Abstract
BackgroundAlthough Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults. The relation between its presence in the genitourinary tract and manifested clinical symptoms of STD patients remains an open question. In this study, a complex epidemiological investigation of GBS isolates from a venerology clinic was performed.MethodsNinety-six GBS isolates were serotyped and their genetic relatedness determined by PFGE. MLST was also performed for a subset of 20 isolates. The antibiotic susceptibility was tested with agar dilution. Surface proteins and the ST-17 hypervirulent clone was detected by PCR.ResultsThe serotype prevalence was the following: V (29.2%), III (27.1%), Ia (22.9%), IV (10.4%), II (5.2%) and Ib (4.2%). A strong association was demonstrated between surface protein genes and serotypes. All isolates were fully susceptible to penicillin, but erythromycin and clindamycin resistance was high (41.7 and 35.4%, respectively), and 8 phenotypically macrolide sensitive isolates carried the ermB gene.21.9% of all strains belonged to the hypervirulent ST17 clone, most being of serotype III and all were rib +. We found a few serotype IV isolates belonging to several STs and one serotype V/ST110 strain, containing a 44-bp deletion in the atr allele.ConclusionsThe presence of silent ermB genes is of worry, as their expression upon macrolide exposure could lead to unforeseen therapeutic failure, while clindamycin is used for intrapartum antibiotic prophylaxis, in case of penicillin allergy. The other alarming result is the high prevalence of ST17 among these strains from STD patients, who could be sources of further infections.This is the first report from Hungary providing both serotyping and genotyping data of GBS isolates. These results could be helpful for vaccine production as the major vaccine candidates are capsular antigens or surface proteins.
Highlights
Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults
Antibiotic susceptibility All isolates were fully susceptible to penicillin, and only three isolates were resistant to levofloxacin and moxifloxacin (Table 1)
We found one serotype IV isolate, which belonged to the Sequence type (ST)-291 clone, which differs only in a single nucleotide in the pheS allele compared to ST-17, is a member of the Clonal complex (CC)-17 clonal complex
Summary
Streptococcus agalactiae is the leading causative agent of neonatal sepsis and meningitis, recently it is increasingly isolated from non-pregnant adults. Streptococcus agalactiae (or group B streptococcus, GBS) was for long thought to be an animal pathogen especially responsible for mastitis of cows, since the 1970’s it has been known as the leading pathogen of neonatal sepsis and meningitis [1, 2] Still, nowadays, it ranks as the number one infectious cause of neonatal mortality in developed countries [3]. Colonization becomes more frequent in late adolescence and it can reach 10– 40% among pregnant women [4] The presence of this bacterium in the genital flora during pregnancy is the predominant risk factor for the development of invasive neonatal disease [5]. The latter diseases are rarer, but are associated with high mortality: case fatality is considerably higher in adults than in neonates [7, 9, 10]
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