Incidence Of Group B Streptococcus Research Articles

Neonatal Group B Streptococcus infection at a single center in Al-Madinah Al-Munawarah, Saudi Arabia.

To determine the occurrence of Group B Streptococcus (GBS) infection in neonates and its associated risk factors in Al-Madinah Al-Munawarah, Saudi Arabia. This retrospective study was carried out at the Maternity and Child Hospital in Al-Madinah Al-Munawarah, between 2017-2022. The laboratory and clinical data of 64 neonates were collected and analyzed using GraphPad Prism 7 software. Out of 16,022 neonates admitted to the nursery, 64 infants were diagnosed with GBS infection. Approximately 53.1% were male, 46.9% female, 15.6% were preterm, and 84.4% were full-term. Vaginal births accounted for 71.9%. The mean onset age was 10±12.4 days. Among the GBS patients, 53.1% had early-onset disease (EOD, 0-6 days), while 46.9% had late-onset disease (LOD, 7-90 days). Unexamined mothers had a higher incidence of GBS and EOD newborns (p=0.05). Meningitis was more common in LOD than EOD patients and correlated with illness onset (p=0.05). Early-onset disease patients had a higher incidence of sepsis. The mortality rate was 10.9%, while 89.1% were discharged from the hospital. Neonatal GBS infection is prevalent in Al-Madinah Al-Munawarah. Several risk factors may contribute to the occurrence of GBS infection including preterm labor, higher body temperature during delivery, prolonged premature rupture of membranes for more than 18 hours, and GBS bacteriuria. We recommend that larger multi-centric studies are needed in Al-Madinah Al-Munawarah, to study the magnitude of neonatal GBS infection and risk factors to develop a screening protocol in maternity and children's hospital.

MULTIPLE CAVITATORY LUNG LESIONS DUE TO GROUP B STREPTOCOCCUS IN A HEALTHY ADULT

MULTIPLE CAVITATORY LUNG LESIONS DUE TO GROUP B STREPTOCOCCUS IN A HEALTHY ADULT

Group B Streptococcus among Pregnant Women and Neonates in Saudi Arabia: A Systemic Review.

Sepsis caused by Group B Streptococcus (GBS) continues to cause mortality and morbidity in newborns, especially in developing countries. Bacterial sepsis in newborns varies nationally and even within countries. Developing countries have reported 34 deaths per 1000 live births compared to 5 in developed countries. This systemic review aimed to assess the prevalence of GBS colonization among pregnant women and the incidence of neonatal GBS sepsis in Saudi Arabia. A literature search of PubMed, MEDLINE Ovid, and Google Scholar was conducted. A total of 21 studies were found: 15 described maternal GBS colonization and 6 studies described neonatal GBS infections. The GBS colonization prevalence among pregnant women ranged from 2.1% to 32.8%. Inconsistencies in the reporting method for neonatal GBS infection rates were observed. Only two studies have the incidence of neonatal GBS as the primary outcome. No national multicenter studies exist on the GBS rates among neonates. Nationwide studies are warranted to assess the burden of GBS infections in neonates. These studies would guide appropriate GBS screening strategies during pregnancy for application in a national public health program.

Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China.

We performed a systematic review and meta-analysis of the incidence, case-fatality rate (CFR), isolate antimicrobial resistance patterns, and serotype and sequence type distributions for invasive group B Streptococcus (GBS) disease in infants <1–89 days of age in China. We searched the PubMed/Medline, Embase, Wanfang, and China National Knowledge Infrastructure databases for research published during January 1, 2000–March 16, 2018, and identified 64 studies. Quality of included studies was assessed by using Cochrane tools. Incidence and CFR were estimated by using random-effects meta-analyses. Overall incidence was 0.55 (95% CI 0.35–0.74) cases/1,000 live births, and the CFR was 5% (95% CI 3%–6%). Incidence of GBS in young infants in China was higher than the estimated global incidence (0.49 cases/1,000 live births) and higher than previous estimates for Asia (0.3 cases/1,000 live births). Our findings suggest that implementation of additional GBS prevention efforts in China, including maternal vaccination, could be beneficial.

Clinical and Molecular Epidemiology of Invasive Group B Streptococcus Disease among Infants, China.

Invasive group B Streptococcus (GBS) remains a leading cause of illness and death among infants globally. We conducted prospective and retrospective laboratory-based surveillance of GBS-positive cultures from infants <3 months of age in 18 hospitals across China during January 1, 2015–December 31, 2017. The overall incidence of GBS was 0.31 (95% CI 0.27–0.36) cases/1,000 live births; incidence was 0–0.76 cases/1,000 live births across participating hospitals. The case-fatality rate was 2.3%. We estimated 13,604 cases of GBS and 1,142 GBS–associated deaths in infants <90 days of age annually in China. GBS isolates were most commonly serotype III (61.5%) and clonal complex 17 (40.6%). Enhanced active surveillance and implementation of preventive strategies, such as maternal GBS vaccination, warrants further investigation in China to help prevent these infections.

Group B Streptococcus: Trials and Tribulations.

Group B Streptococcus (GBS) is estimated to have caused 319,000 cases of neonatal disease resulting in 90,000 infant deaths globally in 2015. It is also associated with maternal sepsis, preterm births, stillbirths and neonatal encephalopathy. There is a significant burden of neurologic impairment among survivors of infant GBS disease. Intrapartum antibiotic prophylaxis strategies have reduced the incidence of newborn early-onset GBS (occurring days 0-6) in some settings, but they are not feasible in many low and middle-income countries. A maternal vaccine given to pregnant women to stimulate passive transplacental transfer of protective antibodies has the potential to reduce maternal disease, adverse pregnancy outcomes and newborn disease. Phase I and II vaccine studies are occurring, but conducting phase III efficacy studies of a GBS vaccine candidate would require very large numbers due to the relatively low incidence of invasive GBS disease. It has therefore been proposed that alternative pathways to vaccine licensure should be explored, for example, through use of a regulatory approved correlate of protection and safety evaluation in mothers, fetuses and infants. These studies would then be followed-up with post-licensure phase IV studies in which vaccine effectiveness is evaluated.

Group B Streptococci: Declining Incidence in Infants in Germany.

Group B streptococcus (GBS) is a leading cause of morbidity and mortality in newborns worldwide. From 2000 to 2008, national guidelines in Germany recommended intrapartum antibiotic prophylaxis for pregnant women displaying risk factors (eg, perinatal anogenital GBS colonization, rupture of the membranes ≥18 hours before birth) for the vertical transmission of GBS to their children. In 2008, these guidelines were revised to advocate universal, culture-based screening for GBS colonization among all pregnant women between 35 and 37 weeks of gestation. For the period 2009-2010, our prospective active surveillance study assessed the incidence of invasive GBS infections in infants 0-90 days of age in Germany. We did this by means of a capture-recapture analysis of 2 separate, independent systems (pediatric reporting versus laboratory reporting). We compared our results with those from a previous study by employing an equivalent design (2001-2003). We detected a 32% reduction in GBS incidence, from 0.47 per 1000 live births (n = 679) in 2001-2003 to 0.34 per 1000 live births (n = 450) in 2009-2010. This decline primarily is tied to a reduced number of GBS cases in children under 1 week of age. In 2009-2010, the ratio of early-onset disease to late-onset disease reversed from 1.52 (206:136), as determined in 2001-2003, to 0.75 (92:122). This study is the first to assess changes in the incidence of invasive GBS in Germany after the implementation of the guidelines for intrapartum prophylaxis for pregnant women colonized with GBS.

Parallel Evolution of Group B Streptococcus Hypervirulent Clonal Complex 17 Unveils New Pathoadaptive Mutations.

Group B Streptococcus (GBS) is a commensal of the gastrointestinal and genitourinary tracts, while a prevailing cause of neonatal disease worldwide. Of the various clonal complexes (CCs), CC17 is overrepresented in GBS-infected newborns for reasons that are still largely unknown. Here, we report a comprehensive genomic analysis of 626 CC17 isolates collected worldwide, identifying the genetic traits behind their successful adaptation to humans and the underlying differences between carriage and clinical strains. Comparative analysis with 923 GBS genomes belonging to CC1, CC19, and CC23 revealed that the evolution of CC17 is distinct from that of other human-adapted lineages and recurrently targets functions related to nucleotide and amino acid metabolism, cell adhesion, regulation, and immune evasion. We show that the most distinctive features of disease-specific CC17 isolates were frequent mutations in the virulence-associated CovS and Stk1 kinases, underscoring the crucial role of the entire CovRS regulatory pathway in modulating the pathogenicity of GBS. Importantly, parallel and convergent evolution of major components of the bacterial cell envelope, such as the capsule biosynthesis operon, the pilus, and Rib, reflects adaptation to host immune pressures and should be taken into account in the ongoing development of a GBS vaccine. The presence of recurrent targets of evolution not previously implicated in virulence also opens the way for uncovering new functions involved in host colonization and GBS pathogenesis. IMPORTANCE The incidence of group B Streptococcus (GBS) neonatal disease continues to be a significant cause of concern worldwide. Strains belonging to clonal complex 17 (CC17) are the most frequently responsible for GBS infections in neonates, especially among late-onset disease cases. Therefore, we undertook the largest genomic study of GBS CC17 strains to date to decipher the genetic bases of their remarkable colonization and infection ability. We show that crucial functions involved in different steps of the colonization or infection process of GBS are distinctly mutated during the adaptation of CC17 to the human host. In particular, our results implicate the CovRS two-component regulator of virulence in the differentiation between carriage- and disease-associated isolates. Not only does this work raise important implications for the ongoing development of a vaccine against GBS but might also drive the discovery of key functions for GBS adaptation and pathogenesis that have been overlooked until now. Author Video: An author video summary of this article is available.

Status of vaccine research and development of vaccines for GBS

Streptococcus agalactiae (group B streptococcus (GBS)) is the leading cause of neonatal sepsis and meningitis in many countries. Intrapartum antibiotic strategies have reduced the incidence of early-onset neonatal GBS in a number of countries but have had no impact on late onset GBS infection (LOD). In low/middle income settings, the disease burden remains uncertain although in several countries of Southern Africa appears comparable to or higher than that of high-income countries. As disease may be rapidly fulminating cases can be missed before appropriate samples are obtained and this may lead to underestimation of the true burden. Given the rapid onset and progression within hours of birth as well as the deficiencies in IAP strategies and absence of a solution for preventing LOD, it is clear that administration of a suitable vaccine in pregnancy could provide a better solution in all settings; it should also be cost effective. The current leading vaccine candidates are CPS-protein conjugate vaccines but protein-based vaccines are also in development and one has recently commenced clinical trials.

Prevalence of Maternal Genital Tract Colonization by Group B Streptococcus From Western Province, Taif, Saudi Arabia

Background: Group B streptococcus (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. Maternal colonization has been found to be a major risk factor for invasive GBS disease within 6 days of birth. GBS has become the major cause of bacterial infections in the perinatal period, including bacteremia, amnionitis, endometritis, and urinary tract infection in pregnant women as well as sepsis and meningitis in neonates and young infants. Infection of the new born may be acquired by the intra-amniotic route or directly during passage through the birth canal. This study was undertaken to determine the prevalence of GBS colonization in pregnant women attending the antenatal clinic of Al-Hada Armed Forces Hospital in Western province, Taif, Saudi Arabia. This paper was the first data on incidence of GBS in pregnant women at Western province, Taif, Saudi Arabia. Methods: A total of 2,632 pregnant women were screened for GBS colonization between January and December 2014. Standard microbiological methods were used to isolate and identify GBS from vaginal and anorectal swabs obtained from study subjects. An antimicrobial susceptibility test was performed for all GBS isolates according to the criteria of the Clinical and Laboratory Standards Institute (CLSI) by disk diffusion method. Results: A total of 632 out of 2,632 (24%) pregnant women were colonized by GBS. Statistically significant association was observed for GBS colonization with any of socio-demographic characteristics of the study subjects including age, occupation, number of antenatal clinic visits, and type of gravida. All GBS strains were susceptible to penicillin, ampicillin, vancomycin and gentamicin, erythromycin, tetracycline, ceftriaxone, chloramphenicol, ciprofloxacin, clindamycin, and norfloxacin. Resistance was observed in some strains against clindamycin (0.18%). The data from the present study showed that incidence of GBS in Saudi pregnant women increased rapidly. These results are the first record of the database in Saudi Arabia at western province with high prevalence of GBS in pregnant women. Conclusion: This study showed that prevalence of GBS colonization was 24% among the study subjects. The finding of this study was comparable with findings reported from developed and developing countries. However, further epidemiological investigations should be done in different parts of the country (all provinces) in order to know the actual GBS colonization rate in pregnant women and to consider the use of intrapartum antibiotics prophylaxis for prevention of early onset GBS-neonatal diseases, considering the accelerated demand for reducing neonatal morbidity and mortality due to GBS. J Clin Gynecol Obstet. 2015;4(3):258-264 doi: http://dx.doi.org/10.14740/jcgo341w

Group B streptococcus infections of soft tissue and bone in California adults, 1995-2012.

Group B streptococcus (GBS) is an increasing cause of disease in adults. We present long-term trends in incidence of overall infections and identify characteristics of patients with GBS cellulitis, bone and joint infections. Active, population-based surveillance was conducted from 1995-2012 in three California counties and the data were analysed retrospectively. All cases had isolation of GBS from a normally sterile site. Cases of cellulitis were classified based on clinical diagnosis. GBS bone or joint infection was defined as isolation of GBS from a bone or joint or a diagnosis of osteomyelitis or septic arthritis. Medical charts were reviewed for demographic and clinical information. There were 3917 cases of GBS; the incidence of disease increased from 5·8 to 8·3 cases/100 000 persons (P < 0·001) from 1995 to 2012. In adults aged ⩾40 years, the overall incidence of GBS increased from 8·5 to 14·2 cases/100 000 (P < 0·001) persons during the study period. The incidence of cellulitis increased from 1·6 to 3·8 cases/100 000 (P < 0·001), bone infection increased from 0·7 to 2·6 cases/100 000 (P < 0·001), and the incidence of joint infection remained approximately constant at an average rate of 1·0 case/100 000. The highest incidence rates were observed in men, persons aged ⩾80 years, non-Hispanic blacks and Hispanics. Diabetes was the most common underlying condition (51·2% cellulitis cases, 76·3% bone infections, 29·8% joint infections).

Estimation of Group B Streptococcus Colonization in High-Risk Neonates by PCR and Standard Culture

Background:: Group B Streptococcus (GBS) (Streptococcus agalactiae) is the leading cause of morbidity and mortality of newborn infants considered a leading factor causing septicemia after birth. The standard method for the diagnosis of GBS colonization is culture in a selective medium, but PCR has a high sensitivity and specificity. Objectives:: The goal of this study was to estimate the colonization of GBS in rectum of neonates of high-risk mothers by culture and PCR method. Patients and Methods:: Samples were taken from rectal mucosa of 154 neonatesof high-risk mothers for GBS by swabs. Samples were tested by standard culture using Todd Hewitt broth and blood agar and also by PCR using primers specific for cfb gene. Results:: Of 154 neonates, Culture identified 17 (11%) neonates as colonized by GBS; and the PCR assay could identify 27 (17%) neonates with positive results for GBS. Mothers age range was 17-40 years (mean = 26.1 ± 5.1). Maternal age was significantly lower in PCR positive group (P = 0.038) and in culture positive group (P = 0.015). Using culture as the gold standard, sensitivity, NPV, specificity, and PPV of PCR were 100%, 100%, 92%, and 62%, respectively. The time required for PCR assay and culture were 2hours and 36hours, respectively. Conclusions:: This study showed that the incidence of GBS in Iranian high-risk neonates is high, so we strongly recommend screening of high-risk neonates for detection of GBS.

Group B Streptococcal infection in the first 90 days of life in North Queensland

Group B Streptococcus (GBS) infection is recognised as an important cause for neonatal sepsis. To describe the incidence and risk factors for invasive GBS under 90 days of age in North Queensland from January 2002 to December 2011. Patients were identified with positive blood and cerebrospinal fluid cultures to obtain incidence figures. The Townsville district cohort was further investigated for the presence of maternal and fetal risk factors in a retrospective case-controlled study. Early onset GBS continues to occur at 0.43/1000 live births, and late onset disease at 0.38/1000 live births. Early onset GBS and late onset GBS are shown to be two distinct diseases. Early onset disease is significantly different from the control group for these risk factors: previous late fetal loss, prolonged rupture of membranes, inadequate intrapartum antibiotics, abnormal cardiotocography, delivery by emergency caesarean section, lower one minute Apgar scores and need for resuscitation at delivery. Significant variables for late onset disease are earlier gestation and need for resuscitation at birth, first born babies, multiple pregnancy and birth by emergency caesarean section. The incidence of early or late onset GBS in Aboriginal or Torres Strait Islanders was not significantly different. Group B Streptococcus continues to occur in North Queensland at higher than expected rates, and a new approach to its prevention should be considered. Previous fetal loss may be a risk factor which is under recognised. Babies with late onset infection appear to be significantly more preterm.

Colonization with Group B streptococcus and Ureaplasma urealyticum among parturient women in Poland and Ukraine

Colonization with Group B streptococcus and Ureaplasma urealyticum among parturient women in Poland and Ukraine

Incidence and Severity of Invasive Streptococcus pneumoniae, Group A Streptococcus, and Group B Streptococcus Infections Among Pregnant and Postpartum Women

The epidemiology of streptococcal infection in pregnant and postpartum women is poorly described in recent literature. We used data from multistate surveillance for invasive Streptococcus pneumoniae, group A Streptococcus (GAS), and group B Streptococcus (GBS) infections to estimate disease incidence and severity in these populations. Cases were reported through the Centers for Disease Control and Prevention Active Bacterial Core surveillance, an active population- and laboratory-based system. A case was defined as illness in a woman aged 15-44 years with streptococcus isolated from a normally sterile body site during 2007-2009. Pregnant or postpartum status was recorded at the time of culture. Incidence was calculated as cases per 1000 woman-years with use of national Census data; 95% confidence intervals were calculated on the basis of λ distribution. We used multivariable logistic regression to explore associations between pregnant or postpartum status and hospital length of stay, a marker of disease severity. We identified 1848 cases in women; 6.0% of women were pregnant, and 7.5% were postpartum. Pregnant women had a higher mean incidence of GBS disease, compared with nonpregnant women (0.04 cases per 1000 woman-years [range, 0.03-0.05 cases per 1000 woman-years] vs 0.02 cases per 1000 woman-years [range, 0.02-0.02 cases per 1000 woman-years]). Postpartum women had elevated mean incidence of all 3 pathogens, compared with nonpregnant women (S. pneumoniae: 0.15 cases per 1000 woman-years [range, 0.09-0.25 cases per 1000 woman-years] vs 0.052 cases per 1000 woman-years [range, 0.049-0.056 cases per 1000 woman-years]; GAS: 0.56 cases per 1000 woman-years [range, 0.42-0.70 cases per 1000 woman-years] vs 0.019 cases per 1000 woman-years [range, 0.017-0.021 cases per 1000 woman-years]; GBS: 0.49 cases per 1000 woman-years [range, 0.36-0.64 cases per 1000 woman-years] vs 0.018 [range, 0.016-0.020 cases per 1000 woman-years]). Neither pregnancy nor postpartum status was associated with longer length of stay among women infected with any of the 3 pathogens. Although invasive streptococcal infections do not appear to be more severe in pregnant or postpartum women, postpartum women have a 20-fold increased incidence of GAS and GBS, compared with nonpregnant women.

Institution of universal screening for Group B streptococcus (GBS) from a risk management protocol results in reduction of early‐onset GBS disease in a tertiary obstetric unit

To determine the effect of institution of a universal screening protocol as per CDC 2002 guidelines had on the incidence of early-onset Group B streptococcal (GBS) and non-GBS disease in a tertiary obstetric unit. A prospective study with historical control data reporting the incidence of early-onset GBS and non-GBS disease following institution of a universal screening strategy at John Hunter Hospital, Newcastle, Australia. We compared the incidence of early-onset GBS and non-GBS disease during prescreening (1994-2002) with screening period (2004 to June 2006). The outcome measure was the incidence of early-onset GBS disease. We specifically reported the number of women needed to treat (NNT) with antibiotics and the number of women needed to screen. The incidence of early-onset GBS and non-GBS during the prescreening period was 0.84/1000 and 0.94/1000 live births, respectively. After institution of universal screening, the incidence was 0.00/1000 and 0.72/1000 live births, respectively. This is a statistically significant reduction in early-onset GBS disease by 84% (chi(2) = 5.75; P = 0.016). There was no difference in non-GBS disease (chi2 = 0.14; P = 0.71). The NNT is 1191 and we needed to screen 5704 women to prevent one case of early-onset GBS disease. Screening for GBS rather than by assessing risk factors has significantly reduced the incidence of early-onset GBS disease in our unit. Despite low incidence of early-onset GBS prior to screening period, we still found a significant decrease in early-onset GBS disease after institution of universal screening protocol. These results support the screening-based approach at 34-37 weeks gestation.

Group B Streptococcus: global incidence and vaccine development

An ongoing public health challenge is to develop vaccines that are effective against infectious diseases that have global relevance. Vaccines against serotypes of group B Streptococcus (GBS) that are prevalent in the United States and Europe are not optimally efficacious against serotypes common to other parts of the world. New technologies and innovative approaches are being used to identify GBS antigens that overcome serotype-specificity and that could form the basis of a globally effective vaccine against this opportunistic pathogen. This Review highlights efforts towards this goal and describes a template that can be followed to develop vaccines against other bacterial pathogens.

Perinatal Group B Streptococcal Infections and the New Guidelines

After completing this article, readers should be able to: 1. Describe the current literature on surveillance studies and patient outcomes regarding group B Streptococcus (GBS) disease. 2. Discuss the current perinatal GBS prevention guidelines. 3. Describe the limitations of the “limited evaluation” in assessing newborns at risk for GBS disease. 4. Delineate the proposed management of asymptomatic infants at risk for GBS disease, with the goal of decreasing unnecessary testing and avoiding prolonged hospitalization. Group B Streptococcus (GBS), also known as S agalactiae , is an encapsulated gram-positive bacterium that is a common inhabitant of the human gastrointestinal and genitourinary tracts. Despite recent reductions in incidence, it remains the most common cause of neonatal bacterial infections in most developed countries. The most desirable approach suggested to eliminate neonatal GBS infection is the use of GBS vaccines prior to or early in pregnancy. However, until effective GBS vaccines become available, screening pregnant women for GBS colonization and providing intrapartum antibiotic prophylaxis (IAP) will continue to be the mainstay for prevention of GBS infection in neonates, as suggested by the Centers for Disease Control and Prevention (CDC). A 70% decline in the rate of early-onset GBS disease followed the introduction of the first national consensus guidelines in 1996. In 2002, new national guidelines were released based on evidence that the screening-based strategy was superior to a risk factor-based strategy for preventing GBS infections in the neonate. As a result of many obstetricians adopting the screening-based strategy, CDC data from 2004 showed a further decline in the incidence of early-onset GBS infection to 0.34 cases per 1,000 live births. This surpasses the Healthy People 2010 objective of a reduction in the incidence of early-onset disease to 0.5 cases per 1,000 live births for all races. It should be mentioned that different countries may demonstrate different results, but …