Abstract
Background: Streptococcus agalactiae (also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases. Methods: From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia. Results: During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, n = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes. Conclusions: a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.
Highlights
IntroductionStreptococcus agalactiae ( known as group B streptococcus, GBS) is the most important and leading pathogen that causes bacterial meningitis in neonates [1,2]
Streptococcus agalactiae is the most important and leading pathogen that causes bacterial meningitis in neonates [1,2]
Recent studies have found that the incidence of GBS early-onset disease (EOD, disease occurring within the first week of life) decreases, but GBS late-onset disease
Summary
Streptococcus agalactiae ( known as group B streptococcus, GBS) is the most important and leading pathogen that causes bacterial meningitis in neonates [1,2]. Neonatal GBS meningitis causes a high mortality rate and results in neurological complications and long-term neurodevelopmental sequelae [10,11,12,13]. Most studies regarding invasive GBS diseases or meningitis focus on the epidemiology, molecular characteristics, antifungal susceptibility and outcomes [3,4,5,6,7,8]. Little is known about the clinical and microbiological characteristics of complicated GBS sepsis, including cases of meningitis and severe sepsis with/without septic shock [13,14]. Streptococcus agalactiae ( known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. Type III/ST-17 GBS isolates accounted for 56.5%
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