A Population-Based Assessment of Invasive Disease Due to Group B Streptococcus in Nonpregnant Adults

Abstract Background The burden of noninvasive group B Streptococcus (GBS) infections in adults is unknown. We determined population-based rates of hospitalization where invasive or noninvasive GBS infections were identified among US adults in a defined catchment area. Methods We identified adults with clinical and laboratory-confirmed evidence of GBS infection from January 2014 through December 2016 from 6 hospitals in Louisville, Kentucky. Invasive disease was defined as GBS isolated from a normally sterile site. Results Among 1076 adults with GBS infection, the median age was 52 years, 51% were male, and 89% had ≥1 chronic medical condition. The most prevalent infection sites were skin and soft tissue (39%), urinary tract (23%), bone and joint (16%), and bloodstream (11%). Forty percent of infections were polymicrobial. The annual incidence of GBS-associated hospitalization was 73 per 100 000 adults and 68 and 100 per 100 000 for patients aged 18–64 and ≥ 65 years, respectively. For every invasive GBS infection, 3.7 noninvasive infections occurred. Conclusions Our population-based study outlines the full burden of GBS-associated hospitalization in adults and found incidence rates comparable to those of pneumococcal disease, where vaccines are recommended. Noninvasive disease was 3–4 times more common than invasive disease, suggesting that the GBS burden among adults is considerably greater than previously recognized.

Download Full-text

Approach to the Febrile Patient with No Obvious Focus of Infection

Pediatrics in Review ◽

10.1542/pir.5.10.305 ◽

1984 ◽

Vol 5 (10) ◽

pp. 305-315

Author(s):

Sarah S. Long

Keyword(s):

Antimicrobial Agents ◽

Group B Streptococcus ◽

Invasive Disease ◽

Chemotherapeutic Agents ◽

The Body ◽

Therapeutic Modalities ◽

Body Of Knowledge ◽

Age Related ◽

Focus Of Infection ◽

Group B

The summary in Table 1 could be used as a mental checklist for the pediatrician who examines a child with fever. Whether the pediatrician opts to "keep the rules" or appropriately decides to "break the rules," knowledge of the guidelines will help him to focus his approach and to adopt attitudes of caution in certain circumstances. The body of knowledge of infectious agents chemotherapeutic agents has burgeoned over the past 40 years; the rules have changed very little. Thus, the rules might also serve as standards against which "new discoveries" that dictate departure from an established mode of clinical practice would have to be weighed. The adage, "Name the bug before you choose a drug," is especially germaine to pediatrics. Potential pathogens or "bugs" continually change as the patient's age, exposure, and immunity change. The serious diseases they cause mandate that initial treatment be given with the best "drugs." The age-related causes of bacterial meningitis presented in Table 2 could serve as a primer for age-related causes of other invasive disease as well. For bone, joint, and soft tissue infection as well as for septicemia without a focus the age line for group B Streptococcus and H influenzae would be extended upward and S aureus would be added for all ages. Although the relative importance of each pathogen for each clinical entity might vary, therapeutic considerations would be appropriately served by a schema such as this. Unfortunately, the susceptibility of pathogens to antimicrobial agents will continue to change. Fortunately, new and potentially better therapeutic agents will continue to be discovered or invented. When new problems of antibiotic resistance emerge or when superior therapeutic modalities are proved, the pediatrician must be knowledgeable of such events and be prepared for change.

Download Full-text

Characteristics of Group B Streptococcus Isolated from Infants with Invasive Infections: A Population-Based Study in Japan

Japanese Journal of Infectious Diseases ◽

10.7883/yoken.67.356 ◽

2014 ◽

Vol 67 (5) ◽

pp. 356-360 ◽

Cited By ~ 13

Author(s):

Bin Chang ◽

Akihito Wada ◽

Mitsuaki Hosoya ◽

Tomohiro Oishi ◽

Naruhiko Ishiwada ◽

...

Keyword(s):

Group B Streptococcus ◽

Population Based ◽

Population Based Study ◽

Invasive Infections ◽

Group B

Download Full-text

Fatal, Fulminant and Invasive Non-Typeable Haemophilus influenzae Infection in a Preterm Infant: A Re-Emerging Cause of Neonatal Sepsis

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed5010030 ◽

2020 ◽

Vol 5 (1) ◽

pp. 30 ◽

Cited By ~ 2

Author(s):

Sudipta Roy Chowdhury ◽

Srabani Bharadwaj ◽

Suresh Chandran

Keyword(s):

Haemophilus Influenzae ◽

Preterm Infant ◽

Neonatal Sepsis ◽

Group B Streptococcus ◽

Invasive Disease ◽

Preventative Measures ◽

Increased Risk ◽

Extremely Preterm ◽

Serotype B ◽

Group B

Early-onset neonatal sepsis (EOS) is a major cause of neonatal death and long-term neurodevelopmental disabilities among survivors. The common pathogens causing EOS are group B streptococcus (GBS) and Escherichia coli. Haemophilus influenzae (H. influenzae) is a Gram-negative coccobacillus that can cause severe invasive disease and can be divided into either typeable or non-typeable strains. H. influenzae serotype b (Hib) is the most virulent and the major cause of bacterial meningitis in young children prior to routine immunization against Hib. Hib infection rates have dramatically reduced since then. However, a number of studies have reported an increasing incidence of non-typeable H. influenzae (NTHi) sepsis in neonates worldwide and concluded that pregnant women may have an increased risk to invasive NTHi disease with poor pregnancy outcomes. We present a case of fulminant neonatal sepsis caused by NTHi in an extremely preterm infant and discuss potential preventative measures to reduce its re-emergence.

Download Full-text

732: Group B Streptococcus maternal colonization and future respiratory infections in the offspring: Results from a population based cohort of up to 18 years follow-up

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.11.263 ◽

2018 ◽

Vol 218 (1) ◽

pp. S440

Author(s):

Shirley Greenbaum ◽

Eyal Sheiner ◽

Tamar Wainstock ◽

Idit Segal ◽

Jacob Moran-Gilad ◽

...

Keyword(s):

Respiratory Infections ◽

Group B Streptococcus ◽

Population Based ◽

Group B

Download Full-text

Group B Streptococcus (Streptococcus agalactiae)

10.1093/med/9780190604813.003.0019 ◽

2018 ◽

Author(s):

Kirsty Le Doare ◽

Christine E. Jones ◽

Paul T. Heath

Keyword(s):

Early Onset ◽

Late Onset ◽

Group B Streptococcus ◽

Significant Risk ◽

Neonatal Infection ◽

Significant Risk Factor ◽

Invasive Disease ◽

Neurodevelopmental Outcomes ◽

Intrapartum Antibiotic ◽

Group B

Group B Streptococcus (GBS) is a leading cause of early neonatal infection and neonatal mortality, with long-term adverse neurodevelopmental outcomes in up to 50% of survivors of GBS meningitis. GBS has a likely underappreciated role in causing preterm birth and stillbirth. GBS colonizes the vagina and gastrointestinal tract of the pregnant woman, and transmission to the infant occurs during or just before delivery. Although the majority of these infants do not develop invasive disease, maternal colonization is a prerequisite for early onset disease (0–6 days of life, most commonly associated with sepsis and respiratory distress) and a significant risk factor for late onset disease (7–89 days of life, most commonly associated with sepsis and meningitis). The introduction of intrapartum antibiotic prophylaxis has resulted in significant declines in the incidence of early onset disease but provides no protection against late onset disease.

Download Full-text

The Italian arm of the PREPARE study: an international project to evaluate and license a maternal vaccine against group B streptococcus

Italian Journal of Pediatrics ◽

10.1186/s13052-020-00923-3 ◽

2020 ◽

Vol 46 (1) ◽

Author(s):

Alberto Berardi ◽

◽

Tiziana Cassetti ◽

Roberta Creti ◽

Caterina Vocale ◽

...

Keyword(s):

Low Income ◽

Pregnancy Outcomes ◽

Group B Streptococcus ◽

Invasive Disease ◽

Low Income Countries ◽

International Project ◽

Main Body ◽

Non Profit ◽

Maternal Vaccination ◽

Group B

Abstract Background Group B streptococcus (GBS) is a leading cause of sepsis, pneumonia and meningitis in infants, with long term neurodevelopmental sequelae. GBS may be associated with poor pregnancy outcomes, including spontaneous abortion, stillbirth and preterm birth. Intrapartum antibiotic prophylaxis (IAP) is currently the only way to prevent early-onset disease (presenting at 0 to 6 days of life), although it has no impact on the disease presenting over 6 days of life and its implementation is challenging in resource poor countries. A maternal vaccine against GBS could reduce all GBS manifestations as well as improve pregnancy outcomes, even in low-income countries. Main body The term “PREPARE” designates an international project aimed at developing a maternal vaccination platform to test vaccines against neonatal GBS infections by maternal immunization. It is a non-profit, multi-center, interventional and experimental study (promoted by the St George University of London. [UK]) with the aim of developing a maternal vaccination platform, determining pregnancy outcomes, and defining the extent of GBS infections in children and mothers in Africa. PREPARE also aims to estimate the protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa and to conduct two trials on candidate GBS vaccines. PREPARE consists of 6 work packages. In four European countries (Italy, UK, Netherlands, France) the recruitment of cases and controls will start in 2020 and will end in 2022. The Italian PREPARE network includes 41 centers. The Italian network aims to collect: GBS isolates from infants with invasive disease, maternal and neonatal sera (cases); cord sera and GBS strains from colonized mothers whose infants do not develop GBS infection (controls). Short conclusion PREPARE will contribute information on protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa. The vaccine that will be tested by the PREPARE study could be an effective strategy to prevent GBS disease.

Download Full-text

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

Epidemiology and Infection ◽

10.1017/s0950268815000606 ◽

2015 ◽

Vol 143 (15) ◽

pp. 3343-3350 ◽

Cited By ~ 13

Author(s):

E. M. SMITH ◽

M. A. KHAN ◽

A. REINGOLD ◽

J. P. WATT

Keyword(s):

Average Rate ◽

Joint Infection ◽

Group B Streptococcus ◽

Clinical Information ◽

Population Based ◽

Incidence Rates ◽

Active Population ◽

Joint Infections ◽

Sterile Site ◽

Group B

SUMMARYGroup 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).

Download Full-text

Population structure of group B streptococcus from a low-incidence region for invasive neonatal disease

Microbiology ◽

10.1099/mic.0.27826-0 ◽

2005 ◽

Vol 151 (6) ◽

pp. 1875-1881 ◽

Cited By ~ 36

Author(s):

Naiel Bisharat ◽

Nicola Jones ◽

Dror Marchaim ◽

Colin Block ◽

Rosalind M. Harding ◽

...

Keyword(s):

Population Structure ◽

Disease Incidence ◽

Group B Streptococcus ◽

Invasive Disease ◽

Multilocus Genotype ◽

Neonatal Disease ◽

Strain Collection ◽

Low Incidence ◽

Group B ◽

Sequence Types

The population structure of group B streptococcus (GBS) from a low-incidence region for invasive neonatal disease (Israel) was investigated using multilocus genotype data. The strain collection consisted of isolates from maternal carriage (n=104) and invasive neonatal disease (n=50), resolving into 46 sequence types. The most prevalent sequence types were ST-1 (17·5 %), ST-19 (10·4 %), ST-17 (9·7 %), ST-22 (8·4 %) and ST-23 (6·5 %). Serotype III was the most common, accounting for 29·2 % of the isolates. None of the serotypes was significantly associated with invasive neonatal disease. burst analysis resolved the 46 sequence types into seven lineages (clonal complexes), from which only lineage ST-17, expressing serotype III only, was significantly associated with invasive neonatal disease. Lineage ST-22 expressed mainly serotype II, and was significantly associated with carriage. The distribution of the various sequence types and lineages, and the association of lineage ST-17 with invasive disease, are consistent with the results of analyses from a global GBS isolate collection. These findings could imply that the global variation in disease incidence is independent of the circulating GBS populations, and may be more affected by other risk factors for invasive GBS disease, or by different prevention strategies.

Download Full-text