Abstract
Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
Highlights
Group B streptococcus (GBS) is a leading cause of sepsis and meningitis in young infants worldwide [1]
If breast milk contamination is confirmed, offer eradication treatment with oral rifampicin for 5 days and retesting invasive GBS disease (iGBS) With Recurrence and in Multiples and fluctuations in host immunity (Figure 1)
As indicated by the low interval of iGBS in affected multiples, GBS can – probably clonally – deviate from its usually colonizing traits and become highly invasive, spreading across inter-individual boundaries. This occurs with remarkable frequency, i.e. in a sixth of multiple births in which one infant has iGBS
Summary
Group B streptococcus (GBS) is a leading cause of sepsis and meningitis in young infants worldwide [1]. In 2015, over 300 000 cases of invasive GBS disease (iGBS) caused 90 000 deaths in infants < 90 days of age [2] and neurodevelopmental impairment in over 10 000 children [3]. IGBS is divided into early-onset sepsis (EOS), with disease onset – depending on the definition – either in the first 3 or 6 days, and late-onset sepsis (LOS) occurring thereafter and before day 90. Maternal GBS colonization can lead to EOS via vertical transmission at or before birth through ruptured membranes [4]. Prematurity and maternal colonization increase the risk of LOS [7]. Since colonization may precede invasive infection [9]
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