Abstract
BackgroundStreptococcus agalactiae or group B Streptococcus (GBS) has been recognized as a lethal pathogen in neonates worldwide. S. agalactiae infections also severely affect pregnant women and immunosuppressed adults with substantial attributable morbidity and mortality. However, in Latin America, studies on the epidemiology and behaviour of S. agalactiae infections remain limited.MethodsTo better understand the behaviour of S. agalactiae infections in our region, we conducted a retrospective study to phenotypically describe S. agalactiae isolates collected in one of the largest hospitals in Colombia at two time periods: 1994–2001 and 2004–2012. The isolates were identified by biochemical analysis and tested for antimicrobial susceptibility.ResultsIn 1994–2001 a total of 201 S. agalactiae isolates were found in urine 38.3%, vaginal exudates 27.8%, soft tissue 12.9%, and blood 8.5%. Susceptibility to ampicillin or penicillin was 94% whereas resistance to erythromycin and clindamycin were 2.8% and 5.2% respectively. In total 46 culture-positive cases of invasive infections were reported, 11 (24%) in neonates and 35 (76%) in adults. In 2004–2012 a total of 671 isolates were found in urine 47.8%, vaginal exudates 32.6%, soft tissue 2.7% and blood 9%. Susceptibility rates to ampicillin and penicillin were 98% whereas resistance to erythromycin and clindamycin were 12.5% and 9.4%. A total of 95 severe infections were reported: 12 (12.6%) were in neonates, 5 (5.3%) in children and 78 (82.1%) in adults. Over the 17-year study period the averaged prevalence of invasive S. agalactiae isolates was 17.4%. The estimated incidence for neonatal infections was 1.34 per 1000 livebirths (0.99 × 1000 livebirths for early- onset disease and 0.35 × 1000 livebirths for late- onset disease) whereas for non-pregnant adults the estimated incidence was 0.75 × 1000 admissions.ConclusionsA remarkable increase in bloodstream infections in immunosuppressed adults and a shift to early neonatal S. agalactiae infections were seen over time. We also found an increase in S. agalactiae resistance to erythromycin and clindamycin during the study period, and the emergence of penicillin-nonsusceptible isolates. Our findings are consistent with the global trends described elsewhere, reinforcing the need for S. agalactiae control measures in our region.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-428) contains supplementary material, which is available to authorized users.
Highlights
Streptococcus agalactiae or group B Streptococcus (GBS) has been recognized as a lethal pathogen in neonates worldwide
Another raising concern is the potential emergence of tolerance to penicillin [13], the drug of choice for prophylaxis and therapy of S. agalactiae infections, and the resistance to clindamycin and erythromycin which are commonly used in patients with a history of beta-lactams allergy [8]
To better understand the behaviour of S. agalactiae infections in our region, we have described the epidemiological, clinical and microbiological characteristics of invasive and noninvasive S. agalactiae isolates from patients admitted to a tertiary care hospital in Colombia over a 17-year period
Summary
Streptococcus agalactiae or group B Streptococcus (GBS) has been recognized as a lethal pathogen in neonates worldwide. S. agalactiae infections severely affect pregnant women and immunosuppressed adults with substantial attributable morbidity and mortality. Streptococcus agalactiae (Group B Streptococcus, GBS) is a colonizing bacterium in the gastrointestinal and genitourinary tracts of healthy adults, in women [1,2,3]. Since 1970, S. agalactiae has been considered a very significant cause of severe neonatal infections with high morbidity and mortality. It affects pregnant women, non-pregnant adults with underlying conditions and the elderly [4]. The estimated mortality attributable to S. agalactiae severe infections in the elderly is more than 50% [11,12]. Another raising concern is the potential emergence of tolerance to penicillin [13], the drug of choice for prophylaxis and therapy of S. agalactiae infections, and the resistance to clindamycin and erythromycin which are commonly used in patients with a history of beta-lactams allergy [8]
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