Abstract
BackgroundGroup B Streptococcus (GBS) is a common commensal capable of causing severe invasive infections. Most GBS infections occur in neonates (often as pneumonia). GBS can also cause infection in adults with diabetes and other immunological impairments but rarely leads to pneumonia in adults. GBS has occasionally been found in the sputum of Cystic Fibrosis (CF) patients, an inherited condition known for progressive lung disease. However, the epidemiology and clinical significance of GBS in CF are not understood.MethodsWe retrospectively reviewed a large single-centre adult CF population with an associated comprehensive, prospectively collected bacterial biobank beginning in 1978. We identified all individuals with GBS isolated from their sputum on at least one occasion. The primary outcome was risk of pulmonary exacerbation (PEx) at the time of the first GBS isolate compared to the preceding visit. Secondary outcomes included determining: prevalence of GBS infection in a CF population, whether GBS infections where transient or persistent, whether GBS strains were shared among patients, change in % predicted FEV1 at the time of GBS isolate compared to the preceding visit, PEx frequency after the first GBS isolate, change in % predicted FEV1 after the first GBS isolate, and complications of GBS infection.ResultsGBS was uncommon, infecting 3.5% (11/318) adults within our cohort. Only three individuals developed persistent GBS infection, all lasting > 12 months. There were no shared GBS strains among patients. PEx risk was not increased at initial GBS isolation (RR 5.0, CI 0.69–36.1, p=0.10). In the two years preceding initial GBS isolation compared to the two following years, there was no difference in PEx frequency (median 2, range 0–4 vs 1, range 0 to 5, respectively, p=0.42) or lung function decline, as measured by % predicted FEV1, (median −1.0%, range −19 to 7% vs median −6.0%, range −18 to 22%, p=0.86). There were no invasive GBS infections.ConclusionIn adults with CF, GBS is uncommon and is generally a transient colonizer of the lower airways. Despite the presence of structural lung disease and impaired innate immunity in CF, incident GBS infection did not increase PEx risk, PEx frequency, rate of lung function decline, or other adverse clinical outcomes.
Highlights
Group B Streptococcus (GBS) is a common commensal capable of causing severe invasive infections
GBS prevalence and cohort characteristics Thirty GBS isolates were identified within the biobank from 11 individuals (Table 1)
We reviewed 318 Cystic Fibrosis (CF) patients for GBS, this is still a relatively small population to investigate an uncommon organism in a rare disease
Summary
Group B Streptococcus (GBS) is a common commensal capable of causing severe invasive infections. GBS has occasionally been found in the sputum of Cystic Fibrosis (CF) patients, an inherited condition known for progressive lung disease. Cystic Fibrosis (CF) is an inherited autosomal recessive condition that can affect multiple organs but is best recognized for chronic and progressive lung disease [1]. Dysfunction of the CFTR (cystic fibrosis transmembrane conductance regulator) protein channel, found primarily on epithelial cell surfaces, leads to abnormal chloride ion secretion [1]. This results in viscous mucus leading to ductal and luminal plugging in respiratory, gastrointestinal, and reproductive organs [1]. In contrast to GAS, the role of another hemolytic Streptococci, Streptococcus agalactiae (Group B Streptococcus (GBS), has not been investigated in CF
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