241. Molecular patterns of Streptococcus agalactiae (GBS) Strains Associated with Different Clinical Syndromes: Early-Onset Disease in Neonates, Intrauterine Infection, and Vaginal Colonization, an Orthodox Jewish Community (OJC) Residing in Bney Brak

Abstract

BackgroundRectovaginal colonization during pregnancy with Group B Streptococcus (GBS) is a risk factor for early neonatal sepsis, and may also cause chorioamnionitis and fetal death. In Israel, the reported colonization rate in pregnant women is low, and therefore routine screening of pregnant women for GBS colonization is not recommended. We noticed higher rates of early-onset disease (EOD) due to GBS in newborns of women hospitalized in Maayaney Hayeshua Medical Center, which serves an Orthodox Jewish Community (OJC) in Israel. Therefore, our aim was to investigate molecular patterns of GBS strains from mothers and neonates hospitalized in Maayaney Hayeshua.MethodsDuring 2017, GBS isolates were collected from asymptomatic pregnant women (280/1,074), neonates with EOD (n = 7), and intrauterine fetal death remains (IUFD) (n = 7). We serotyped isolates from vaginal carriage (n = 203), EOD (n = 7), IUFD (n = 7) and EOD isolates obtained from the Ministry of Health (n = 11). Multilocus sequence typing (MLST) was performed on isolates from asymptomatic pregnant women (n = 14), EOD (n = 7) and IUFD (n = 7). Antibiotic susceptibilities were determined.ResultsGBS carriage rate was 26.1%. In asymptomatic pregnant women the dominant serotype was VI [84 women (41.3%)], followed by III, IV and V in 32 (15.7%), 23 (11.3%) and 21 (10.3%) women, respectively. The dominant serotype in EOD was III [15/18 (83.3%)] and in IUFD VI [5 (71.4%)]. ST-17 was expressed mainly by serotype III, and was associated with EOD. ST-1, expressed mainly by serotype VI, was associated with IUFD. See Tables 1 and 2 and Figure 1. Resistance to erythromycin and clindamycin was 19.3% and 18.2% while resistance in invasive isolates was 45.5% to both antibiotics.ConclusionGBS vaginal colonization rate in an OJC was significantly higher than the reported carriage rate of 21.6% reported in Israeli pregnant women. Serotypes VI was dominant in carriage and in cases of IUFD while EOD was exclusively associated with serotype III. Resistance rates to erythromycin clindamycin were high, particularly in invasive disease. These results advocate routine GBS screening in this population and caution against empirical treatment with macrolides or clindamycin in penicillin-allergic women. Disclosures All authors: No reported disclosures.