Early-onset Group B Streptococcus Infection Research Articles

Antibiotic Prevention for Maternal Group B Streptococcal Colonization on Neonatal GBS-Related Adverse Outcomes: A Meta-Analysis.

Maternal colonization with group B Streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. However, it remains unclear whether treating all colonized women during labor exposes a large number of their neonates to possible adverse effects without benefit. We performed a meta-analysis to assess the effect of intrapartum antibiotic prophylaxis on neonatal adverse outcomes. We identified studies by searching several English and Chinese electronic databases and reviewing relevant articles. Data were pooled using fixed-effects or random-effects meta-analysis, and for each outcome both risk ratio (RR) and 95% confidence intervals (95% CIs) were calculated. Fourteen studies (2,051 pregnant women and 2,063 neonates) were included, comprising 13 randomized clinical trials and 1 cohort study. Antibiotic prophylaxis is associated with a significant reduced risk of all cause infections (RR = 0.28, 95% CI = 0.18–0.42), GBS infection (RR = 0.24, 95% CI = 0.13–0.44), early-onset GBS infection (RR = 0.24, 95% CI = 0.13–0.45), non-GBS infections (RR = 0.34, 95% CI = 0.20–0.59), and GBS colonization (RR = 0.10, 95% CI = 0.06–0.16). But no significant reduction was observed in late-onset GBS infection, mortality from early-onset GBS infection or from non-GBS infections. Notably, no significant differences were found between ampicillin and penicillin prevention for neonatal adverse outcomes. Our findings suggest that antibiotic prophylaxis is effective in reducing neonatal GBS colonization and infection.

Late Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?

We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.

Reductions in neonatal listeriosis: “Collateral benefit” of Group B streptococcal prophylaxis?

We tested the hypothesis that declines in Listeria monocytogenes in infants are related to declines in rates of early-onset Group B Streptococcus (GBS) infections associated with widespread prophylaxis using agents with Listeria activity. We performed a retrospective cohort analysis using a national administrative database Pediatric Health Information System (PHIS). We searched for ICD-9 codes for Listeriosis in infants <30 days old and for early-onset GBS infection of any kind in infants <5 days old during the study period. We identified 183 cases of Listeriosis in infants <30 days in the PHIS database from 1992 to 2013. We noted a statistically significant decline in case rates over the years studied: 4.78 cases per 10,000 admissions (1992-1995) to 2.24 (1996-2002) to 1.31 from (2003-2013) (p < 0.0001). Case rates of early-onset GBS dropped significantly over the study period: 30.10 cases per 1000 admissions (1992-1995) to 21.70 (1996-2002) to 18.57 (2003-2013) (p < 0.0001). There was a statistically significant correlation between yearly rates of Listeriosis and early-onset GBS (rho: 0.53; p = 0.01). These results support the hypothesis of a "collateral benefit" to widespread GBS prophylaxis and further support the position that empiric antibiotic regimens for febrile infants may no longer require Listeria activity.

Incidence and serotype distribution of invasive group B streptococcal disease in young infants: a multi-country observational study.

BackgroundGroup B Streptococcus (GBS) is a leading cause of serious infection in very young infants. Robust incidence data from many geographic regions, including Latin America and Asia, are however lacking.MethodsA multicenter, hospital-based observational study was performed in Panama, Dominican Republic, Hong Kong and Bangladesh. All represented urban, tertiary referral hospitals, except Bangladesh. GBS cases (microbiological isolation from normally sterile sites in infants aged 0–89 days) were collected over 12 months.ResultsAt 2.35 (95 % CI: 1.74–3.18) cases per 1000 live births, the incidence of early onset GBS disease (EOD) was highest in the Dominican Republic, compared with 0.76 (95 % CI: 0.41–1.39) in Hong Kong and 0.77 (95 % CI: 0.44–1.35) in Panama, while no cases were identified in Bangladesh. Over 90 % of EOD cases occurred on the first day of life, with case fatality ratios ranging from 6.7 % to 40 %, varying by center, age of onset and clinical presentation. Overall, 90 % of GBS (EOD and late onset disease) was due to serotypes Ia, Ib and III.ConclusionsThe incidence rate of early onset GBS infection reported in Dominican Republic was not dissimilar from that described in the United States prior to screening and intrapartum antibiotic prophylaxis, while the incidence in Hong Kong was higher than previously reported in the Asian region. The failure to identify GBS cases in Bangladesh highlights a need to better understand the contribution of population, healthcare and surveillance practice to variation in reported incidence. Overall, the identified disease burden and serotype distribution support the need for effective prevention methods in these populations, and the need for community based surveillance studies in rural areas where access to healthcare may be challenging.

Prevention of neonatal group B streptococcal infections

Group B streptococcal infections (GBS) are the leading cause of sepsis, pneumonia and meningitis in infants during the first three months of life. GBS infections presenting within the first week of life are designated early-onset diseases, and those affecting infants between one week and three months - late-onset diseases. Intrapartum intravenous administration of antibiotics to women at high risk of transmitting the microorganism to the infants is currently considered the most effective method of prevention of early-onset GBS infections, and universal screening for GBS in late pregnancy - as the most effective method to detect women to whom antibiotic prophylaxis is indicated. Vaccination of pregnant women appears to be a promising approach to prevent both early- and late-onset GBS infections in infants, as well as GBS-associated diseases in women.

Current Status of Vaccine Development for Group B Streptococcus

The incidence of neonatal early-onset sepsis due to group B Streptococcus (GBS) has decreased with the use of intrapartum antibiotic prophylaxis, but GBS infection remains a significant clinical concern. Early-onset disease still occurs among term infants born to women falsely screened GBS-negative, and premature infants still disproportionately suffer from both early-onset and late-onset GBS infection. In addition, there is no current strategy for preventing GBS disease among elderly and immunocompromised, nonpregnant adults. The development of GBS vaccines with efficacy across serotypes may address many of the clinical gaps left by GBS intrapartum antibiotic prophylaxis. Multiple preclinical and human phase I studies have been completed demonstrating the safety and immunogenicity of candidate glycoconjugate GBS vaccines. Phase III vaccine trials are needed to determine the clinical efficacy of maternal and nonpregnant adult vaccination.

PLD.33 Intrapartum antibiotic prophylaxis against early onset Neonatal Group B Streptococcal (GBS) sepsis in women known to be colonised; how good are we?

ObjectivesEvaluate practice in tertiary care obstetric unit on the prevention of early-onset neonatal GBS disease.BackgroundThe single most important risk factor for early-onset GBS infection is maternal colonisation leading to fetal...

Unexplained Benefits of Antibiotics in Childhood: Empiricism in Need of Enlightenment

Infections remain relentless causes of morbidity and mortality, particularly in the developing world. Pneumonia, diarrhea, and malaria kill 3.5 million, 2.5 million, and 655 000 people annually, respectively, and disproportionately injure children less than 5 years of age [1]. Any reduction in thisburdentochildrenshouldbewelcomed. In this issue of The Journal of Infectious Diseases, Gilliams et al [2] report that by adding azithromycin to chloroquine to treat childhood malaria, the incidences of subsequent respiratory and gastrointestinal infections are lowered, and times to next pulmonary and diarrheal illness are prolonged. For every 7 children treated with chloroquine-azithromycin for malaria, 1 case of respiratory-tract infection and 1 case of gastrointestinal-tract infection were apparently averted. This work extends prior efforts in Ethiopia, demonstrating that mass azithromycin treatment for trachoma reduced all-cause and infectious childhood mortality [3] and that azithromycin was associated with reduced mortality in a cluster-randomized trial for trachoma control [4]. The data of Gilliams et al also complement those of Trehan et al, who demonstrated a 40% reduction in mortality in Malawian children by adding amoxicillin or cefdinir to readyto-use therapeutic food regimens for the outpatient treatment of acute severe malnutrition [5]. Why might the addition of azithromycin to chloroquine reduce gut and respiratory infections? It is possible that the illnesses averted in the azithromycin antibiotic group were, in reality, unusual presentations of malaria [6, 7]. However, these children had no smear evidence of malaria when they had these gut and lung infections, making this explanation less likely. Alternatively, the azithromycin could have fortuitously inhibited growth of a specific pathogen acquired by a susceptible child before or during the course of the antibiotic treatment, thereby prohibiting pathogen population expansion or preventing colonization. The nonplasmodial, nonchlamydial target(s) of azithromycin in this cohort might have been Streptococcus pneumoniae, Haemophilus influenzae, Salmonella typhi, nontyphoidal salmonella, other gramnegative bacilli, group B streptococcus, and even mycobacteria, based on studies of childhood sepsis in Africa [8–13]. Another potential explanation for the success of azithromycin is that it altered the host’s commensal microbial population such that a yet to be encountered pulmonary or intestinal pathogen did not take hold. Finally, azithromycin might have had a nonspecific antiinflammatory effect that ameliorated the manifestations of illnesses that resemble lower-respiratory-tract infections or gastroenteritis [14]. There are precedents for antibiotics conferring unintended benefits. For example, 4 decades ago, Steigman et al, at Mount Sinai Hospital in New York, reported the complete absence of earlyonset group B Streptococcus (GBS) infections in their newborns, which they associated with universal use of intramuscular penicillin to prevent opthalmia neonatorum [15].They stated “ . . . we believe there is an urgent need to encourage appropriate, carefully designed prospective alternate case studies in order to determine whether a serendipitous observation can or cannot prevent deaths due to early-onset invasive GBS disease. . . . ” Intrapartum antibiotic prophylaxis of women, prompted by controlled studies and guided by diagnostic microbiology [16], is now established as an intervention to reduce the morbidity and mortality of early-onset GBS infections [17]. Sometimes the benefit of antibiotics is demonstrated before the etiology of a disease is Received 28 February 2014; accepted 13 March 2014; electronically published 20 March 2014. Correspondence: Lori R. Holtz, MD, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8208, St. Louis, MO 63110 (holtz_l@kids.wustl.edu). The Journal of Infectious Diseases 2014;210:514–6 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com. DOI: 10.1093/infdis/jiu172

Do we need a different approach to GBS screening?

Group B Streptococcus (GBS) infections remain an important cause of perinatal complications, despite advanced preventive measures. The most common clinical symptoms of early-onset disease, diagnosed in neonates up to 7 days of life, are sepsis and pneumonia. Late-onset disease is diagnosed in children between 7 and 89 days of life and presents also in forms of other infections. As a result of collaborative efforts of clinicians, researchers and many organizations, various recommendations for intrapartum prevention of perinatal GBS disease have been issued so far. Revised 2002 CDC guidelines for the prevention of early-onset GBS disease recommended universal culture-based screening of all pregnant women at 35-37 weeks of gestation to optimize the identification of those who should receive intrapartum antibiotic prophylaxis (IAP). They were customized by the Polish Gynecological Society and applied in Poland as well. As a result of preventive efforts worldwide, global incidence of GBS infections has declined dramatically over the past 15 years. About 10-30% of pregnant women are colonized with Group B Streptococcus. According to the literature, GBS culture at 35 to 37 weeks of gestation has about 95% negative predictive value for the absence of colonization at the time of labor. However, studies reporting early-onset GBS disease in newborns found that about 60 to 80% of all cases occurred in neonates with negative maternal screening during pregnancy. If the only available screening test is vagino-rectal swab during pregnancy about 7.5% of women with GBS colonization during labor are not administered IAP. It seems optimal to perform routine screening not during pregnancy but directly before the delivery--preferably at the time of regular uterine contractions or the rupture of membranes. As the screening test should be widely accessible and rapid, the usual microbiological culture is not a suitable option. Recently new biochemical and genetic methods have become available. Polymerase chain reaction (PCR) and optical immunoassay are candidates for rapid patient intrapartum GBS testing to determine whether women in labor are colonized with GBS. PCR tests have the sensitivity of over 90% with the specificity of 99%, which is about 13% higher than microbiological culture. According to the literature, IAP does not reduce the overall neonatal mortality mortality due to GBS infection, or due to other bacterial infections. The incidence of early-onset GBS infection was reduced with IAP in comparison to no intrapartum prophylaxis, but there was no difference in late-onset GBS disease occurrence. Besides GBS, IAP may influence maternal and neonatal infections caused by other pathogens. Moreover, it can also induce GBS and no-GBS pathogen resistance to antibiotics. It therefore seems necessary to replace the current type of GBS screening with GBS DNA PCR intrapartal test--a rapid, highly sensitive and specific method of carrier identification--in order to optimize IAP and, eventually to decrease the rate of early onset GBS disease in neonates.

489: Repeat antepartum GBS screening: a cost-effectiveness analysis

Group B streptococcus (GBS) is a leading cause of neonatal infectious morbidity and often occurs secondary to perinatal transmission from GBS-colonized mothers. Current CDC guidelines recommend single GBS screening at 35-37 weeks to guide intrapartum prophylaxis against GBS transmission. However, neonatal GBS infections still occur from mothers with an initial negative antepartum culture. Thus, our goal was to evaluate whether repeat GBS screening in term pregnancies is a cost-effective strategy compared to current guidelines to prevent neonatal early onset GBS infections.

Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: A review of national guidelines

Maternal colonisation with group B streptococcus (GBS) is recognised as the most frequent cause of severe early onset infection in newborns. National and international guidelines outline two approaches to the prevention of early onset disease in the neonate: risk based management and antenatal culture-based screening. We undertook an analysis of existing national and international guidelines in relation to GBS in pregnancy using a standardised and validated instrument to highlight the different recommended approaches to care. English language guidelines on the screening and management of GBS colonisation in pregnant women and the prevention of early-onset group B streptococcal disease in newborns were sought. Four guidelines met the inclusion criteria, one from the United States of America (USA), the United Kingdom (UK), Canada and New Zealand. All four were appraised as at a high standard in terms of development using the AGREE II tool. Both approaches were recommended in the guidelines with different regions of the world advocating different approaches often based on the same evidence. Guidelines from the USA recommend an antenatal culture-based approach while the UK guidelines recommend risk-based management. Based on an AGREE II analysis, the standard of the guidelines was high despite having disparate recommendations. Both approaches to the prevention of early onset GBS infection in neonates are recommended with the split being geographically-based.

Maternal Antibody at Delivery Protects Neonates From Early Onset Group B Streptococcal Disease

Further reduction in the group B streptococcal (GBS) disease burden in neonates in the United States awaits an additional prevention strategy, such as maternal immunization. We performed a prospective, multicenter, case-control study of 33 mothers delivering neonates with early onset GBS infection (cases), and 99 age- and ethnicity-matched mothers colonized with the same capsular polysaccharide (CPS) types delivering healthy neonates (controls). Relative risk and absolute risk were calculated for early onset disease associated with concentrations of type Ia, III, or V CPS-specific antibody in maternal serum. For GBS types Ia and III, maternal CPS-specific antibody concentrations of ≥ 0.5 µg/mL were associated with a relative risk of approximately 0.1 (95% confidence intervals [CIs], .01-.74 and 0-.72, respectively; P = .02 for each), corresponding to a 90% risk reduction (by logistic regression). For type V, the relative risk was 0.3 (95% CI, .01-3.1), corresponding to a 70% risk reduction. By Bayesian modeling, the risk of early onset disease would decrease by 70% if maternal CPS-specific antibody concentrations for these 3 GBS types were ≥ 1 µg/mL. Maternal CPS-specific antibody serum concentrations of ≥ 1 μg/mL at the time of delivery appear to protect most neonates from early onset GBS type Ia and III disease.

Neonatal purpura fulminans manifestation in early-onset group B Streptococcal infection

Patient: Male, 0Final Diagnosis: Purpura fulminansSymptoms: Fever • letargyMedication: —Clinical Procedure: —Specialty: Pediatrics and NeonatologyObjective:Rare diseaseBackground:Neonatal purpura fulminans (PF) is a rare but frequently fatal disorder associated with high morbidity and mortality. It may be congenital, as a result of protein C and S deficiency, or acquired due to severe infection. Gram-negative organisms and Staphylococcus species are the most common causes of the acute infectious type, and a few cases of causative neonatal group B Streptococcus (GBS) disease have been reported worldwide.Case Report:We present a full-term male neonate with purpura fulminans secondary to early-onset group B streptococcal (GBS) infection. The mother brought the infant to the emergency department at the age of 43 hours of life, with fever (39.5°C) and lethargy. Neonatal sepsis was suspected, and he was immediately started on intravenous ampicillin and gentamicin. The initial workup revealed disseminated intravascular coagulopathy, and both blood and CSF cultures grew GBS. He had normal levels of protein C and protein S for his age. The infant died 48 hours after admission due to multiorgan system failure despite aggressive neonatal intensive care support.Conclusions:Neonatal PF secondary to early-onset GBS infection is a fatal condition that should not be missed. Screening pregnant women for GBS colonization and use of protocols for preventing perinatal GBS infection is considered the most important preventive measure of this fatal condition, especially among Saudi women, who have a relatively high rate of GBS infection.

Evaluation of intrapartum antibiotic prophylaxis for the prevention of early-onset group B streptococcal infection

We retrospectively assessed the medical records of pregnant women who delivered at Asahikawa Kosei Hospital during a period of 3years between January 2009 and December 2011 and their neonates. Our prophylactic measures against group B Streptococcus (GBS) infection are based on the Japanese guidelines. More specifically, we performed screening by examining bacterial cultures of vaginal-perianal swabs from pregnant women between gestational weeks 33 and 37. Then, sulbactam/ampicillin (SBT/ABPC) was given at a dose of 1.5g through a drip intravenous infusion at delivery if pregnant women were screened positive for GBS. For neonates born to GBS carrier women, bacterial cultures of pharyngeal swabs, vernix caseosa, stool, and gastric juice were performed at birth. There were 2,399 deliveries and 2,499 births at our hospital. In 169 of the deliveries (175 of the births), GBS was isolated from specimens obtained from gestational weeks 33-37. According to delivery mode, there were 42 cases of cesarean section (45 births) and 127 cases of vaginal delivery (130 births). The GBS-positive neonates accounted for 4.1% of all deliveries in pregnant women who tested positive for GBS at gestational weeks 33-37. In neonates born by vaginal delivery, the GBS-positive rate was 5.5%. Of the 2,499 neonates born at our hospital during a period of 3years, early-onset GBS infection occurred in 1 neonate. The incidence of early-onset GBS infection was 0.40 per 1,000 live births. From 1997 to 2001 (routine GBS screening of mothers was not performed), there were 2,097 deliveries and 2,166 births. Early-onset GBS infection occurred in 1 neonate during this period; thus, the incidence of early-onset GBS infection was 0.46 per 1,000 live births. There were no significant differences in the two periods. The present prophylactic measures such as screening of maternal GBS carriers and intrapartum antibiotic administration are inadequate to decrease the occurrence of early-onset GBS infection.

Prevention of neonatal group B streptococcus disease in the 21st century

There have been significant reductions in early-onset neonatal group B streptococcus (GBS) disease following implementation of maternal intrapartum antibiotic prophylaxis (IAP) policies. Nevertheless, GBS remains a leading cause of neonatal sepsis in Australia and New Zealand resulting in considerable morbidity and mortality, particularly among preterm infants. In the United States, the universal screening-based approach for identifying women for IAP results in apparently lower rates of early-onset neonatal GBS infection than risk-based assessment. In addition, IAP has altered the profile of newborn infants who develop early-onset disease. Many affected infants lack the typical intrapartum risk factors for GBS infection, are born to mothers with a negative GBS screen or represent missed opportunities for prevention. Clinicians should remain alert for signs of sepsis in any newborn infant. We provide an update of GBS preventative management strategies in the perinatal period taking into account recent United States, Australian and New Zealand guidelines.

Variation in erythromycin and clindamycin resistance patterns between New Zealand and Australian group B streptococcus isolates

Intrapartum chemoprophylaxis for group B streptococcus (GBS) carriers reduces the risk of early-onset neonatal GBS infection. For women with β-lactam allergy, either erythromycin or clindamycin are administered. Recent reports worldwide suggest that GBS resistance to these antibiotics is increasing. To compare erythromycin and clindamycin resistance phenotypes in invasive neonatal GBS isolates across New Zealand and Australia over the past two decades and to determine whether regional variation in resistance patterns exist. Invasive neonatal GBS isolates were collected from laboratories across New Zealand (n=107) and Australia (n=74) over two time periods (1992-1994 and 2002-2004 in New Zealand; 1982-2001 and 2002-2006 in Australia) and subjected to standard antibiotic susceptibility testing. A nested sub-study in New Zealand examined antibiotic susceptibilities of 112 maternal colonising GBS isolates during 2003-2004. Erythromycin resistance among invasive neonatal GBS isolates increased across both countries over the past decade, with similar rates of resistance in New Zealand (9%) and Australia (6%) in recent years. New Zealand erythromycin-resistant GBS isolates commonly displayed cross-resistance to clindamycin. Also, there were significantly higher rates of isolated clindamycin resistance in GBS isolates from New Zealand than Australia (P=0.034). Maternal GBS isolates from New Zealand showed similar resistance patterns to neonatal isolates. Erythromycin and clindamycin resistance among invasive neonatal GBS isolates has emerged in both New Zealand and Australia over the past decade and is consistent with global trends in GBS resistance patterns. Although regional variations exist, these findings should be considered when implementing intrapartum GBS prevention strategies.

A Four-week-old Infant With an Intracardiac Mass

A Four-week-old Infant With an Intracardiac Mass

Detection of maternal colonization of group B streptococcus in late pregnancy by real-time polymerase chain reaction and its effect on perinatal outcome

To study the sensitivity of the real-time polymerase chain reaction (RT-PCR) in detecting group B streptococcus (GBS) in late pregnant women and the influence of vaginal/rectal GBS colonization on maternal and neonatal outcomes. Microbiological culture and RT-PCR for GBS were both performed for each sample taken from the vagina and rectus in 617 gravidas at 35-37 weeks of gestation, with an average age of 30.1, among which 80 aged over 35. Forty-one out of the 617 women were multiparous and 576 primiparous. The laboratory results were collected and the pregnant outcomes were followed. (1) Out of the 617 gravidas, 21 (3.4%) were GBS positive by culture (all positive in RT-PCR) and 57 (9.2%) were GBS positive by RT-PCR. Thirty-six cases with PCR positive but culture negative results were analyzed by sequencing, and 34 showed GBS positive and 2 negative. (2) The sensitivity and specificity of RT-PCR was 100% (55/55) and 99.6% (560/562) respectively. (3) The average age of GBS positive gravidas was 30 ± 4, without significant difference compared with that of GBS negative women (31 ± 4), P > 0.05. The GBS positive rates were also similar between the primiparas and the multiparous [7.3% (3/41) vs. 9.4% (54/576)], between elderly women and those under the age of 35, and between those women who had abortions over and less than 3 times (all P > 0.05). (4) No significant difference was found in the cesarean section rate between the GBS positive and negative group [54.4% (31/57) vs. 44.6% (250/560), P > 0.05]. (5) Compared with the GBS negative group, the GBS positive group had higher incidence of intrauterine infection [6.6% (37/560) vs. 15.8% (9/57)], postpartum hemorrhage (2.9% vs. 10.5%) and fetal distress (25.9% vs. 38.6%) all P < 0.05, but had similar incidence of premature rupture of membranes [25.0% (140/560) vs. 33.3% (19/57)], preterm birth and meconium-stained amniotic fluid. (6) The neonatal infection rate in the GBS positive group was significantly higher than that of the GBS negative group [29.8% (17/57) vs. 13.2% (77/560), P < 0.05]. One neonate in the GBS positive group developed early-onset severe GBS infection and achieved better outcome under proper treatment. Maternal GBS carrier at 35-37 weeks of gestation can lead to adverse pregnant outcomes by increasing the incidences of intrauterine infection and neonatal infections. However, RT-PCR could be a routine method to detect GBS status in late pregnant women with its higher sensitivity and specificity.

小児におけるB群溶連菌感染症の臨床的検討

We evaluated 12 children infected with group B Streptococcus (GBS) at Asahikawa Kosei Hospital, in Japan between 1998 and 2007. The diagnosis was bacteremia in 8 and meningitis in 4. Infection occurred before day 7 in 3 patients, between days 7 and 28 in 4, and between days 29 and 131 in 5. The incidence of early onset GBS infection was 0.4 cases/1,000 live births. Four of 11 mothers were found to have GBS in antenatal culture screening. Although 2 underwent intrapartum antibiotic prophylaxis, infants suffered GBS infection. No patients with GBS infection died, but sequelae seen in 3 patients involved epilepsy and developmental delay of varying severity. The most frequent serotypes were III in 7 patients, followed by Ia in 2, Ib in 2, and II in 1. The MIC90 was 0.015 microg/mL in panipenem and imipenem, 0.03 microg/mL in meropenem, 0.06 microg /mL in cefotaxime and ceftriaxone, and 0.12 microg/mL in ampicillin. Serotypes and MICs were measured in 28 strains from pregnant women, 11 from newborns, 19 from children, and 30 from adults between May 2007 and December 2008. The frequency of serotype III in patients with GBS infection was significantly more than that in pregnant women or adults (p < 0.05). The MIC90 in these strains was the same as those of patients with GBS infection.

Group B streptococcal disease in Portuguese infants younger than 90 days

Background:Group B streptococcus (GBS) is the most common isolate in mother-related infection in newborns.Aims:To evaluate the epidemiology of GBS infection in the first 90 days after birth; to determine if...