Streptococcus agalactiae infections in a newborn

Czech version

Authors: J. Malý ¹; Lenka Ryšková ²
Authors‘ workplace: Dětská klinika, LF UK a FN, Hradec Králové ¹; Ústav klinické mikrobiologie, LF UK a FN, Hradec Králové ²
Published in: Čes-slov Neonat 2022; 28 (2): 73-81.
Category: Reviews

Overview

Sepsis caused by group B streptococcus (GBS) remains among the most commonly occurring infections in the neonatal period despite the decrease in incidence of early onset neonatal disease (GBS EOD) over the last 25 years. This decline in incidence can be attributed to the screening of pregnant women and subsequent targeted intrapartum antibiotic prophylaxis upon positive culture testing. About 70 % of the cases of GBS EOD occur in term neonates, however the most vulnerable group of patients are neonates born prior to 35 weeks of gestation. The leading clinical symptom in infected neonates is respiratory distress and GBS EOD frequently manifests as sepsis and/or pneumonia which is typically associated with varying degrees of organ dysfunction. Unlike GBS EOD, late onset GBS infections (GBS LOD) are not influenced by peripartum antibiotic prophylaxis, and their incidence has remained unchanged during last decades. In such cases, preterm delivery is the most important risk factor (delivery before 37 weeks of gestation). Contrary to early onset infections, GBS LOD commonly clinically presents with fever and thereafter usually also manifests as sepsis, which is accompanied by purulent meningitis in approximately 30 % of cases.

Keywords:

GBS – neonatal disease – current recommendation

Sources

1. Manning SD, Neighbors K, Tallman PA, et al. Prevalence of group B streptococcus colonization and potential for transmission by casual contact in healthy young men and women. Clin Infect Dis 2004; 39: 380–388.

2. Johri A, Paoletti L, Glaser P, et al. Group B Streptococcus: global incidence and vaccine development. Nat Rev Microbiol 2006; 4: 932–942.

3. Russel NJ, Seale AC, O´Driscoll M, et al. Maternal colonization with group B streptococcus and serotype distribution worldwide: systematic review and meta–analyses. Clin Infect Dis 2017; 65: S100–S111.

4. Edwards MS, Nizet V, Baker CJ. Group B streptococcal infections. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO (Eds.). Remington and Klein´s infectious diseases of the fetus and newborn infant (8th ed.). Philadelphia: Saunders 2016; 411.

5. Seale AC, Blencowe H, Bianchi-Jassir F, et al. Stillbirth with group B streptococcus disease worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(Suppl 2): S125–S132.

6. ACOG Committee. Prevention of group B streptococcal early- onset disease in newborns. Obstet Gynecol 2019; 134(1): e19–e40.

7. Měchurová A, Vlk R, Unzeitig V. Diagnostika a léčba streptokoků skupiny B v těhotenství a za porodu – doporučený postup. Česká gynekologická a porodnická společnost ČSL JEP. Poslední revize 2013. [cit. 30. 7. 2022]. Dostupné z: https://www.gynultrazvuk.cz/ uploads/recommendedaction/71/doc/p-2013-diagnostika-a-lecba- streptokoku-skupiny-b-v-tehotenstvi.pdf

8. Nanduri SA, Petit S, Smelser C, et al. Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the US, 2006 to 2015: multistate laboratory and population–based surveillance. JAMA Pediatr 2019; 173e(3): 224–233.

9. Jess T, Morgen CS, Harpsøe MC, et al. Antibiotic use during pregnancy and childhood overweight: a population-based nationwide cohort study. Sci Rep 2019; 8(1): 11528.

10. Corvaglia L, Tonti G, Martini S, et al. Influence of intrapartum antibiotic prophylaxis for group B streptococcus on gut microbiota in the first months of life. J Pediatr Gastroenterol Nutr 2016; 62(2): 304–308.

11. Hasperhoven GF, Al-Nasiry S, Bekker V, et al. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis. BJOG 2020; 127: 680–691.

12. O´Sullivan CP, Lamagni T, Patel D, et al. Group B streptococcal disease in UK and Irish infants younger than 90 days. 2014–2015: a prospective surveillance study. Lancet Infect Dis 2019; 9(1): 83–90.

13. Bekker V, Bijlsma MW, van den Beek D, et al. Incidence of invasive group streptococcal disease and pathogen genotype distribution innewborn babies in the Netherlands over 25 years: a nationwide surveillance study. Lancet Infect Dis 2019; 19: 83–90.

14. El Helali N, Nguyen JC, Ly A, et al. Diagnostic accuracy of a rapid real–time polymerase chain reaction assay for universal intrapartum group B streptococcus screening. Clin Infect Dis 2009; 49(3): 417–423.

15. Helming RB, Gertsen JB. Diagnostic accuracy of polymerase chain reaction for intrapartum detection of group B streptococcus colonization. Acta Obstet Gynecol Scand 2017; 96: 1070–1074.

16. Filkins L, Hauser JR, Robinson-Dunn B, et al. On behalf of the American Society for Microbiology Clinical and Public Health Microbiology Committee, Subcommittee on Laboratory Practices. American Society for Microbiology provides 2020 guidelines for detection and identification of group B Streptococcus. J Clin Microbiol 2021; 59: e01230-20.

17. ACOG Committee. Prevention of group B streptococcal early- onset disease in newborns. Obstet Gynecol 2019; 134(1): e19–e40.

18. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy: a review. JAMA 2019; 321(2): 188–199.

19. Macy E, Vyles D. Who needs penicillin allergy testing? Ann Allergy Asthma Immunol 2018; 121: 523–529.

20. Mulla ZD, Ebrahim MS, Gonzales JL. Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database. An Allergy Asthma Immunol 2010; 104: 55–59.

21. https://www.cdc.gov/drugresistance/pdf/threats-report/gbs-508.pdf

22. Schelonka RL, Chai MK, Yoder BA, et al. Volume of blood required to detect common neonatal pathogens. J Pediatr 1996; 129(2): 275–278.

23. Yaacobi N, Bar-Meir M, Shchors I, Bromiker R. A prospective controlled trial of the optimal volume for neonatal blood cultures. Pediatr Infect Dis J 2015; 34(4): 351–354.

24. Stoll BJ, Puopolo KM, Hansen NI, et al. Early-onset neonatal sepsis 2015 to 2017, the rise of Escherichia coli, and the need for novel prevention strategies. JAMA Pediatr 2020; 174(7): e200593.

25. Puopolo KM, Benitz WE, Zaoutis TE, Committee on Fetus and Newborn, Committee on Infectious Diseases. Management of neonates born at ≥35 0/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics 2018; 142: e20182894.

26. Straňák Z, Boráková K. Biomarkery v diagnostice neonatální sepse. Čes-slov. Pediatr. 2021; 76(1): 55–62.

27. Puopolo KM, Benitz WE, Zaoutis TE, Committee on Fetus and Newborn, Committee on Infectious Diseases. Management of neonates born at ≤ 34 6/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics 2018; 142(6): e20182896.

28. Puopolo KM, Lynfield R, Cummings JJ. Management of infants at risk for group B streptococcal disease. Pediatrics 2019; 144(2): e20191881.

29. Macko J, Malý J, Zach J. Doporučený postup k profylaxi a léčbě infekcí vyvolaných Streptococcus agalactiae (GBS) 2020. Neonatologické listy 2020; 26: 26–29.

30. Puopolo KM, Benitz WE, Zaoutis TE, Committee on Fetus and Newborn, Committee on Infectious Diseases. Management of neonates born at ≥35 0/7 weeks’ gestation with suspected or proven early-onset bacterial sepsis. Pediatrics 2018; 142: e20182894.

31. https://cneos.cz/wp-content/uploads/2022/08/GBS_Infekce_2020_ Algoritmus.pdf

32. Kaiser Permanente Research. Neonatal Early-Onset Sepsis Calculator [online] [cit. 26. 7. 2022]. Dostupné z: https://neonatalsepsiscalculator. kaiserpermanente.org/

33. Berardi A, Fornaciari S, Rossi C, et al. Safety of physical examination alone for managing well-appearing neonates ≥ 35 weeks’ gestation at risk for early-onset sepsis. J Matern Fetal Neonatal Med 2015; 28(10): 1123–1127.

34. Joshi NS, Gupta A, Allan JM, et al. Clinical monitoring of well-appearing infants born to mothers with chorioamnionitis. Pediatrics 2018; 141(4): e20172056. doi:10.1542/peds.2017-2056

35. Kuzniewicz MW, Walsh EM, Li S, et al. Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates. Jt Comm J Qual Patient Saf 2016; 42(5): 232–239.

36. Davis AL, Carcillo JA, Aneja RK, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. American college of critical care medicine. Crit Care Med 2017; 45(6): 1061–1093.

37. Joubrel C, Tazi A, Six A, et al. Group B streptococcus neonatal invasive infections, France 2007–2012. Clin Microbiol Infect 2015; 21(10): 910–916.

38. Payne NR, Burke BA, Day D et al. Correlation of clinical and pathologic findings in early onset neonatal group B streptococcal infection with disease severity and prediction of outcome. Pediatr Infect Dis J 1988; 7(12): 836–847.

39. Yeo KT, Lahra M, Bajuk B, et al. Long-term outcomes after group B streptococcus infection: a cohort study. Arch Dis Child 2019; 104(2): 172–178.

40. Libster R, Edwards KM, Levent F, et al. Long-term outcomes of group B streptococcal meningitis. Pediatrics 2012; 130(1): e8–e15.