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Volume 27, Number 9—September 2021
CME ACTIVITY - Research

Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy

Alberto BerardiComments to Author , Caterina Spada, Roberta Creti, Cinzia Auriti, Lucia Gambini, Vittoria Rizzo, Mariagrazia Capretti, Nicola Laforgia, Irene Papa, Anna Tarocco, Angela Lanzoni, Giacomo Biasucci, Giancarlo Piccinini, Giovanna Nardella, Giuseppe Latorre, Daniele Merazzi, Laura Travan, Maria Letizia Bacchi Reggiani, Lorenza Baroni, Matilde Ciccia, Laura Lucaccioni, Lorenzo Iughetti, and Licia Lugli
Author affiliations: Azienda Ospedaliero–Universitaria Policlinico, Modena, Italy (A. Berardi, C. Spada, L. Lucaccioni, L. Iughetti, L. Lugli); Istituto Superiore di Sanità, Rome, Italy (R. Creti); Ospedale Pediatrico Bambino Gesù, Rome (C. Auriti); Azienda Ospedaliero-Universitaria Policlinico, Parma, Italy (L. Gambini); Ospedale Civile M. Bufalini, Cesena, Italy (V. Rizzo); Azienda Ospedaliero–Universitaria S. Orsola–Malpighi, Bologna, Italy (M. Capretti, M.L. Bacchi Reggiani); Ospedale Policlinico, Bari, Italy (N. Laforgia); Ospedale Infermi, Rimini, Italy (I. Papa); Azienda Ospedaliero–Universitaria S. Anna, Ferrara, Italy (A. Tarocco); Ospedale Santa Maria della Scaletta, Imola, Italy (A. Lanzoni); Ospedale G. da Saliceto, Piacenza, Italy (G. Biasucci); Ospedale Santa Maria Delle Croci, Ravenna, Italy (G. Piccinini); Azienda Ospedaliero–Universitaria Ospedali Riuniti, Foggia, Italy (G. Nardella); Ospedale F. Miulli, Acquaviva delle Fonti, Italy (G. Latorre); Ospedale Valduce, Como, Italy (D. Merazzi); I; RCCS Materno Infantile Burlo Garofolo, Trieste, Italy (L. Travan); Arcispedale Santa Maria Nuova, Reggio Emilia, Italy (L. Baroni); Ospedale Maggiore, Bologna (M. Ciccia)

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Table 1

Demographics and clinical data of neonates with late-onset group B Streptococcus disease, Italy*

Characteristic LOD cases in preterm neonates, n = 18† LOD cases in full-term neonates, n = 80 p value Total, N = 98
Median birthweight, g (IQR) 1,285 (987–1,800) 3,185 (2,898–3,518) NA 3,110 (2,570–3,425)
Gestational age at delivery, wks, median (IQR) 31.0 (27.0–33.0) 39.0 (38.0–40.0) NA 39 (38–40)
Vaginal delivery 4 (22.2) 56 (70.0) <0.01 60 (61.2)
Planned caesarean section 8 (44.4) 18 (22.5) 0.11 26 (26.5)
IAP exposure‡ 9 (50.0) 29 (36.3) 0.42 38 (38.8)
Age at onset, median, d (IQR) 33 (26–45) 27 (15–43) 0.08 29 (16–43)
Mechanical ventilation 7 (38.9) 4 (5.0) <0.01 11 (11.2)
Focal infection§ 0 6 (7.5) 0.51 6 (6.1)
Meningitis with or without sepsis¶ 8 (57.1) 32 (56.1) 0.82 40 (56.3·)
Brain lesions at discharge from hospital# 7 (38.9) 15 (18.8) 0.12 22 (22.4)
Death 1 (5.6) 1 (1.3) 0.81 2 (1.0)

*Values are no. (%) except as indicated. GBS, group B streptococcus; IAP, intrapartum antibiotic prophylaxis; IQR, interquartile range; LOD, late-onset disease; NA, not applicable. †14 were early to moderate and 4 were late preterm neonates. ‡IAP was adequate (ampicillin, penicillin, or cefazolin given >4 h before delivery) in 3/9 (33.3%) cases in preterm neonates and in 17/29 (58.6%) cases in full-term neonates. §GBS-positive blood culture result associated with focal signs outside the respiratory tract (cellulitis, arthritis, parotiditis, others) (10). ¶Percentage and significance were calculated based on findings from lumbar puncture (in preterm neonates, 14 cases; in full-term neonates, 57 cases). Meningitis was culture-proven in 36/40 cases. #Brain lesions were confirmed through ultrasound, magnetic resonance study, or both.

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References
  1. Madrid  L, Seale  AC, Kohli-Lynch  M, Edmond  KM, Lawn  JE, Heath  PT, et al.; Infant GBS Disease Investigator Group. Infant group B streptococcal disease incidence and serotypes worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017;65(suppl_2):S160–72. DOIPubMedGoogle Scholar
  2. Puopolo  KM, Lynfield  R, Cummings  JJ; COMMITTEE ON FETUS AND NEWBORN; COMMITTEE ON INFECTIOUS DISEASES. Committee on Infectious Diseases. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019;144:e20191881. DOIPubMedGoogle Scholar
  3. Nanduri  SA, Petit  S, Smelser  C, Apostol  M, Alden  NB, Harrison  LH, et al. Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr. 2019;173:224–33. DOIPubMedGoogle Scholar
  4. Seale  AC, Bianchi-Jassir  F, Russell  NJ, Kohli-Lynch  M, Tann  CJ, Hall  J, et al. Estimates of the burden of group B streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin Infect Dis. 2017;65(suppl_2):S200–19. DOIPubMedGoogle Scholar
  5. Berardi  A, Rossi  C, Creti  R, China  M, Gherardi  G, Venturelli  C, et al. Group B streptococcal colonization in 160 mother-baby pairs: a prospective cohort study. J Pediatr. 2013;163:1099–104.e1. DOIPubMedGoogle Scholar
  6. Tazi  A, Plainvert  C, Anselem  O, Ballon  M, Marcou  V, Seco  A, et al. Risk factors for infant colonization by hypervirulent CC17 group B Streptococcus: toward the understanding of late-onset disease. Clin Infect Dis. 2019;69:1740–8. DOIPubMedGoogle Scholar
  7. Manning  SD, Lewis  MA, Springman  AC, Lehotzky  E, Whittam  TS, Davies  HD. Genotypic diversity and serotype distribution of group B streptococcus isolated from women before and after delivery. Clin Infect Dis. 2008;46:1829–37. DOIPubMedGoogle Scholar
  8. Lin  FY, Weisman  LE, Troendle  J, Adams  K. Prematurity is the major risk factor for late-onset group B streptococcus disease. J Infect Dis. 2003;188:267–71. DOIPubMedGoogle Scholar
  9. Joubrel  C, Tazi  A, Six  A, Dmytruk  N, Touak  G, Bidet  P, et al. Group B streptococcus neonatal invasive infections, France 2007-2012. Clin Microbiol Infect. 2015;21:910–6. DOIPubMedGoogle Scholar
  10. Berardi  A, Rossi  C, Lugli  L, Creti  R, Bacchi Reggiani  ML, Lanari  M, et al.; GBS Prevention Working Group, Emilia-Romagna. Group B streptococcus late-onset disease: 2003-2010. Pediatrics. 2013;131:e361–8. DOIPubMedGoogle Scholar
  11. Verani  JR, McGee  L, Schrag  SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR-10):1–36.PubMedGoogle Scholar
  12. Le Doare  K, Kampmann  B. Breast milk and Group B streptococcal infection: vector of transmission or vehicle for protection? Vaccine. 2014;32:3128–32. DOIPubMedGoogle Scholar
  13. Filleron  A, Lombard  F, Jacquot  A, Jumas-Bilak  E, Rodière  M, Cambonie  G, et al. Group B streptococci in milk and late neonatal infections: an analysis of cases in the literature. Arch Dis Child Fetal Neonatal Ed. 2014;99:F41–7. DOIPubMedGoogle Scholar
  14. Zimmermann  P, Gwee  A, Curtis  N. The controversial role of breast milk in GBS late-onset disease. J Infect. 2017;74(Suppl 1):S34–40. DOIPubMedGoogle Scholar
  15. Le Doare  K, Kampmann  B, Vekemans  J, Heath  PT, Goldblatt  D, Nahm  MH, et al. Serocorrelates of protection against infant group B streptococcus disease. Lancet Infect Dis. 2019;19:e162–71. DOIPubMedGoogle Scholar
  16. Imperi  M, Pataracchia  M, Alfarone  G, Baldassarri  L, Orefici  G, Creti  R. A multiplex PCR assay for the direct identification of the capsular type (Ia to IX) of Streptococcus agalactiae. J Microbiol Methods. 2010;80:212–4. DOIPubMedGoogle Scholar
  17. Creti  R, Fabretti  F, Orefici  G, von Hunolstein  C. Multiplex PCR assay for direct identification of group B streptococcal alpha-protein-like protein genes. J Clin Microbiol. 2004;42:1326–9. DOIPubMedGoogle Scholar
  18. Imperi  M, Gherardi  G, Berardi  A, Baldassarri  L, Pataracchia  M, Dicuonzo  G, et al. Invasive neonatal GBS infections from an area-based surveillance study in Italy. Clin Microbiol Infect. 2011;17:1834–9. DOIPubMedGoogle Scholar
  19. Creti  R, Imperi  M, Berardi  A, Pataracchia  M, Recchia  S, Alfarone  G, et al.; Italian Neonatal GBS Infections Working Group. Neonatal group B Streptococcus infections. Pediatr Infect Dis J. 2017;36:256–62. DOIPubMedGoogle Scholar
  20. Springman  AC, Lacher  DW, Waymire  EA, Wengert  SL, Singh  P, Zadoks  RN, et al. Pilus distribution among lineages of group b streptococcus: an evolutionary and clinical perspective. BMC Microbiol. 2014;14:159. DOIPubMedGoogle Scholar
  21. Berardi  A, Baroni  L, Bacchi Reggiani  ML, Ambretti  S, Biasucci  G, Bolognesi  S, et al.; GBS Prevention Working Group Emilia-Romagna. The burden of early-onset sepsis in Emilia-Romagna (Italy): a 4-year, population-based study. J Matern Fetal Neonatal Med. 2016;29:3126–31. DOIPubMedGoogle Scholar
  22. Berardi  A, Rossi  C, Bacchi Reggiani  ML, Bastelli  A, Capretti  MG, Chiossi  C, et al. An area-based study on intrapartum antibiotic prophylaxis for preventing group B streptococcus early-onset disease: advances and limitations. J Matern Fetal Neonatal Med. 2017;30:1739–44. DOIPubMedGoogle Scholar
  23. Khatami  A, Randis  TM, Tavares  L, Gegick  M, Suzman  E, Ratner  AJ. Vaginal co-colonization with multiple Group B Streptococcus serotypes. Vaccine. 2019;37:409–11. DOIPubMedGoogle Scholar
  24. Carreras-Abad  C, Cochet  M, Hall  T, Ramkhelawon  L, Khalil  A, Peregrine  E, et al. Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study. Health Technol Assess. 2019;23:1–40. DOIPubMedGoogle Scholar
  25. Ratner  AJ. Enhanced postnatal acquisition of hypervirulent group B Streptococcus. Clin Infect Dis. 2019;69:1749–51. DOIPubMedGoogle Scholar
  26. Tazi  A, Disson  O, Bellais  S, Bouaboud  A, Dmytruk  N, Dramsi  S, et al. The surface protein HvgA mediates group B streptococcus hypervirulence and meningeal tropism in neonates. J Exp Med. 2010;207:2313–22. DOIPubMedGoogle Scholar
  27. Campisi  E, Rosini  R, Ji  W, Guidotti  S, Rojas-López  M, Geng  G, et al. Genomic analysis reveals multi-drug resistance clusters in group B Streptococcus CC17 hypervirulent isolates causing neonatal invasive disease in southern mainland China. Front Microbiol. 2016;7:1265. DOIPubMedGoogle Scholar
  28. Martins  ER, Pedroso-Roussado  C, Melo-Cristino  J, Ramirez  M; Portuguese Group for the Study of Streptococcal Infections. Streptococcus agalactiae causing neonatal infections in Portugal (2005–2015): diversification and emergence of a CC17/PI-2b multidrug resistant sublineage. Front Microbiol. 2017;8:499. DOIPubMedGoogle Scholar
  29. Teatero  S, Ramoutar  E, McGeer  A, Li  A, Melano  RG, Wasserscheid  J, et al. Clonal Complex 17 Group B Streptococcus strains causing invasive disease in neonates and adults originate from the same genetic pool. Sci Rep. 2016;6:20047. DOIPubMedGoogle Scholar
  30. Perez  PF, Doré  J, Leclerc  M, Levenez  F, Benyacoub  J, Serrant  P, et al. Bacterial imprinting of the neonatal immune system: lessons from maternal cells? Pediatrics. 2007;119:e724–32. DOIPubMedGoogle Scholar
  31. Le Doare  K, Bellis  K, Faal  A, Birt  J, Munblit  D, Humphries  H, et al. SIgA, TGF-β1, IL-10, and TNFα in colostrum are associated with infant group B Streptococcus colonization. Front Immunol. 2017;8:1269–79. DOIPubMedGoogle Scholar
  32. Dangor  Z, Khan  M, Kwatra  G, Izu  A, Nakwa  F, Ramdin  T, et al. The association between breast milk group B streptococcal capsular antibody levels and late-onset disease in young infants. Clin Infect Dis. 2020;70:1110–4.PubMedGoogle Scholar

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Page created: July 15, 2021
Page updated: August 19, 2021
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