistance of pathogens among different types of neonatal sepsis. The choice of empirical antimicrobial drugs should be based on the latest surveillance data from the region.
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13
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Kabiri D, Paltiel O, Ofek-shlomai N, Nir-Paz R, Sompolinsky Y, Ezra Y. Membrane stripping in group B streptococcus carriers does not impede adequate intrapartum antibiotic prophylaxis: a retrospective study. Front Med (Lausanne) 2024; 11:1368998. [PMID: 38646549 PMCID: PMC11026581 DOI: 10.3389/fmed.2024.1368998] [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: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Objective Membrane stripping in group B streptococcus (GBS) carriers poses an increased risk of inadequate antibiotic prophylaxis, potentially due to accelerated labor, thereby potentially impacting the management of GBS colonization during delivery. We compared the adequacy of intrapartum antibiotic prophylaxis between pregnant women colonized with GBS, who underwent membrane stripping and those who did not. The study aimed to determine whether the performance of membrane stripping, by potentially shortening labor duration, increases the risk of inadequate antibiotic prophylaxis dispensation. Study design A retrospective cohort study was conducted on GBS screen-positive women with a full-term singleton pregnancy in cephalic presentation, who were eligible for vaginal delivery. The exposed group consisted of women who underwent membrane stripping, while the unexposed group consisted of women who did not undergo membrane stripping. The primary outcome was defined as inadequate duration of antibiotic prophylaxis during labor, wherein less than 4 h of beta-lactam antibiotics were administered prior to delivery. Neonatal outcome was compared between the groups. Results This retrospective cohort study comprised 1,609 women, with 129 in the exposed group (stripping group) and 1,480 in the unexposed group (no stripping group). Adequate intrapartum antibiotic prophylaxis was received by 64.3% (83/129) of the exposed group, compared to 46.9% (694/1,480) of the unexposed group (p = 0.003). Membrane stripping was associated with increased odds of receiving adequate prophylaxis (OR 1.897, 95% CI 1.185-3.037, p = 0.008). After excluding women who presented to the labor ward in active labor and delivered in less than 4 h, both the exposed and unexposed groups had similarly high rates of adequate intrapartum antibiotic prophylaxis (87.5% vs. 85.8%, respectively). No significant difference was observed in adverse neonatal outcomes between the groups. Conclusion The provision of membrane stripping did not impede adequate intrapartum antibiotic prophylaxis and was correlated with a higher rate of sufficient prophylaxis in comparison to non-swept patients. These observations suggest that membrane stripping can be considered a safe option for ensuring adequate antibiotic prophylaxis in women colonized with GBS.
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Affiliation(s)
- Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Hebrew Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Hebrew Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Noa Ofek-shlomai
- Department of Neonatology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Yishai Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah Hebrew Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Hebrew Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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14
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Pell ME, Blankenship HM, Gaddy JA, Davies HD, Manning SD. Intrapartum antibiotic prophylaxis selects for mutators in group B streptococci among persistently colonized patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.01.587590. [PMID: 38617326 PMCID: PMC11014637 DOI: 10.1101/2024.04.01.587590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Through vaginal colonization, GBS causes severe pregnancy outcomes including neonatal sepsis and meningitis. Although intrapartum antibiotic prophylaxis (IAP) has reduced early-onset disease rates, persistent GBS colonization has been observed in patients following prophylaxis. To determine whether IAP selects for genomic signatures that enhance GBS survival and persistence in the vaginal tract, whole-genome sequencing was performed on 97 isolates from 58 patients before (prenatal) and after (postpartum) IAP/childbirth. Core-gene mutation analysis identified 7,025 mutations between the paired isolates. Three postpartum isolates accounted for 98% of mutations and were classified as "mutators" because of point mutations within DNA repair systems. In vitro assays revealed stronger biofilms in two mutators. These findings suggest that antibiotics select for mutations that promote survival in vivo, which increases the likelihood of transmission to neonates. They also demonstrate how mutators can provide a reservoir of beneficial mutations that enhance fitness and genetic diversity in the GBS population.
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Affiliation(s)
- Macy E Pell
- Michigan State University, Department of Microbiology, Genetics, and Immunology (MGI), E. Lansing, MI
| | - Heather M Blankenship
- Michigan Department of Health and Human Services, Bureau of Laboratories, Division of Infectious Diseases, Lansing, MI
| | - Jennifer A Gaddy
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Tennessee Valley Healthcare Systems, Department of Veterans Affairs, Nashville, TN
| | | | - Shannon D Manning
- Michigan State University, Department of Microbiology, Genetics, and Immunology (MGI), E. Lansing, MI
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15
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Thapa R, Goh KGK, Desai D, Copeman E, Acharya D, Sullivan MJ, Ulett GC. Alterations in cell arrangements of group B streptococcus due to virulence factor expression can bias estimates of bacterial populations based on colony count measures. MICROBIOLOGY (READING, ENGLAND) 2024; 170:001453. [PMID: 38656296 PMCID: PMC11084685 DOI: 10.1099/mic.0.001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
Group B streptococcus (GBS) is a chain-forming commensal bacterium and opportunistic pathogen that resides in the gastrointestinal and genitourinary tract of healthy adults. GBS can cause various infections and related complications in pregnant and nonpregnant women, adults, and newborns. Investigations of the mechanisms by which GBS causes disease pathogenesis often utilize colony count assays to estimate bacterial population size in experimental models. In other streptococci, such as group A streptococcus and pneumococcus, variation in the chain length of the bacteria that can occur naturally or due to mutation can affect facets of pathogenesis, such as adherence to or colonization of a host. No studies have reported a relationship between GBS chain length and pathogenicity. Here, we used GBS strain 874391 and several derivative strains displaying longer chain-forming phenotypes (874391pgapC, 874391ΔcovR, 874391Δstp1) to assess the impact of chain length on bacterial population estimates based on the colony-forming unit (c.f.u.) assay. Disruption of GBS chains via bead beating or sonication in conjunction with fluorescence microscopy was used to compare chaining phenotypes pre- and post-disruption to detect long- and short-chain forms, respectively. We used a murine model of GBS colonization of the female reproductive tract to assess whether chaining may affect bacterial colonization dynamics in the host during chronic infection in vivo. Overall, we found that GBS exhibiting long-chain form can significantly affect population size estimates based on the colony count assay. Additionally, we found that the length of chaining of GBS can affect virulence in the reproductive tract colonization model. Collectively, these findings have implications for studies of GBS that utilize colony count assays to measure GBS populations and establish that chain length can affect infection dynamics and disease pathogenesis for this important opportunistic pathogen.
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Affiliation(s)
- Ruby Thapa
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Kelvin G. K. Goh
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Devika Desai
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Ellen Copeman
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
- School of Biological Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Dhruba Acharya
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Matthew J. Sullivan
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
- School of Biological Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Glen C. Ulett
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
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16
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Ling J, Hryckowian AJ. Re-framing the importance of Group B Streptococcus as a gut-resident pathobiont. Infect Immun 2024:e0047823. [PMID: 38436256 DOI: 10.1128/iai.00478-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is a Gram-positive bacterial species that causes disease in humans across the lifespan. While antibiotics are used to mitigate GBS infections, it is evident that antibiotics disrupt human microbiomes (which can predispose people to other diseases later in life), and antibiotic resistance in GBS is on the rise. Taken together, these unintended negative impacts of antibiotics highlight the need for precision approaches for minimizing GBS disease. One possible approach involves selectively depleting GBS in its commensal niches before it can cause disease at other body sites or be transmitted to at-risk individuals. One understudied commensal niche of GBS is the adult gastrointestinal (GI) tract, which may predispose colonization at other body sites in individuals at risk for GBS disease. However, a better understanding of the host-, microbiome-, and GBS-determined variables that dictate GBS GI carriage is needed before precise GI decolonization approaches can be developed. In this review, we synthesize current knowledge of the diverse body sites occupied by GBS as a pathogen and as a commensal. We summarize key molecular factors GBS utilizes to colonize different host-associated niches to inform future efforts to study GBS in the GI tract. We also discuss other GI commensals that are pathogenic in other body sites to emphasize the broader utility of precise de-colonization approaches for mitigating infections by GBS and other bacterial pathogens. Finally, we highlight how GBS treatments could be improved with a more holistic understanding of GBS enabled by continued GI-focused study.
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Affiliation(s)
- Joie Ling
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Healthon, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew J Hryckowian
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Healthon, Madison, Wisconsin, USA
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17
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Liu M, Wang H, Chu C, Min F, Sun L, Zhang T, Meng Q. Establishment and application of a rapid molecular diagnostic platform for the isothermal visual amplification of group B Streptococcus based on recombinase polymerase. Front Cell Infect Microbiol 2024; 14:1281827. [PMID: 38465235 PMCID: PMC10920233 DOI: 10.3389/fcimb.2024.1281827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
With growing concerns about Group B streptococcal (GBS) infections and their adverse effects on perinatal pregnancies, including infection, premature delivery, neonatal septicemia, and meningitis, it is urgent to promote GBS screening at all pregnancy stages. The purpose of this study is to establish a device-independent, fast, sensitive, and visual GBS detection method. Taking advantage of the characteristics of the recombinase polymerase isothermal amplification (RPA), the activity of the nfo nuclease cleavage base analog (tetrahydrofuran, THF) site, and the advantages of visual reading of the lateral flow chromatography strip (LFS), a GBS detection method was developed. This method focused on the conservative region of the Christie-Atkins-Munch-Petersen factor encoded by the cfb gene, a virulence gene specific to GBS. Two forward primers, two biotin-labeled reverse primers, and one fluorescein isothiocyanate (FITC)-labeled and C3spacer-blocked probe were designed. The study involved optimizing the primer pair and probe combination, determining the optimal reaction temperature and time, evaluating specificity, analyzing detection limits, and testing the method on 87 vaginal swabs from perinatal pregnant women. The results showed that the visual detection method of GBS-RPA-LFS, using the cfb-F1/R2/P1 primer probe, could detect GBS within 15 min at the temperature ranging from 39°C to 42°C. Furthermore, the method specifically amplified only GBS, without cross-reacting with pathogens like Lactobacillus iners, Lactobacillus crispatus, Candida albicans, Listeria monocytogenes, Yersinia enterocolitica, Klebsiella Pneumoniae, Enterobacter cloacae, Citrobacter freundii, Vibrio alginolyticus, Vibrio parahaemolyticus, Salmonella typhimurium, Staphylococcus aureus, Pseudomonas aeruginosa, or Trichomonas vaginalis. It could detect a minimum of 100 copies per reaction. In clinical 98 samples of vaginal swabs from pregnant women, the agreement rate between the GBS-RPA-LFS method and TaqMan real-time fluorescence quantification method was 95.92%. In conclusion, this study successfully established a combined RPA and LFS GBS in situ detection platform, with short reaction time, high sensitivity, high specificity, portability, and device independence, providing a feasible strategy for clinical GBS screening.
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Affiliation(s)
- Meilin Liu
- Obstetrical Department, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Huan Wang
- Obstetrical Department, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Chu Chu
- Obstetrical Department, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Fanli Min
- Obstetrical Department, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Lizhou Sun
- Obstetrical Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Teng Zhang
- Obstetrical Department, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
| | - Qian Meng
- Obstetrical Department, Lianyungang Maternal and Child Health Hospital, Lianyungang, Jiangsu, China
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18
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Quincer EM, Cranmer LM, Kamidani S. Prenatal Maternal Immunization for Infant Protection: A Review of the Vaccines Recommended, Infant Immunity and Future Research Directions. Pathogens 2024; 13:200. [PMID: 38535543 PMCID: PMC10975994 DOI: 10.3390/pathogens13030200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 04/01/2024] Open
Abstract
Prenatal maternal immunization is an effective tool to protect mothers and infants from poor health outcomes due to infectious diseases. We provide an overview of the rationale for the use of prenatal vaccines, discuss the immunologic environment of the maternal-fetal interface including the impact of maternal vaccines prenatally and subsequently on the infant's immune response, and review vaccines currently recommended in pregnancy and landscape for the future of maternal vaccination. This review aims to provide an understanding of the recent history and progress made in the field and highlight the importance of continued research and development into new vaccines for pregnant populations.
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Affiliation(s)
- Elizabeth M. Quincer
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Lisa M. Cranmer
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Satoshi Kamidani
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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19
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Petca A, Șandru F, Negoiță S, Dumitrașcu MC, Dimcea DAM, Nedelcu T, Mehedințu C, Filipov MM, Petca RC. Antimicrobial Resistance Profile of Group B Streptococci Colonization in a Sample Population of Pregnant Women from Romania. Microorganisms 2024; 12:414. [PMID: 38399818 PMCID: PMC10893514 DOI: 10.3390/microorganisms12020414] [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: 12/31/2023] [Revised: 01/31/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Group B Streptococcus (GBS) represents one of the leading causes of life-threatening invasive disease in pregnant women and neonates. Rates of GBS colonization vary by region, but studies on maternal GBS status are limited in Romania. This study aims to identify the prevalence of colonization with GBS and whether the obstetrical characteristics are statistically associated with the study group's antimicrobial susceptibility patterns of tested GBS strains. This observational study was conducted between 1 May and 31 December 2021 at The Department of Obstetrics and Gynecology at Elias University Emergency Hospital (EUEH) in Bucharest, Romania. A total of 152 samples were positive for GBS and included in the study according to the inclusion criteria. As a result, the prevalence of colonized patients with GBS was 17.3%. GBS isolated in this population had the highest resistance to erythromycin (n = 38; 25%), followed by clindamycin (n = 36; 23.7%). Regarding the susceptibility patterns of tested strains to penicillin, the 152 susceptible strains had MIC breakpoints less than 0.06 μg/μL. The susceptibility patterns of tested strains to linezolid indicated three resistant strains with low levels of resistance (MICs ranging between 2 and 3 μg/μL). Multidrug resistance (at least three antibiotic classes) was not observed. In conclusion, although GBS naturally displays sensitivity to penicillin, the exact bacterial susceptibility testing should be performed in all cases where second-line therapy is taken into consideration for treatment. We acknowledge the need for future actions to limit multidrug-resistant bacteria.
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Affiliation(s)
- Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (A.P.); (M.C.D.); (D.A.-M.D.); (C.M.)
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Silvius Negoiță
- Department of Anesthesiology and Critical Care, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Anesthesiology and Critical Care, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (A.P.); (M.C.D.); (D.A.-M.D.); (C.M.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Daiana Anne-Marie Dimcea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (A.P.); (M.C.D.); (D.A.-M.D.); (C.M.)
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Tiberiu Nedelcu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania;
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania; (A.P.); (M.C.D.); (D.A.-M.D.); (C.M.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Marinela Magdalena Filipov
- Department of Laboratory Medicine, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania;
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania;
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
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Ainonen S, Ronkainen E, Hakkola M, Pokka T, Honkila M, Paalanne M, Kajantie E, Paalanne N, Ruuska TS. Risk of immune-related diseases in childhood after intrapartum antibiotic exposure. Am J Obstet Gynecol 2024:S0002-9378(24)00086-3. [PMID: 38368916 DOI: 10.1016/j.ajog.2024.02.020] [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: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease in newborn infants, but it influences gut microbiota development. Gut microbiota composition is, in turn, associated with immune-related diseases in childhood. OBJECTIVE This study hypothesized that intrapartum antibiotic exposure is associated with immune-related diseases in childhood. STUDY DESIGN We conducted a population-based cohort study of vaginally delivered children. We retrieved data on intrapartum antibiotic exposure from structured electronic medical records and obtained outcome data on childhood autoimmune, allergic, and obstructive airway diseases from comprehensive national registers. We used Cox regression analysis with adjustment for maternal and neonatal covariates and regarded death as a competing risk in the analyses. RESULTS The study population comprised 45,575 vaginally born children of whom 9733 (21%) had been exposed to intrapartum antibiotics. Intrapartum antibiotic exposure was associated with an autoimmune disease diagnosis (adjusted hazard ratio, 1.28; 95% confidence interval, 1.02-1.62), which corresponds to 22% (95% confidence interval, 6-39) as a theoretical population-attributable fraction. Intrapartum antibiotic exposure was not associated with diagnoses of allergic (adjusted hazard ratio, 1.08; 95% confidence interval, 0.97-1.20) or obstructive airway diseases (adjusted hazard ratio, 1.04; 95% confidence interval, 0.96-1.14). CONCLUSION Intrapartum antibiotic exposure may be associated with an increased risk for autoimmune diseases in childhood. This finding supports the efforts to develop more specific group B streptococcal disease prevention strategies in the future.
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Affiliation(s)
- Sofia Ainonen
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
| | - Eveliina Ronkainen
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Mikael Hakkola
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Tytti Pokka
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Research Service Unit, Oulu University Hospital, Finland
| | - Minna Honkila
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Marika Paalanne
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Eero Kajantie
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Population Health Unit, Finnish Institute for Health and Welfare, Oulu, Finland; Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
| | - Niko Paalanne
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Terhi S Ruuska
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
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21
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Kamińska D, Ratajczak M, Nowak-Malczewska DM, Karolak JA, Kwaśniewski M, Szumala-Kakol A, Dlugaszewska J, Gajecka M. Macrolide and lincosamide resistance of Streptococcus agalactiae in pregnant women in Poland. Sci Rep 2024; 14:3877. [PMID: 38366099 PMCID: PMC10873391 DOI: 10.1038/s41598-024-54521-y] [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: 11/11/2022] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
Knowing about the antibiotic resistance, serotypes, and virulence-associated genes of Group B Streptococcus for epidemiological and vaccine development is very important. We have determined antimicrobial susceptibility patterns, serotype, and virulence profiles. The antibiotic susceptibility was assessed for a total of 421 Streptococcus agalactiae strains, isolated from pregnant women and neonates. Then, 89 erythromycin and/or clindamycin-resistant strains (82 isolates obtained from pregnant women and seven isolates derived from neonates) were assessed in detail. PCR techniques were used to identify the studied strains, perform serotyping, and assess genes encoding selected virulence factors. Phenotypic and genotypic methods determined the mechanisms of resistance. All tested strains were sensitive to penicillin and levofloxacin. The constitutive MLSB mechanism (78.2%), inducible MLSB mechanism (14.9%), and M phenotype (6.9%) were identified in the macrolide-resistant strains. It was found that macrolide resistance is strongly associated with the presence of the ermB gene and serotype V. FbsA, fbsB, fbsC, scpB, and lmb formed the most recurring pattern of genes among the nine surface proteins whose genes were analysed. A minority (7.9%) of the GBS isolates exhibited resistance to lincosamides and macrolides, or either, including those that comprised the hypervirulent clone ST-17. The representative antibiotic resistance pattern consisted of erythromycin, clindamycin, and tetracycline resistance (71.9%). An increase in the fraction of strains resistant to macrolides and lincosamides indicates the need for monitoring both the susceptibility of these strains and the presence of the ST-17 clone.
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Affiliation(s)
- Dorota Kamińska
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland
| | - Magdalena Ratajczak
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland
| | - Dorota M Nowak-Malczewska
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland
| | - Justyna A Karolak
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland
| | - Marek Kwaśniewski
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland
| | - Anna Szumala-Kakol
- Unit of Microbiology, Gynecological and Obstetric Clinical Hospital, Poznan University of Medical Sciences, Polna 33, 60-535, Poznan, Poland
| | - Jolanta Dlugaszewska
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland
| | - Marzena Gajecka
- Chair and Department of Genetics and Pharmaceutical Microbiology, Collegium Pharmaceuticum, Poznan University of Medical Sciences, Rokietnicka 3, 60-806, Poznan, Poland.
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479, Poznan, Poland.
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22
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Mercado-Evans V, Mejia ME, Zulk JJ, Ottinger S, Hameed ZA, Serchejian C, Marunde MG, Robertson CM, Ballard MB, Ruano SH, Korotkova N, Flores AR, Pennington KA, Patras KA. Gestational diabetes augments group B Streptococcus infection by disrupting maternal immunity and the vaginal microbiota. Nat Commun 2024; 15:1035. [PMID: 38310089 PMCID: PMC10838280 DOI: 10.1038/s41467-024-45336-6] [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: 07/03/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024] Open
Abstract
Group B Streptococcus (GBS) is a pervasive perinatal pathogen, yet factors driving GBS dissemination in utero are poorly defined. Gestational diabetes mellitus (GDM), a complication marked by dysregulated immunity and maternal microbial dysbiosis, increases risk for GBS perinatal disease. Using a murine GDM model of GBS colonization and perinatal transmission, we find that GDM mice display greater GBS in utero dissemination and subsequently worse neonatal outcomes. Dual-RNA sequencing reveals differential GBS adaptation to the GDM reproductive tract, including a putative glycosyltransferase (yfhO), and altered host responses. GDM immune disruptions include reduced uterine natural killer cell activation, impaired recruitment to placentae, and altered maternofetal cytokines. Lastly, we observe distinct vaginal microbial taxa associated with GDM status and GBS invasive disease status. Here, we show a model of GBS dissemination in GDM hosts that recapitulates several clinical aspects and identifies multiple host and bacterial drivers of GBS perinatal disease.
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Affiliation(s)
- Vicki Mercado-Evans
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Marlyd E Mejia
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jacob J Zulk
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Samantha Ottinger
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Zainab A Hameed
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Camille Serchejian
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Madelynn G Marunde
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Clare M Robertson
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mallory B Ballard
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Simone H Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Natalia Korotkova
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, KY, USA
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA
| | - Anthony R Flores
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School, UTHealth Houston, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Kathleen A Pennington
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Kathryn A Patras
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA.
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, 77030, USA.
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23
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Surrati AM, Alharbi KM, Mohammedsaeed W, Almohammadi HF. Neonatal Group B Streptococcus infection at a single center in Al-Madinah Al-Munawarah, Saudi Arabia. Saudi Med J 2024; 45:163-170. [PMID: 38309734 PMCID: PMC11115410 DOI: 10.15537/smj.2024.45.2.20230533] [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: 07/16/2023] [Accepted: 12/11/2023] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To determine the occurrence of Group B Streptococcus (GBS) infection in neonates and its associated risk factors in Al-Madinah Al-Munawarah, Saudi Arabia. METHODS This retrospective study was carried out at the Maternity and Child Hospital in Al-Madinah Al-Munawarah, between 2017-2022. The laboratory and clinical data of 64 neonates were collected and analyzed using GraphPad Prism 7 software. RESULTS Out of 16,022 neonates admitted to the nursery, 64 infants were diagnosed with GBS infection. Approximately 53.1% were male, 46.9% female, 15.6% were preterm, and 84.4% were full-term. Vaginal births accounted for 71.9%. The mean onset age was 10±12.4 days. Among the GBS patients, 53.1% had early-onset disease (EOD, 0-6 days), while 46.9% had late-onset disease (LOD, 7-90 days). Unexamined mothers had a higher incidence of GBS and EOD newborns (p=0.05). Meningitis was more common in LOD than EOD patients and correlated with illness onset (p=0.05). Early-onset disease patients had a higher incidence of sepsis. The mortality rate was 10.9%, while 89.1% were discharged from the hospital. CONCLUSION Neonatal GBS infection is prevalent in Al-Madinah Al-Munawarah. Several risk factors may contribute to the occurrence of GBS infection including preterm labor, higher body temperature during delivery, prolonged premature rupture of membranes for more than 18 hours, and GBS bacteriuria. We recommend that larger multi-centric studies are needed in Al-Madinah Al-Munawarah, to study the magnitude of neonatal GBS infection and risk factors to develop a screening protocol in maternity and children's hospital.
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Affiliation(s)
- Amal M. Surrati
- From the Department of Family and Community Medicine and Medical Education (Surrati), College of Medicine, Taibah University; from the Department of Pediatrics (Alharbi), College of Medicine, Taibah University; from the Department of Clinical Laboratory Sciences (Mohammedsaeed), Faculty of Applied Medical Sciences, Taibah University, and from the Department of Neonatal Intensive Care Unit (Almohammadi), Maternity and Children Hospital, King Salman bin abdulaziz Medical City, Ministry of Health, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Khulood M. Alharbi
- From the Department of Family and Community Medicine and Medical Education (Surrati), College of Medicine, Taibah University; from the Department of Pediatrics (Alharbi), College of Medicine, Taibah University; from the Department of Clinical Laboratory Sciences (Mohammedsaeed), Faculty of Applied Medical Sciences, Taibah University, and from the Department of Neonatal Intensive Care Unit (Almohammadi), Maternity and Children Hospital, King Salman bin abdulaziz Medical City, Ministry of Health, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Walaa Mohammedsaeed
- From the Department of Family and Community Medicine and Medical Education (Surrati), College of Medicine, Taibah University; from the Department of Pediatrics (Alharbi), College of Medicine, Taibah University; from the Department of Clinical Laboratory Sciences (Mohammedsaeed), Faculty of Applied Medical Sciences, Taibah University, and from the Department of Neonatal Intensive Care Unit (Almohammadi), Maternity and Children Hospital, King Salman bin abdulaziz Medical City, Ministry of Health, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
| | - Hanaa F. Almohammadi
- From the Department of Family and Community Medicine and Medical Education (Surrati), College of Medicine, Taibah University; from the Department of Pediatrics (Alharbi), College of Medicine, Taibah University; from the Department of Clinical Laboratory Sciences (Mohammedsaeed), Faculty of Applied Medical Sciences, Taibah University, and from the Department of Neonatal Intensive Care Unit (Almohammadi), Maternity and Children Hospital, King Salman bin abdulaziz Medical City, Ministry of Health, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia.
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24
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Ma H, Xu J, Zhang Y, Zhang R, Wu J. The current status of Group B Streptococcus infection in the reproductive tract of late-pregnancy women and its impact on pregnancy outcomes. Arch Gynecol Obstet 2024:10.1007/s00404-023-07343-8. [PMID: 38270623 DOI: 10.1007/s00404-023-07343-8] [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: 10/30/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Analyze Group B Streptococcus (GBS) infection in late-pregnancy pregnant women in Shanghai, the risk factors of GBS infection, and its impact on pregnancy outcomes, providing guidance for early prevention and treatment in clinical practice. METHODS We selected 12,132 late-pregnancy pregnant women admitted from January 2022 to December 2022 as the research subjects. Based on the GBS test results of reproductive tract secretion samples from pregnant women, 210 cases of GBS positive pregnant women were randomly selected as the observation group, and 200 cases of GBS negative pregnant women were selected as the control group. The risk factors of infection and the impact on pregnancy outcomes were compared between the two groups. RESULTS The GBS colonization rate of pregnant women in this study was 6.52%; the incidence of Vaginal delivery and Neonatal infection in GBS positive group was significantly higher than that in GBS negative group (P < 0.05); with Neonatal infection as the dependent variable, and the GBS infection, Vaginal delivery and GDM of the elderly and women in late pregnancy as independent variables, the results showed that GBS infection of women in late pregnancy was an independent risk factor for Neonatal infection. CONCLUSION Clinical practice should attach great importance to GBS infection in late pregnancy, strengthen GBS screening in late pregnancy, and actively implement the strategy of intrapartum antibiotic intervention (IAP), which is of great significance in reducing the vertical infection rate of maternal and infant GBS and improving the quality of newborn birth.
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Affiliation(s)
- Hui Ma
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - JingWen Xu
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - YanHong Zhang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - RenYan Zhang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jie Wu
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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25
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Wang F, Yi L, Ming F, Dong R, Wang F, Chen R, Hu X, Chen X, Sun B, Tang YW, Zhu Y, Wu L. Evaluation of the Xpert Xpress GBS test for rapid detection of group B Streptococcus in pregnant women. Microbiol Spectr 2024; 12:e0220623. [PMID: 38054718 PMCID: PMC10783076 DOI: 10.1128/spectrum.02206-23] [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: 06/04/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE This was the first study evaluating the performance of the Xpert Xpress group B Streptococcus (GBS) test using rectovaginal swabs from Chinese pregnant women. Compared to the other three assays, the Xpert Xpress GBS test demonstrated high sensitivity and specificity when screening 939 pregnant women for GBS in rectovaginal specimens. Additionally, its reduced time to obtain results makes it valuable for the rapid detection of GBS.
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Affiliation(s)
- Feiling Wang
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Lehui Yi
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zhuhai, Guangdong, China
| | - Fang Ming
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Rui Dong
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Feng Wang
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Ruirui Chen
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Xiaoling Hu
- Clinical Affairs, Cepheid, Sunnyvale, California, USA
| | - Xuri Chen
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Bo Sun
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Yi-Wei Tang
- Medical Affairs, Cepheid, Sunnyvale, California, USA
- Danaher Diagnostic Platform China, Shanghai, China
| | - Yuanfang Zhu
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Lijuan Wu
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
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Manuel G, Coleman M, Orvis AS, Munson J, Li A, Kapur RP, Li M, Li E, Armistead B, Rajagopal L, Adams Waldorf KM. Spatial profiling of the placental chorioamniotic membranes reveals upregulation of immune checkpoint proteins during Group B Streptococcus infection in a nonhuman primate model. Front Cell Infect Microbiol 2024; 13:1299644. [PMID: 38239507 PMCID: PMC10794649 DOI: 10.3389/fcimb.2023.1299644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024] Open
Abstract
Background Preterm birth is a leading cause of neonatal mortality, which is often complicated by intrauterine infection and inflammation. We have established a nonhuman primate model of Group B Streptococcus (GBS, Streptococcus agalactiae) infection-associated preterm birth. Immune checkpoints are modulators of the immune response by activating or suppressing leukocyte function and are understudied in preterm birth. The objective of this study was to spatially profile changes in immune protein expression at the maternal-fetal interface during a GBS infection with a focus on immune checkpoints. Methods Twelve nonhuman primates (pigtail macaques, Macaca nemestrina) received a choriodecidual inoculation of either: 1) 1-5 X 108 colony forming units (CFU) of hyperhemolytic/hypervirulent GBS (GBSΔcovR, N=4); 2) an isogenic/nonpigmented strain (GBS ΔcovRΔcylE, N=4); or, 3) saline (N=4). A Cesarean section was performed at preterm labor or 3 days after GBS infection or 7 days after saline inoculation. Nanostring GeoMx® Digital Spatial Profiling technology was used to segment protein expression within the amnion, chorion, and maternal decidua at the inoculation site using an immuno-oncology panel targeting 56 immunoproteins enriched in stimulatory and inhibitory immune checkpoint proteins or their protein ligands. Statistical analysis included R studio, Kruskal-Wallis, Pearson and Spearman tests. Results Both inhibitory and stimulatory immune checkpoint proteins were significantly upregulated within the chorioamniotic membranes and decidua (VISTA, LAG3, PD-1, CD40, GITR), as well as their ligands (PD-L1, PD-L2, CD40L; all p<0.05). Immunostaining for VISTA revealed positive (VISTA+) cells, predominantly in the chorion and decidua. There were strong correlations between VISTA and amniotic fluid concentrations of IL-1β, IL-6, IL-8, and TNF-α (all p<0.05), as well as maternal placental histopathology scores (p<0.05). Conclusion Differential regulation of multiple immune checkpoint proteins in the decidua at the site of a GBS infection indicates a major perturbation in immunologic homeostasis that could benefit the host by restricting immune-driven pathologies or the pathogen by limiting immune surveillance. Protein expression of VISTA, an inhibitory immune checkpoint, was upregulated in the chorion and decidua after GBS infection. Investigating the impact of innate immune cell expression of inhibitory immune checkpoints may reveal new insights into placental host-pathogen interactions at the maternal-fetal interface.
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Affiliation(s)
- Gygeria Manuel
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Michelle Coleman
- Center for Global Infectious Disease Research, Seattle Childrens Research Institute, Seattle, WA, United States
| | - Austyn S. Orvis
- Center for Global Infectious Disease Research, Seattle Childrens Research Institute, Seattle, WA, United States
| | - Jeff Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Amanda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Department of Biology, Case Western Reserve University, Cleveland, OH, United States
| | - Raj P. Kapur
- Department of Laboratory Medicine and Pathology, Seattle Children’s Hospital and University of Washington, Seattle, WA, United States
| | - Miranda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Edmunda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Blair Armistead
- Center for Global Infectious Disease Research, Seattle Childrens Research Institute, Seattle, WA, United States
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Childrens Research Institute, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristina M. Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
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27
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Matsubara K, Shibata M. Group B Streptococcal Disease in Infants in Japan. Pediatr Infect Dis J 2024; 43:e3-e10. [PMID: 37922509 DOI: 10.1097/inf.0000000000004144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
This review describes the epidemiology of group B Streptococcus (GBS) infection in infants in Japan and discusses unresolved issues and future perspectives. Guidelines for the prevention of vertical transmission in Japan were implemented in 2008. The incidence of early-onset disease in Japan has remained stable at approximately 0.10/1000 livebirths or less, which is lower than in Europe and North America. The incidence of late-onset disease is also low, but has increased over the last decade, with an estimated 0.29/1000 livebirths in 2020. National surveillance studies in 2011-2015 and 2016-2020 reported case fatality rates of 4.5% and 6.5% for early-onset disease and 4.4% and 3.0% for late-onset disease, respectively. Sequelae of neurodevelopmental impairments were considerably associated with infants who developed meningitis. Predominant neonatal invasive strains have remained in the following order of serotypes: III, Ia, Ib and V, for the past 30 years. Conversely, the predominant serotypes of maternal colonization strains markedly changed from serotypes VI and VIII around 2000 to serotypes Ia, Ib, III and V over the last decade. Recurrence rates among infants < 1-year-old were estimated to be 2.8%-3.7%, and preterm birth and antenatal maternal GBS colonization were risk factors for recurrence. Several unresolved issues remain. First, the exact disease burden remains unclear because Japan does not have a nationwide system to register all infants affected by invasive GBS disease, and even population-based surveys are limited to up to 10 of the 47 prefectures. Others include low adherence to prevention guidelines of vertical transmission and the development of strategies based on Japanese epidemiological evidence rather than the Center for Disease Control and Prevention guidelines. The effectiveness of introducing maternal vaccines in Japan, where the disease incidence is low, needs to be carefully verified.
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Affiliation(s)
- Kousaku Matsubara
- From the Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Meiwa Shibata
- Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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28
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Kharrat R, Ben Ayed N, Ktari S, Regaieg C, Mezghani S, Hmida N, Mahjoubi F, Gargouri A, Hammami A. Group B Streptococcus and Perinatality in the South of Tunisia: Epidemiology, Serotype Distribution, and Antibiotic Susceptibility. Fetal Pediatr Pathol 2024; 43:21-32. [PMID: 38069499 DOI: 10.1080/15513815.2023.2287519] [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] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION In the lack of updated Tunisian epidemiological data, we sought to describe the epidemiology of Group B Streptococcus (GBS) in pregnant women and newborns. MATERIALS AND METHODS A retrospective analysis of GBS neonatal invasive infections and a cross-sectional study evaluating the prevalence of maternal GBS colonization were conducted. GBS isolates were tested for antimicrobial susceptibility, serotyped, and assessed for the appurtenance to the hypervirulent ST17 clone. RESULTS Of 98 neonates with GBS, early-onset GBS disease (EOD) comprised 83.7 and 16.3% were late-onset GBS disease (LOD). The prevalence of maternal GBS colonization was 27%. All GBS isolates were susceptible to penicillin. Serotype III predominated (42.6%) for neonatal invasive infections. GBS isolates belonging to the ST17 sequence type were found only as serotype III. CONCLUSION This study documents the frequency of GBS EOD, the high rate of maternal GBS colonization, and the predominance of the hypervirulent clone type III/ST17 in infants.
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Affiliation(s)
- Rim Kharrat
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nourelhouda Ben Ayed
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Ktari
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Chiraz Regaieg
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sonda Mezghani
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nedia Hmida
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Faouzia Mahjoubi
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Abdellatif Gargouri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Adnene Hammami
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Björklund V, Saxén H, Hertting O, Malchau Carlsen EL, Hoffmann S, Håkansson S, Stefánsson Thors V, Haraldsson Á, Brigtsen AK, Döllner H, Huhtamäki H, Pokka T, Ruuska TS. Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019. Euro Surveill 2024; 29:2300193. [PMID: 38240058 PMCID: PMC10797658 DOI: 10.2807/1560-7917.es.2024.29.3.2300193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/30/2023] [Indexed: 01/22/2024] Open
Abstract
BackgroundNeonatal early-onset disease caused by group B Streptococcus (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.AimThe aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.MethodsIn 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995-2011) and Period II (2012-2019) were collected from each national register, covering 6,605,564 live births.ResultsIn Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34-0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80-1.0), specifically 0.89 (95% CI: 0.70-1.5) in Denmark, 0.34 (95% CI: 0.15-0.81) in Iceland, 0.72 (95% CI: 0.59-0.88) in Norway and 0.97 (95% CI: 0.85-1.1) in Sweden.ConclusionsIn this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.
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Affiliation(s)
- Verna Björklund
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxén
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olof Hertting
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Emma Louise Malchau Carlsen
- Department of Intensive Care for Newborns and Infants, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Stellan Håkansson
- Department of Clinical Science/Paediatrics, Umeå University, Umeå, Sweden
| | - Valtýr Stefánsson Thors
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Ásgeir Haraldsson
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Döllner
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Children's Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Heikki Huhtamäki
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Terhi Susanna Ruuska
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Biocenter Oulu and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
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Borg SA, Cao J, Nguyen PY, Aziz S, Vogel JP. Self-collection of samples for group B streptococcus testing during pregnancy: a systematic review and meta-analysis. BMC Med 2023; 21:498. [PMID: 38110910 PMCID: PMC10729404 DOI: 10.1186/s12916-023-03186-x] [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] [Received: 06/18/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Sample self-collection for reproductive tract infection diagnosis has been found to offer greater convenience, privacy, autonomy, and expanded access to testing in non-pregnant adults. This review aimed to determine whether sample self-collection is as accurate as provider-collection for detection of group B streptococcus colonisation in pregnancy and whether a strategy of self-collection compared to provider-collection might improve maternal and neonatal health outcomes. METHODS We searched CINAHL Plus, Medline, EMBASE, Maternity and Infant Care Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews in June 2022. Eligible studies compared self-collected and provider-collected samples taken from the same participants or participants randomised to either self-collection or provider-collection for reproductive tract infection testing using the same test and testing method in pregnant individuals. We included trials and observational studies. Reviewers assessed risk of bias using the QUADAS-2 checklist and independently extracted data. Sensitivity and specificity for group B streptococcus colonisation of self-collected compared to provider-collected samples were pooled using a bivariate, random-effects, meta-analytic model. This review was registered with PROSPERO (CRD42023396573). RESULTS The search identified 5909 references, of which eleven diagnostic accuracy group B streptococcus studies were included (n = 3269 participants). No studies assessed the effects of self-collection in pregnancy on health outcomes. All studies had high or unclear risk of bias. Pooled sensitivities of self-collected samples for group B streptococcus detection were 82% (95% CI: 66-91%; I2 = 68.85%) in four trials (n = 1226) and 91% (95% CI: 83-96%; I2 = 37.38%) in seven non-randomised studies (n = 2043). Pooled specificities were 99% (95% CI: 98-99%; I2 = 12.08%) and 97% (95% CI: 94-99%; I2 = 72.50%), respectively. CONCLUSIONS Self-collected samples for group B streptococcus detection in pregnancy had high specificity compared to provider-collection, but lower sensitivity, particularly for included trials. Studies investigating the effect of self-collection on health outcomes, and further higher quality trials comparing accuracy of self-collection to provider-collection, are required.
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Affiliation(s)
- Sarah A Borg
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Jenny Cao
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Phi-Yen Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Samia Aziz
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
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Stephens VR, Moore RE, Spicer SK, Talbert JA, Lu J, Chinni R, Chambers SA, Townsend SD, Manning SD, Rogers LM, Aronoff DM, Vue Z, Neikirk K, Hinton AO, Damo SM, Noble KN, Eastman AJ, McCallister MM, Osteen KG, Gaddy JA. Environmental Toxicant Exposure Paralyzes Human Placental Macrophage Responses to Microbial Threat. ACS Infect Dis 2023; 9:2401-2408. [PMID: 37955242 DOI: 10.1021/acsinfecdis.3c00490] [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] [Indexed: 11/14/2023]
Abstract
Exposure to environmental toxicants (such as dioxins) has been epidemiologically linked to adverse reproductive health outcomes, including placental inflammation and preterm birth. However, the molecular underpinnings that govern these outcomes in gravid reproductive tissues remain largely unclear. Placental macrophages (also known as Hofbauer cells) are crucial innate immune cells that defend the gravid reproductive tract and help promote maternal-fetal tolerance. We hypothesized that exposure to environmental toxicants such as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) could alter placental macrophage responses to inflammatory insults such as infection. To test this, placental macrophages were cultured in the presence or absence of TCDD and then infected with the perinatal pathogen Group B Streptococcus (GBS). Our results indicate that TCDD is lethal to placental macrophages at and above a 5 nM concentration and that sublethal dioxin exposure inhibits phagocytosis and cytokine production. Taken together, these results indicate that TCDD paralyzes placental macrophage responses to bacterial infection.
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Affiliation(s)
- Victoria R Stephens
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Rebecca E Moore
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Sabrina K Spicer
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37240, United States
| | - Julie A Talbert
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37240, United States
| | - Jacky Lu
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Pathology, Stanford University, Palo Alto, California 94304, United States
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, California 90027, United States
| | - Riya Chinni
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Schuyler A Chambers
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37240, United States
- Department of Chemistry, Stanford University, Palo Alto, California 94305, United States
| | - Steven D Townsend
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37240, United States
| | - Shannon D Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48824, United States
| | - Lisa M Rogers
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
| | - David M Aronoff
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
| | - Zer Vue
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Kit Neikirk
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Antentor O Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Steven M Damo
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee 37205, United States
- Center for Structural Biology, Vanderbilt University, Nashville, Tennessee 37205, United States
- Department of Life and Physical Sciences, Fisk University, Nashville, Tennessee 37208, United States
| | - Kristen N Noble
- Department of Pediatrics, Vanderbilt University Medical Center Nashville, Tennessee 37232, United States
| | - Alison J Eastman
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Monique M McCallister
- Department of Biological Sciences, Tennessee State University, Nashville, Tennessee 37209, United States
| | - Kevin G Osteen
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee 37208, United States
- Tennessee Valley Health Systems, Department of Veterans Affairs, Nashville, Tennessee 37212, United States
| | - Jennifer A Gaddy
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee 37235, United States
- Tennessee Valley Health Systems, Department of Veterans Affairs, Nashville, Tennessee 37212, United States
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McCabe S, Bjånes E, Hendriks A, Wang Z, van Sorge NM, Pill-Pepe L, Bautista L, Chu E, Codée JDC, Fairman J, Kapoor N, Uchiyama S, Nizet V. The Group A Streptococcal Vaccine Candidate VAX-A1 Protects against Group B Streptococcus Infection via Cross-Reactive IgG Targeting Virulence Factor C5a Peptidase. Vaccines (Basel) 2023; 11:1811. [PMID: 38140215 PMCID: PMC10747066 DOI: 10.3390/vaccines11121811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Group B Streptococcus (Streptococcus agalactiae or GBS) is the leading infectious cause of neonatal mortality, causing roughly 150,000 infant deaths and stillbirths annually across the globe. Approximately 20% of pregnant women are asymptomatically colonized by GBS, which is a major risk factor for severe fetal and neonatal infections as well as preterm birth, low birth weight, and neurodevelopmental abnormalities. Current clinical interventions for GBS infection are limited to antibiotics, and no vaccine is available. We previously described VAX-A1 as a highly effective conjugate vaccine against group A Streptococcus that is formulated with three antigens, SpyAD, streptolysin O, and C5a peptidase (ScpA). ScpA is a surface-expressed, well-characterized GAS virulence factor that shares nearly identical sequences with the lesser studied GBS homolog ScpB. Here, we show that GBS C5a peptidase ScpB cleaves human complement factor C5a and contributes to disease severity in the murine models of pneumonia and sepsis. Furthermore, antibodies elicited by GAS C5a peptidase bind to GBS in an ScpB-dependent manner, and VAX-A1 immunization protects mice against lethal GBS heterologous challenge. These findings support the contribution of ScpB to GBS virulence and underscore the importance of choosing vaccine antigens; a universal GAS vaccine such as VAX-A1 whose formulation includes GAS C5a peptidase may have additional benefits through some measure of cross-protection against GBS infections.
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Affiliation(s)
- Sinead McCabe
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; (S.M.); (E.B.); (S.U.)
| | - Elisabet Bjånes
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; (S.M.); (E.B.); (S.U.)
| | - Astrid Hendriks
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (A.H.); (N.M.v.S.)
| | - Zhen Wang
- Leiden Institute of Chemistry, Leiden University, 2333 CC Leiden, The Netherlands; (Z.W.); (J.D.C.C.)
| | - Nina M. van Sorge
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (A.H.); (N.M.v.S.)
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Lucy Pill-Pepe
- Vaxcyte, Inc., San Carlos, CA 94070, USA; (L.P.-P.); (L.B.); (E.C.); (J.F.); (N.K.)
| | - Leslie Bautista
- Vaxcyte, Inc., San Carlos, CA 94070, USA; (L.P.-P.); (L.B.); (E.C.); (J.F.); (N.K.)
| | - Ellen Chu
- Vaxcyte, Inc., San Carlos, CA 94070, USA; (L.P.-P.); (L.B.); (E.C.); (J.F.); (N.K.)
| | - Jeroen D. C. Codée
- Leiden Institute of Chemistry, Leiden University, 2333 CC Leiden, The Netherlands; (Z.W.); (J.D.C.C.)
| | - Jeff Fairman
- Vaxcyte, Inc., San Carlos, CA 94070, USA; (L.P.-P.); (L.B.); (E.C.); (J.F.); (N.K.)
| | - Neeraj Kapoor
- Vaxcyte, Inc., San Carlos, CA 94070, USA; (L.P.-P.); (L.B.); (E.C.); (J.F.); (N.K.)
| | - Satoshi Uchiyama
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; (S.M.); (E.B.); (S.U.)
| | - Victor Nizet
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; (S.M.); (E.B.); (S.U.)
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA 92093, USA
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Alzayer M, Alkhulaifi MM, Alyami A, Aldosary M, Alageel A, Garaween G, Shibl A, Al-Hamad AM, Doumith M. Molecular typing and antimicrobial resistance of group B Streptococcus clinical isolates in Saudi Arabia. J Glob Antimicrob Resist 2023; 35:244-251. [PMID: 37844802 DOI: 10.1016/j.jgar.2023.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES Group B Streptococcus (GBS) has emerged as an important cause of severe infections in adults. However, limited data are available regarding the epidemiology of GBS in Saudi Arabia. METHODS Isolates were collected over a period of eight months from colonized (n = 104) and infected adults (n = 95). Serotypes and virulence determinants were detected by polymerase chain reactions (PCRs). Genetic relatedness was assessed using Multiple Locus Variable Number Tandem Repeat Analysis (MLVA). Antimicrobial susceptibilities were determined by disk diffusion. RESULTS Serotypes III and V (25% each) were the most prevalent, followed by serotypes II (16.18%), Ia (13.24%), VI (9.31%), and Ib (8.82%), while five isolates remained non-typeable (2.45%). Hypervirulent serotype III/CC17 clone (n = 21) accounted for 41.18% of the serotype III isolates. Most isolates (53.92%) harboured pilus island (PI) 1 and 2a types, while PI-2b was predominantly detected in the hypervirulent clone. Isolates were variably resistant to tetracycline (76.47%), erythromycin (36.76%), clindamycin (25.49%), and levofloxacin (6.37%), but remained susceptible to penicillin. Macrolide resistant isolates exhibited constitutive (55.42%) and inducible macrolide-lincosamide-streptogramin B resistance phenotypes (33.74%), while a few had L (9.64%) or M (1.2%) phenotypes. MLVA patterns of dominant serotypes III and V revealed 40 different types divided into 12 clusters and 28 singletons. Interestingly, macrolide resistance was significantly associated with two major MLVA types. CONCLUSIONS GBS isolates belonged predominantly to serotypes III and V, but there were no clear associations between serotypes and patient groups. The studied isolates exhibited high levels of resistance to erythromycin and clindamycin that need further surveillance.
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Affiliation(s)
- Maha Alzayer
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia; Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Manal M Alkhulaifi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alyami
- Pathology and Clinical Laboratory, Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Aldosary
- Pathology and Clinical Laboratory, Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alageel
- Pathology and Clinical Laboratory, Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ghada Garaween
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Atef Shibl
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Arif M Al-Hamad
- Division of Clinical Microbiology, Pathology and Laboratory Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Michel Doumith
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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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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Liu Y, Liu W, Zhuang G, Liu W, Qiu C. Colonisation of Group B Streptococcus and its effects on pregnancy outcomes in pregnant women in Guangzhou, China: a retrospective study. BMJ Open 2023; 13:e078759. [PMID: 38011982 PMCID: PMC10685966 DOI: 10.1136/bmjopen-2023-078759] [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] [Received: 08/11/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES This study was to investigate the colonisation rate of Group B Streptococcus (GBS) during pregnancy, and to evaluate the influence of GBS colonisation on pregnancy outcomes. DESIGN A retrospective cohort study. SETTING Data of 47 380 pregnant women from 2016 to 2022 were collected from the Maternal and Child Health Hospital of Huadu District, Guangzhou City, China. PARTICIPANTS A total of 15 040 pregnant women were eligible for this study, of which 32 340 were excluded due to non-native pregnant women, in vitro fertilization infants, malformed fetuses, habitual abortion, abortions due to poor reproductive or obstetrical history, artificial insemination, umbilical cord torsion, and other diseases during pregnancy. PRIMARY OUTCOME MEASURES The incidence rates of GBS colonisation and premature delivery, fetal distress, premature rupture of membranes (PROM), low birth weight (LBW), abortion and stillbirth. RESULTS Of the 15 040 pregnant women included in this study, 1445 developed GBS colonisation, with a prevalence of 9.61% (95% CI, 9.15 to 10.09). Advanced maternal age (≥35 years) predisposed women to GBS colonisation, and the occurrence of GBS colonisation varied among different ethnic groups. Our data revealed that fetal distress, PROM and LBW were more common in pregnant women colonised with GBS than in pregnant women not colonised with GBS. The incidence for premature delivery, fetal distress, PROM and LBW in infants of pregnant women colonised with GBS was 41.0% (OR=1.410, 95% CI, 1.134 to 1.753), 282.5% (OR=3.825, 95% CI, 3.185 to 4.593), 14.9% (OR=1.149, 95% CI, 1.005 to 1.313), and 29.7% (OR=1.297, 95% CI, 1.010 to 1.664), respectively. CONCLUSIONS GBS colonisation was relatively low in pregnant women in Guangzhou. Women of advanced maternal age were more prone to GBS colonisation, and pregnant women colonised with GBS were more predisposed to fetal distress, PROM and LBW.
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Affiliation(s)
- Yanxia Liu
- Department of Clinical Laboratory, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
| | - Weiling Liu
- Department of Clinical Laboratory, Foshan Fosun Chancheng Hospital, Foshan, Guangdong, China
| | - Guiying Zhuang
- Department of Neonatology, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
| | - Weiqi Liu
- Department of Clinical Laboratory, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
| | - Cuiqing Qiu
- Medical Information Office, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
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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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Founou LL, Khan UB, Medugu N, Pinto TCA, Darboe S, Chendi Z, Founou RC, To KN, Jamrozy D, Karampatsas K, Carr VR, Pepper K, Dangor Z, Ip M, Le Doare K, Bentley SD. Molecular epidemiology of Streptococcus agalactiae in non-pregnant populations: a systematic review. Microb Genom 2023; 9. [PMID: 38019122 DOI: 10.1099/mgen.0.001140] [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: 11/30/2023] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) has recently emerged as an important pathogen among adults. However, it is overlooked in this population, with all global efforts being directed towards its containment among pregnant women and neonates. This systematic review assessed the molecular epidemiology and compared how the lineages circulating among non-pregnant populations relate to those of pregnant and neonatal populations worldwide. A systematic search was performed across nine databases from 1 January 2000 up to and including 20 September 2021, with no language restrictions. The Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool (PCAT) was used to assess the quality of included studies. The global population structure of GBS from the non-pregnant population was analysed using in silico typing and phylogenetic reconstruction tools. Twenty-four articles out of 13 509 retrieved across 9 databases were eligible. Most studies were conducted in the World Health Organization European region (12/24, 50 %), followed by the Western Pacific region (6/24, 25 %) and the Americas region (6/24, 25 %). Serotype V (23%, 2310/10240) and clonal complex (CC) 1 (29 %, 2157/7470) were the most frequent serotype and CC, respectively. The pilus island PI1 : PI2A combination (29 %, 3931/13751) was the most prevalent surface protein gene, while the tetracycline resistance tetM (55 %, 5892/10624) was the leading antibiotic resistance gene. This study highlights that, given the common serotype distribution identified among non-pregnant populations (V, III, Ia, Ib, II and IV), vaccines including these six serotypes will provide broad coverage. The study indicates advanced molecular epidemiology studies, especially in resource-constrained settings for evidence-based decisions. Finally, the study shows that considering all at-risk populations in an inclusive approach is essential to ensure the sustainable containment of GBS.
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Affiliation(s)
- Luria Leslie Founou
- Reproductive, Maternal, Newborn and Child Health (ReMARCH) Research Unit, Centre of Expertise and Biological Diagnostic of Cameroon Research Institute (CEDBCAM-RI), Yaoundé, Cameroon
- Bioinformatics and Applied Machine Learning Research Unit, EDEN Biosciences Research Institute (EBRI), EDEN Foundation, Yaoundé, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4041, South Africa
| | - Uzma Basit Khan
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Nubwa Medugu
- Department of Medical Microbiology and Parasitology, National Hospital Abuja, Abuja, Nigeria
| | - Tatiana C A Pinto
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Saffiatou Darboe
- Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Zhu Chendi
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong, PR China
| | - Raspail Carrel Founou
- Antibiotic Resistance Infectious Diseases (ARID) Research Unit, Centre of Expertise and Biological Diagnostic of Cameroon Research Institute (CEDBCAM-RI), Yaoundé, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4041, South Africa
- Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Ka-Ning To
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Dorota Jamrozy
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | | | - Victoria R Carr
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, SE1 9RT, UK
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Kevin Pepper
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Ziyaad Dangor
- Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Ip
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong, PR China
| | - Kirsty Le Doare
- Medical Research Council Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stephen D Bentley
- Department of Pathology, University of Cambridge, Cambridge, UK
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
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Coleman M, Orvis A, Brokaw A, Furuta A, Sharma K, Quach P, Bhullar A, Sanghavi R, Nguyen S, Sweeney E, Seepersaud R, Armistead B, Adams Waldorf KM, Rajagopal L. GBS hyaluronidase mediates immune suppression in a TLR2/4- and IL-10-dependent manner during pregnancy-associated infection. mBio 2023; 14:e0204923. [PMID: 37747229 PMCID: PMC10653848 DOI: 10.1128/mbio.02049-23] [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: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
IMPORTANCE Bacteria such as GBS can cause infections during pregnancy leading to preterm births, stillbirths, and neonatal infections. The interaction between host and bacterial factors during infections in the placenta is not fully understood. GBS secretes a hyaluronidase enzyme that is thought to digest host hyaluronan into immunosuppressive disaccharides that dampen TLR2/4 signaling, leading to increased bacterial dissemination and adverse outcomes. In this study, we show that GBS HylB mediates immune suppression and promotes bacterial infection during pregnancy that requires TLR2, TLR4, and IL-10. Understanding the interaction between host and bacterial factors can inform future therapeutic strategies to mitigate GBS infections.
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Affiliation(s)
- Michelle Coleman
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kavita Sharma
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Phoenicia Quach
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Avneet Bhullar
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Rhea Sanghavi
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Shayla Nguyen
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Erin Sweeney
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ravin Seepersaud
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Blair Armistead
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Kristina M. Adams Waldorf
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Hanze Villavicencio KL, Job MJ, Burghard AC, Taffet A, Banda FM, Vurayai M, Mokomane M, Arscott-Mills T, Mazhani T, Nchingane S, Thomas B, Steenhoff AP, Ratner AJ. Genomic Analysis of Group B Streptococcus Carriage Isolates From Botswana Reveals Distinct Local Epidemiology and Identifies Novel Strains. Open Forum Infect Dis 2023; 10:ofad496. [PMID: 37869411 PMCID: PMC10588617 DOI: 10.1093/ofid/ofad496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023] Open
Abstract
In pregnant people colonized with group B Streptococcus (GBS) in Botswana, we report the presence/expansion of sequence types 223 and 109, a low rate of erythromycin resistance, and 3 novel sequence types. These data highlight the importance of local epidemiologic studies of GBS, a significant source of neonatal disease.
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Affiliation(s)
- Karen L Hanze Villavicencio
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan J Job
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Anne Claire Burghard
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NewYork, USA
| | - Allison Taffet
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Francis M Banda
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Moses Vurayai
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Margaret Mokomane
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-UPenn Partnership, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tiny Mazhani
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Brady Thomas
- Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Andrew P Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-UPenn Partnership, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam J Ratner
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
- Department of Microbiology, NewYork University Grossman School of Medicine, New York, New York, USA
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Wang X, Chan PHY, Lau HYS, Tsoi K, Lam HS. Epidemiologic Changes of Neonatal Early-onset Sepsis After the Implementation of Universal Maternal Screening for Group B Streptococcus in Hong Kong. Pediatr Infect Dis J 2023; 42:914-920. [PMID: 37406223 PMCID: PMC10501353 DOI: 10.1097/inf.0000000000004022] [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: 05/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The epidemiology of neonatal early-onset sepsis (EOS) has changed with time and with changes in prevention strategy. Population-representative contemporary data provide insights on how to further improve EOS prevention and triage strategies. METHODS Neonates born in public hospitals in Hong Kong from January 1, 2006, to December 31, 2017 were included. The epidemiological characteristics of EOS and the use of intrapartum antibiotic prophylaxis (IAP) were compared between the 2 epochs before (January 1, 2006 to December 31, 2011) and after (January 1, 2012 to December 31, 2017) the territory-wide implementation of universal maternal group B Streptococcus (GBS) screening. RESULTS EOS developed in 1.07‰ of live births (522/490,034). After the implementation of universal GBS screening, the EOS rate decreased in neonates born ≥34 weeks (1.17‰-0.56‰, P < 0.001) and remained similar in those born <34 weeks (7.8‰-10.9‰, P = 0.15), whereas the proportions of IAP coverage increased in both groups [7.6%-23.3% ( P < 0.001) and 28.5%-52.0% ( P < 0.001), respectively]. The major pathogen for EOS shifted from GBS to Escherichia coli , and for early-onset meningitis from GBS to Streptococcus bovis . IAP was associated with subsequent isolation of pathogens resistant to ampicillin [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI): 1.3-4.2], and second-generation [aOR 2.0; 95% CI: 1.02-4.3] and third-generation [aOR 2.2; 95% CI: 1.1-5.0] cephalosporins. CONCLUSIONS Pathogen profile of EOS changed with the implementation of universal GBS screening. S. bovis has emerged as a more common pathogen associated with the risk of meningitis. IAP may not be as effective in reducing EOS rate among infants born <34 weeks as compared with those ≥34 weeks, and newer strategies may be needed.
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Affiliation(s)
- Xuelian Wang
- From the Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peggy Hiu Ying Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hoi Ying Sharon Lau
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kathleen Tsoi
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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Field C, Bank TC, Spees CK, Germann K, Landon MB, Gabbe S, Grobman WA, Costantine MM, Venkatesh KK. Association between glycemic control and group B streptococcus colonization among pregnant individuals with pregestational diabetes. Am J Reprod Immunol 2023; 90:e13779. [PMID: 37766411 DOI: 10.1111/aji.13779] [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: 07/06/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
PROBLEM Pregestational diabetes increases the risk of group B streptococcus (GBS) colonization in pregnancy. Whether glycemic control is associated with differences in this risk is unknown. We examined the association between glycemic control and GBS colonization among pregnant individuals with pregestational diabetes. METHOD OF STUDY A retrospective cohort of pregnant individuals with pregestational diabetes at a tertiary care center. The exposure was glycemic control, measured as hemoglobin A1c (A1c) at >20 weeks and assessed categorically at thresholds of <6.5% and <6.0%, and secondarily, as a continuous percentage. The outcome was maternal GBS colonization. Multivariable logistic regression was used and adjusted for age, parity, race, and ethnicity as a social determinant, body mass index, type of diabetes, and gestational age at A1c assessment. RESULTS Among 305 individuals (33% Type 1, 67% type 2), 45.0% (n = 140) were colonized with GBS. Individuals with an A1c < 6.5% were half as likely to be colonized with GBS compared with those with a A1c ≥ 6.5% (38.8% vs. 53.9%; adjusted odds ratio, AOR: 0.55; 95% CI: 0.33-0.91). Results were unchanged at an A1c threshold of <6.0% (35.7% vs. 48.5%; AOR: 0.60; 95% CI: 0.36-0.98). Individuals with a higher A1c as a continuous measure (%) were more likely to be colonized (AOR: 1.57 per 1%; 95% CI: 1.25-1.97). CONCLUSIONS Pregnant individuals with pregestational diabetes with worse glycemic control were at an increased risk of GBS colonization. Further study is needed to understand if improved glycemic control leads to lower risk of GBS colonization.
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Affiliation(s)
- Christine Field
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - T Caroline Bank
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Colleen K Spees
- School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Steven Gabbe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
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Laycock KM, Acosta F, Valera S, Villegas A, Mejia E, Mateo C, Felipe R, Fernández A, Job M, Dongas S, Steenhoff AP, Ratner AJ, Geoghegan S. Near-term pregnant women in the Dominican Republic experience high rates of Group B Streptococcus rectovaginal colonization with virulent strains. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002281. [PMID: 37733668 PMCID: PMC10513192 DOI: 10.1371/journal.pgph.0002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023]
Abstract
Maternal colonization with Group B Streptococcus (GBS) is an important cause of stillbirth, prematurity, and serious infection and death in infants worldwide. Resource constraints limit prevention strategies in many regions. Maternal GBS vaccines in development could be a more accessible prevention strategy, but data on geographic variations in GBS clones are needed to guide development of a broadly effective vaccine. In the Dominican Republic (DR), limited data suggest that pregnant women experience GBS colonization at rates among the highest globally. We aimed to determine the prevalence of maternal rectovaginal GBS colonization and describe clonal characteristics of colonizing strains in the DR. A cross-sectional study assessed rectovaginal GBS colonization in 350 near-term pregnant women presenting for routine prenatal care at an urban tertiary center in the DR. Rectovaginal samples were tested with chromogenic Strep B Carrot Broth and cultured for confirmatory whole-genome sequencing. In a secondary analysis, participants' demographics and histories were assessed for association with GBS colonization. Rectovaginal GBS colonization occurred in 26.6% of women. Serotypes Ia, Ib, II, III, IV, and V were detected, with no one serotype predominating; serotype III was identified most frequently (21.5%). Virulent and emerging strains were common, including CC17 (15.1%) and ST1010 (17.2%). In this first characterization of maternal GBS serotypes in the DR, we found high rates of rectovaginal colonization including with virulent and emerging GBS strains. The serotypes observed here are all targeted by candidate hexavalent GBS vaccines, suggesting effective protection in the DR.
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Affiliation(s)
- Katherine M. Laycock
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Sandra Valera
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Ana Villegas
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Elia Mejia
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Christian Mateo
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Rosa Felipe
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Anabel Fernández
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Megan Job
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Sophia Dongas
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Andrew P. Steenhoff
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Adam J. Ratner
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York, United States of America
- Department of Microbiology, Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Sarah Geoghegan
- Division of Paediatric Infectious Diseases, Children’s Health Ireland at Crumlin, Dublin, Ireland
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Hemingway-Foday J, Tita A, Chomba E, Mwenechanya M, Mweemba T, Nolen T, Lokangaka A, Tshefu Kitoto A, Lomendje G, Hibberd PL, Patel A, Das PK, Kurhe K, Goudar SS, Kavi A, Metgud M, Saleem S, Tikmani SS, Esamai F, Nyongesa P, Sagwe A, Figueroa L, Mazariegos M, Billah SM, Haque R, Shahjahan Siraj M, Goldenberg RL, Bauserman M, Bose C, Liechty EA, Ekhaguere OA, Krebs NF, Derman R, Petri WA, Koso-Thomas M, McClure E, Carlo WA. Prevention of maternal and neonatal death/infections with a single oral dose of azithromycin in women in labour in low-income and middle-income countries (A-PLUS): a study protocol for a multinational, randomised placebo-controlled clinical trial. BMJ Open 2023; 13:e068487. [PMID: 37648383 PMCID: PMC10471878 DOI: 10.1136/bmjopen-2022-068487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/15/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Maternal and neonatal infections are among the most frequent causes of maternal and neonatal mortality, and current antibiotic strategies have been ineffective in preventing many of these deaths. A randomised clinical trial conducted in a single site in The Gambia showed that treatment with an oral dose of 2 g azithromycin versus placebo for all women in labour reduced certain maternal and neonatal infections. However, it is unknown if this therapy reduces maternal and neonatal sepsis and mortality. In a large, multinational randomised trial, we will evaluate the impact of azithromycin given in labour to improve maternal and newborn outcomes. METHODS AND ANALYSIS This randomised, placebo-controlled, multicentre clinical trial includes two primary hypotheses, one maternal and one neonatal. The maternal hypothesis is to test whether a single, prophylactic intrapartum oral dose of 2 g azithromycin given to women in labour will reduce maternal death or sepsis. The neonatal hypothesis will test whether this intervention will reduce intrapartum/neonatal death or sepsis. The intervention is a single, prophylactic intrapartum oral dose of 2 g azithromycin, compared with a single intrapartum oral dose of an identical appearing placebo. A total of 34 000 labouring women from 8 research sites in sub-Saharan Africa, South Asia and Latin America will be randomised with a one-to-one ratio to intervention/placebo. In addition, we will assess antimicrobial resistance in a sample of women and their newborns. ETHICS AND DISSEMINATION The study protocol has been reviewed and ethics approval obtained from all the relevant ethical review boards at each research site. The results will be disseminated via peer-reviewed journals and national and international scientific forums. TRIAL REGISTRATION NUMBER NCT03871491 (https://clinicaltrials.gov/ct2/show/NCT03871491?term=NCT03871491&draw=2&rank=1).
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Affiliation(s)
| | - Alan Tita
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Elwyn Chomba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | | | - Trecious Mweemba
- University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Tracy Nolen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Adrien Lokangaka
- University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Antoinette Tshefu Kitoto
- University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | - Gustave Lomendje
- Kinshasa School of Public Health, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Datta Meghe Institute of Higher Education & Research (Deemed to be University), Wardha, Maharashtra, India
| | | | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Avinash Kavi
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Mrityunjay Metgud
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belgavi, Karnataka, India
| | - Sarah Saleem
- Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Shiyam S Tikmani
- Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | | | | | - Amos Sagwe
- Moi University School of Medicine, Eldoret, Kenya
| | - Lester Figueroa
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Manolo Mazariegos
- Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala
| | - Sk Masum Billah
- The University of Sydney, Sydney, New South Wales, Australia
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Md Shahjahan Siraj
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Melissa Bauserman
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Carl Bose
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward A Liechty
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Richard Derman
- Office of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | | | - Waldemar A Carlo
- The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Dhar N, Mohamed E, Kirstein F, Williams M, Dorasamy S, van Zyl P, Robertson MJ, Anderson T, Harden LM, Jardine K, Veeraraghavan B, Wilson S, Tippoo P, Madhi SA, Kwatra G. Immune responses against group B Streptococcus monovalent and pentavalent capsular polysaccharide tetanus toxoid conjugate vaccines in Balb/c mice. iScience 2023; 26:107380. [PMID: 37575182 PMCID: PMC10415928 DOI: 10.1016/j.isci.2023.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/31/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Immunization of pregnant women with Group B Streptococcus (GBS) capsular polysaccharide (CPS) conjugate vaccine (CV) could protect young infants against invasive GBS disease. We evaluated the immunogenicity of investigational five GBS monovalent (serotypes Ia, Ib, II, III, and V) CPS-tetanus toxoid (TT)-CV with adjuvant and GBS pentavalent CPS-TT-CV with adjuvant (GBS5-CV-adj) and without adjuvant (GBS5-CV-no-adj), in Balb/c mice. Aluminum phosphate was the adjuvant in the formulations, where included. The homotypic immunoglobulin G (IgG) geometric mean concentration (GMC) and opsonophagocytic activity (OPA) geometric mean titer (GMT) did not differ after the third dose of the GBS5-CV-adj vaccine compared with the monovalent counterparts for all five serotypes. The GBS5-CV-adj induced higher post-vaccination serotype-specific IgG GMCs and OPA GMTs compared to GBS5-CV-no_adj. The GBS5-CV with and without adjuvant should be considered for further development as a potential vaccine for pregnant women to protect their infants against invasive GBS disease.
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Affiliation(s)
- Nisha Dhar
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kimberly Jardine
- Wits Research Animal Facility, 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
| | - Gaurav Kwatra
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cowley ES, Chaves IZ, Osman F, Suen G, Anantharaman K, Hryckowian AJ. Determinants of Gastrointestinal Group B Streptococcus Carriage in Adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.17.553755. [PMID: 37645860 PMCID: PMC10462156 DOI: 10.1101/2023.08.17.553755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Streptococcus agalactiae (Group B Streptococcus, GBS) is a commensal Gram-positive bacterium found in the human gastrointestinal and urogenital tracts. Much of what is known about GBS relates to the diseases it causes in pregnant people and neonates. However, GBS is a common cause of disease in the general population with 90% of GBS mortality occurring in non-pregnant people. There are limited data about the predisposing factors for GBS and the reservoirs in the body. To gain an understanding of the determinants of gastrointestinal GBS carriage, we used stool samples and associated metadata to determine the prevalence and abundance of GBS in the gut microbiome of adults and find risk factors for GBS status. Methods We used 754 stool samples collected from adults in Wisconsin from 2016-2017 to test for the prevalence and abundance of GBS using a Taqman probe-based qPCR assay targeting two GBS-specific genes: cfp and sip. We compared the microbiome compositions of the stool samples by GBS status using 16S rRNA analysis. We compared associations with GBS status and 557 survey variables collected during sample acquisition (demographics, diet, overall health, and reproductive health) using univariate and multivariate analyses. Results We found 137/754 (18%) of participants had detectable GBS in their stool samples with a median abundance of 104 copies per nanogram of starting DNA. There was no difference in GBS status or abundance based on gender. Beta-diversity, Bray-Curtis and Unweighted UniFrac, was significantly different based on carrier status of the participant. Prior to p-value correction, 59/557 (10.6%) survey variables were significantly associated with GBS carrier status and 11/547 (2.0%) variables were significantly associated with abundance (p-value<0.05). After p-value correction, 2/547 (0.4%) variables were associated with GBS abundance: an increased abundance of GBS was associated with a decreased frequency since last dental checkup (p<0.001) and last dental cleaning (p<0.001). Increased GBS abundance was significantly associated with increased frequency of iron consumption (p=0.007) after p-value correction in multivariate models. Conclusions GBS is found in stool samples from adults in Wisconsin at similar frequencies as pregnant individuals screened with rectovaginal swabs. We did not find associations between risk factors historically associated with GBS in pregnant people, suggesting that risk factors for GBS carriage in pregnancy may differ from those in the general population. We found that frequency of iron consumption and dental hygiene are risk factors for GBS carriage in Wisconsin adults. Given that these variables were not assayed in previous GBS surveys, it is possible they also influence carriage in pregnant people. Taken together, this work serves as a foundation for future work in developing approaches to decrease GBS abundance in carriers.
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Affiliation(s)
- Elise S. Cowley
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Ibrahim Zuniga Chaves
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Fauzia Osman
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison
| | | | - Andrew J. Hryckowian
- Department of Medical Microbiology & Immunology, University of Wisconsin-Madison
- Department of Medicine (Division of Gastroenterology & Hepatology), School of Medicine and Public Health, University of Wisconsin-Madison
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Le Gallou B, Pastuszka A, Lemaire C, Mereghetti L, Lanotte P. Group B Streptococcus CRISPR1 Typing of Maternal, Fetal, and Neonatal Infectious Disease Isolates Highlights the Importance of CC1 in In Utero Fetal Death. Microbiol Spectr 2023; 11:e0522122. [PMID: 37341591 PMCID: PMC10434043 DOI: 10.1128/spectrum.05221-22] [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: 12/22/2022] [Accepted: 05/24/2023] [Indexed: 06/22/2023] Open
Abstract
We performed a descriptive analysis of group B Streptococcus (GBS) isolates responsible for maternal and fetal infectious diseases from 2004 to 2020 at the University Hospital of Tours, France. This represents 115 isolates, including 35 isolates responsible for early-onset disease (EOD), 48 isolates responsible for late-onset disease (LOD), and 32 isolates from maternal infections. Among the 32 isolates associated with maternal infection, 9 were isolated in the context of chorioamnionitis associated with in utero fetal death. Analysis of neonatal infection distribution over time highlighted the decrease in EOD since the early 2000s, while LOD incidence has remained relatively stable. All GBS isolates were analyzed by sequencing their CRISPR1 locus, which is an efficient way to determine the phylogenetic affiliation of strains, as it correlates with the lineages defined by multilocus sequence typing (MLST). Thus, the CRISPR1 typing method allowed us to assign a clonal complex (CC) to all isolates; among these isolates, CC17 was predominant (60/115, 52%), and the other main CCs, such as CC1 (19/115, 17%), CC10 (9/115, 8%), CC19 (8/115, 7%), and CC23 (15/115, 13%), were also identified. As expected, CC17 isolates (39/48, 81.3%) represented the majority of LOD isolates. Unexpectedly, we found mainly CC1 isolates (6/9) and no CC17 isolates that were responsible for in utero fetal death. Such a result highlights the possibility of a particular role of this CC in in utero infection, and further investigations should be conducted on a larger group of GBS isolated in a context of in utero fetal death. IMPORTANCE Group B Streptococcus is the leading bacterium responsible for maternal and neonatal infections worldwide, also involved in preterm birth, stillbirth, and fetal death. In this study, we determined the clonal complex of all GBS isolates responsible for neonatal diseases (early- and late-onset diseases) and maternal invasive infections, including chorioamnionitis associated with in utero fetal death. All GBS was isolated at the University Hospital of Tours from 2004 to 2020. We described the local group B Streptococcus epidemiology, which confirmed national and international data concerning neonatal disease incidence and clonal complex distribution. Indeed, neonatal diseases are mainly characterized by CC17 isolates, especially in late-onset disease. Interestingly, we identified mainly CC1 isolates responsible for in utero fetal death. CC1 could have a particular role in this context, and such a result should be confirmed on a larger group of GBS isolated from in utero fetal death.
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Affiliation(s)
- Brice Le Gallou
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Adeline Pastuszka
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Coralie Lemaire
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Laurent Mereghetti
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Philippe Lanotte
- Université de Tours, INRAE, Infectiologie et Santé Publique, BRMF, Tours, France
- Service de Bactériologie-Virologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
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Werter DE, Schuster HJ, Schneeberger C, Pajkrt E, de Groot CJM, van Leeuwen E, Kazemier BM. Changes in the Prevalence of Infection in Pregnant Women during the COVID-19 Lockdown. Microorganisms 2023; 11:1973. [PMID: 37630533 PMCID: PMC10459395 DOI: 10.3390/microorganisms11081973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND During the outbreak of SARS-CoV-2, strict mitigation measures and national lockdowns were implemented. Our objective was to investigate to what extent the prevalence of some infections in pregnancy was altered during different periods of the COVID-19 pandemic. METHODS This was a single centre retrospective cohort study conducted in the Netherlands on data collected from electronic patient files of pregnant women from January 2017 to February 2021. We identified three time periods with different strictness of mitigation measures: the first and second lockdown were relatively strict; the inter-lockdown period was less strict. The prevalence of the different infections (Group B Streptococcus (GBS)-carriage, urinary tract infections and Cytomegalovirus infection) during the lockdown was compared to the same time periods in previous years (2017-2019). RESULTS In the first lockdown, there was a significant decrease in GBS-carriage (19.5% in 2017-2019 vs. 9.1% in 2020; p = 0.02). In the period following the first lockdown and during the second, no differences in prevalence were found. There was a trend towards an increase in positive Cytomegalovirus IgM during the inter-lockdown period (4.9% in 2017-2019 vs. 12.8% in 2020; p = 0.09), but this did not reach statistical significance. The number of positive urine cultures did not significantly change during the study period. CONCLUSIONS During the first lockdown there was a reduction in GBS-carriage; further studies are warranted to look into the reason why.
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Affiliation(s)
- Dominique E. Werter
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Heleen J. Schuster
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Caroline Schneeberger
- Department of Medical Microbiology and Infection Control, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, 3721 MA Bilthoven, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Christianne J. M. de Groot
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
- Department of Human Genetics, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
| | - Brenda M. Kazemier
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, 1105 AZ Amsterdam, The Netherlands
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Davi SD, Okwu DG, Luetgehetmann M, Abba FM, Aepfelbacher M, Endamne LR, Alabi A, Zoleko-Manego R, Mombo-Ngoma G, Mahmoudou S, Addo MM, Ramharter M, Mischlinger J. Epidemiology of co-infections in pregnant women living with human immunodeficiency virus 1 in rural Gabon: a cross-sectional study. Infect Dis Poverty 2023; 12:64. [PMID: 37408012 DOI: 10.1186/s40249-023-01114-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND There is no recent epidemiological data on HIV infection in Gabon, particularly in pregnant women. To close this gap, an HIV-prevalence survey was conducted among Gabonese pregnant women, followed by a cross-sectional case-control study in which the prevalence of various co-infections was compared between HIV-positive and HIV-negative pregnant women. METHODS Between 2018 and 2019, data for the HIV-prevalence survey were collected retrospectively in 21 Gabonese antenatal care centres (ANCs). Subsequently, for the prospective co-infection study, all HIV-positive pregnant women were recruited who frequented the ANC in Lambaréné and a comparator sub-sample of HIV-negative pregnant women was recruited; these activities were performed from February 2019 to February 2020. The mean number of co-infections was ascertained and compared between HIV-positive and HIV-negative women. Additionally, the odds for being co-infected with at least one co-infection was evaluated and compared between HIV-positive and HIV-negative women. RESULTS HIV-positivity was 3.9% (646/16,417) among pregnant women. 183 pregnant women were recruited in the co-infection study. 63% of HIV-positive and 75% of HIV-negative pregnant women had at least one co-infection. There was a trend indicating that HIV-negative women were more often co-infected with sexually transmitted infections (STIs) than HIV-positive women [mean (standard deviation, SD): 2.59 (1.04) vs 2.16 (1.35), respectively; P = 0.056]; this was not the case for vector-borne infections [mean (SD): 0.47 (0.72) vs 0.43 (0.63), respectively; P = 0.59]. CONCLUSIONS Counterintuitively, the crude odds for concomitant STIs was lower in HIV-positive than in HIV-negative women. The change of magnitude from the crude to adjusted OR is indicative for a differential sexual risk factor profile among HIV-positive and HIV-negative women in this population. This might potentially be explained by the availability of sexual health care counselling for HIV-positive women within the framework of the national HIV control programme, while no such similar overall service exists for HIV-negative women. This highlights the importance of easy access to sexual healthcare education programmes for all pregnant women irrespective of HIV status.
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Affiliation(s)
- Saskia Dede Davi
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Marc Luetgehetmann
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Martin Aepfelbacher
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ayodele Alabi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef, The Netherlands
| | | | - Ghyslain Mombo-Ngoma
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Marylyn Martina Addo
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Department for Clinical Immunology of Infectious Diseases and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Johannes Mischlinger
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
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Husen O, Kannaiyan Abbai M, Aliyo A, Daka D, Gemechu T, Tilahun D, Dedecha W. Prevalence, Antimicrobial Susceptibility Pattern and Associated Factors of Group B Streptococcus Among Pregnant Women Attending Antenatal Care at Bule Hora University Teaching Hospital, Southern Ethiopia. Infect Drug Resist 2023; 16:4421-4433. [PMID: 37435237 PMCID: PMC10332419 DOI: 10.2147/idr.s415414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Background In many parts of the world, Group B Streptococcus (GBS) is a major cause of maternal and neonatal illness and mortality. It has a negative impact on neonatal and pregnancy outcomes. A worrisome problem in Ethiopia is the unknown rate of antibiotic resistance and the risk factors connected to GBS infections. Objective This study was to determine the prevalence, antibiotic susceptibility pattern, and related variables of Group B Streptococcus among pregnant women receiving prenatal treatment conducted at Bule Hora University Teaching Hospital, Southern Ethiopia, between June 1 and August 30, 2022. Methods An institutional-based cross-sectional study was conducted among 213 pregnant women attending antenatal care at Bule Hora University Teaching Hospital. Data on sociodemographic and related factors were gathered using structured questionnaires. The study's participants were selected using the consecutive sampling method. The lower vaginal/rectum area was brushed with a sterile cotton swab to capture the vaginal/rectum swab sample, which was then examined using microbiological techniques. The Kirby-Bauer disc diffusion method was used to assess antibiotic susceptibility in GBS isolates. Logistic regression analysis was performed on the data using SPSS version 26. It was deemed statistically significant when the p-value was 0.05 with a 95% confidence interval (CI). Results The overall prevalence of GBS was 16.9% (CI: 0.12-0.23). A history of prematurity of the membrane (AOR: 3.35, 95% CI: 1.19-9.45), a history of stillbirth (AOR: 2.88, 95% CI: 1.07-7.71), and preterm delivery history (AOR: 3.41, 95% CI: 1.31-8.89) (p 0.05) were independent predictors of GBS infection. Cefepime had the highest resistance at 58.3%. Most GBS isolates showed high susceptibility to vancomycin (97.2%) and ampicillin (91.7%). Multidrug resistance was 13.9%. Conclusion The prevalence of GBS was considerably high among pregnant women in this study. This finding emphasises the need for routine screening and testing of antimicrobial susceptibility to provide antibiotic prophylaxis and minimise newborn infection and comorbidity.
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Affiliation(s)
- Oliyad Husen
- Department of Medical Laboratory Science, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Moorthy Kannaiyan Abbai
- Department of Medical Laboratory Science, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Alqeer Aliyo
- Department of Medical Laboratory Science, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Deresse Daka
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tibeso Gemechu
- Department of Medical Laboratory Science, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Dagnamyelew Tilahun
- Department of Medical Laboratory Science, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Wako Dedecha
- Department of Medical Laboratory Science, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
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Dangor Z, Seale AC, Baba V, Kwatra G. Early-onset group B streptococcal disease in African countries and maternal vaccination strategies. Front Public Health 2023; 11:1214844. [PMID: 37457277 PMCID: PMC10338870 DOI: 10.3389/fpubh.2023.1214844] [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: 04/30/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Invasive group B streptococcal (GBS) disease is the commonest perinatally-acquired bacterial infection in newborns; the burden is higher in African countries where intrapartum antibiotic prophylaxis strategies are not feasible. In sub-Saharan Africa, almost one in four newborns with GBS early-onset disease will demise, and one in ten survivors have moderate or severe neurodevelopmental impairment. A maternal GBS vaccine to prevent invasive GBS disease in infancy is a pragmatic and cost-effective preventative strategy for Africa. Hexavalent polysaccharide protein conjugate and Alpha family surface protein vaccines are undergoing phase II clinical trials. Vaccine licensure may be facilitated by demonstrating safety and immunological correlates/thresholds suggestive of protection against invasive GBS disease. This will then be followed by phase IV effectiveness studies to assess the burden of GBS vaccine preventable disease, including the effect on all-cause neonatal infections, neonatal deaths and stillbirths.
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Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna C. Seale
- Bill and Melinda Gates Foundation, Seattle, WA, United States
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Vuyelwa Baba
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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