Abstract
Group B streptococcus (GBS) or Streptococcus agalactiae is an opportunistic pathogen that causes serious illness in newborns, pregnant women, and adults. However, insufficient detection methods and disease prevention programs have contributed to an increase in the incidence and fatality rates associated with this pathogen in non-neonatal patients. This study aimed to investigate factors of the observed increased incidence by investigation of serotype distribution, virulence factors, and antimicrobial susceptibility patterns from invasive GBS disease among non-neonatal patients in Thailand. During 2017–2018, a total of 109 S. agalactiae isolates were collected from non-pregnant patients. There were 62 males and 47 females, with an average age of 63.5 years (range: 20 – 96). Serotypes were determined by latex agglutination assay and multiplex polymerase chain reaction (PCR)-based assay. Among those isolates, seven virulence genes (rib, bca, pavA, lmb, scpB, cylE, and cfb) were detected by PCR amplification, and were determined for their susceptibility to 20 antimicrobial agents using a SensititreTM Streptococcus species STP6F AST plate. Among the study isolates, serotype III was predominant (52.3%), followed by serotype V and serotype VI (13.8% for each), serotype Ib (11.9%), and other serotypes (8.2%). Of the seven virulence genes, pavA was found in 67.0%. Except for one, there were no significant differences in virulence genes between serotype III and non-serotype III. Study isolates showed an overall rate of non-susceptibility to penicillin, the first-line antibiotic, of only 0.9%, whereas the resistance rates measured in tetracycline, clindamycin, azithromycin, and erythromycin were 41.3, 22.0, 22.0, and 22.0%, respectively. Strains that were resistant to all four of those drugs were significantly associated with non-serotype III (p < 0.001). Using multi-locus sequence typing (MLST), 40.0% of the four-drug-resistant isolates belonged to serotype VI/ST1, followed by serotype Ib/ST1 (35.0%). Cluster analysis with global GBS isolates suggested that the multiple drug-resistant isolates to be strongly associated with the clonal complex (CC) 1 (p < 0.001). Compared to the 2014 study of 210 invasive GBS isolates conducted in 12 tertiary hospitals in Thailand, the proportion of serotype III has dramatically dropped from nearly 90% to about 50%. This suggests that resistances to the second-line antibiotics for GBS might be the selective pressure causing the high prevalence of non-serotype III isolates.
Highlights
Group B streptococcus (GBS) or Streptococcus agalactiae is an opportunistic human pathogen that can cause invasive disease in neonates, pregnant women, and non-pregnant adults with chronic medical illness
During January 2017 to December 2018, all S. agalactiae strains isolated from the blood of non-pregnant patients aged not less than 3 years were collected at the Bacteriology Laboratory at the Department of Microbiology, Faculty of Medicine Siriraj Hospital, a large tertiary teaching hospital in Thailand
A total of 446 GBS isolates with different 150 sequence types (STs) was retrieved from the pubMLST database for categorical analysis
Summary
Group B streptococcus (GBS) or Streptococcus agalactiae is an opportunistic human pathogen that can cause invasive disease in neonates, pregnant women, and non-pregnant adults with chronic medical illness. GBS can transmit from the birth canal of colonized mothers during delivery or through aspiration of infected amniotic fluid. The mortality rate among neonates with GBS disease was reported to be as high as 55% (Dermer et al, 2004). GBS can be associated with post-partum infections that can lead to maternal bacteremia. To prevent mortality from neonatal GBS disease, guidelines for diagnosing maternal GBS colonization and prescribing antimicrobial prophylaxis have been introduced, and these guidelines have helped to reduce the mortality rate in neonatal GBS infection from 55% to approximately 5% (Puopolo et al, 2019). Another study reported a 70–90% decrease in the incidence of invasive GBS infection in infants aged 0–6 days (Rao et al, 2017)
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