scholarly journals Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS Late-Onset Sepsis

2021 ◽  
Vol 12 ◽  
Author(s):  
Mirjam Freudenhammer ◽  
Konstantinos Karampatsas ◽  
Kirsty Le Doare ◽  
Fabian Lander ◽  
Jakob Armann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Risk ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Retrospective Case ◽  
Late Onset Sepsis ◽  
Increased Risk ◽  
Group B ◽  
The Individual ◽  
The Uk

Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.

scholarly journals Poor Adherence to the Screening-Based Strategy of Group B Streptococcus Despite Colonization of Pregnant Women in Greece

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 418
Author(s):  
Maria Maroudia Berikopoulou ◽  
Aikaterini Pana ◽  
Theodota Liakopoulou-Tsitsipi ◽  
Nikos F. Vlahos ◽  
Vasiliki Papaevangelou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pregnant Women ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Culture Collection ◽  
Carrier Status ◽  
Cross Sectional ◽  
Screening Guidelines ◽  
Group B

Group B streptococcus (GBS) is a leading cause of serious neonatal infections. Maternal GBS colonization is associated with early- and late-onset neonatal disease (EOD/LOD). In Greece, a screening-based strategy is recommended, in which concurrent vaginal-rectal cultures should be obtained between 36 0/7 and 37 6/7 weeks’ gestation. We sought to examine the level of adherence to the GBS screening guidelines and estimate the prevalence of GBS colonization among pregnant women. Although in Greece the screening-based strategy is followed, we also examined known EOD risk factors and linked them to GBS colonization. A cross-sectional study of 604 women postpartum in three hospitals and maternity clinics was conducted. Following written informed consent, data were collected via a short self-completed questionnaire and review of patients’ records. In 34.6% of the enrolled pregnant women, no culture had been taken. Of the remaining, 12.8% had proper vaginal-rectal sample collections. The overall maternal colonization rate was 9.6%. At least one risk factor for EOD was identified in 12.6% of participants. The presence of risk factors was associated with positive cultures (p = 0.014). The rate of culture collection did not differ between women with or without an EOD risk factor. Adherence to a universal screening of pregnant women with vaginal-rectal cultures was poor. Despite probable underestimation of GBS carrier status, almost 1 in 10 participants were GBS positive during pregnancy. Screening of women with risk factors for EOD should, at least, be prioritized to achieve prevention and prompt intervention of EOD.

scholarly journals A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya

2011 ◽  
Vol 5 (11) ◽  
pp. 799-803 ◽  
Author(s):  
Ruchika Kohli-Kochhar ◽  
Geoffrey Omuse ◽  
Gunturu Revathi
Keyword(s):  
Developing Countries ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Gram Positive ◽  
Late Onset Sepsis ◽  
Group B ◽  
The Right

Introduction: Neonatal mortality in developing countries is usually due to an infectious cause.  The gold standard of investigation in developing countries is a positive blood culture.  It is important to know the aetiology of neonatal bloodstream infections so that empiric treatment can be effective.  Methodology: We conducted a retrospective clinical audit over ten years between January 2000 until December 2009, looking at the aetiology of both early and late onset neonatal sepsis.  We analysed data from 152 (23%) patient isolates out of 662 suspected cases of neonatal sepsis.  Results: Our study revealed that Gram-positive organisms were the predominant cause of both early and late onset sepsis; the common isolates were Staphylococcus epidermidis (34%) and Staphylococcus aureus (27%).  There were no isolates of group B Streptococcus.  Candida species was isolated only in patients with late onset sepsis (6.9%).  Bacterial isolates were relatively sensitive to the commonly used first- and second-line empiric antibiotics. Conclusion: Gram-positive organisms remain the major cause of neonatal bloodstream infections in our setup.  The findings of this study will guide clinicians in prescribing the right empiric therapy in cases of suspected neonatal sepsis before the definitive culture results are obtained.

The concomitant use of vancomycin and piperacillin-tazobactam is associated with acute kidney injury (AKI) in extremely low birth weight infants (ELBW)

2021 ◽  
pp. 1-7
Author(s):  
Y. Al-Jebawi ◽  
K. Karalic ◽  
P. Shekhawat ◽  
M.J. Mhanna
Keyword(s):  
Acute Kidney Injury ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Late Onset ◽  
Kidney Injury ◽  
Extremely Low Birth Weight ◽  
Retrospective Case ◽  
Low Birth Weight Infants ◽  
Late Onset Sepsis ◽  
Increased Risk

BACKGROUND: Late-onset sepsis is common in extremely low birth weight (ELBW) infants, and it leads to the use of antibiotics to cover resistant organisms, which can be nephrotoxic. Here we have investigated the role of vancomycin plus piperacillin-tazobactam on the rate of acute kidney injury (AKI). METHODS: In a retrospective case-control study, medical records of all ELBW infants who were admitted to our Neonatal Intensive Care Unit (NICU) with late onset sepsis who were prescribed vancomycin plus piperacillin-tazobactam were reviewed for demographics, clinical characteristics, use of potential nephrotoxic medications and outcomes. RESULTS: During the study period, 264 patients were admitted, of whom 28.4%(75/264) received vancomycin plus piperacillin-tazobactam and were matched with 64 controls. There were no differences in gestational age or birth weight between cases and controls [688±160 vs. 689±162 grams (p = 0.99), and 24.7±1.8 vs. 24.7±1.6 weeks (p = 0.99) respectively]. There was no difference in the rate of sepsis between cases and controls [76%(55/72) vs. 64%(41/64) respectively, p = 0.11]. Infants exposed to vancomycin plus piperacillin-tazobactam had a higher percentage of concomitant use of vasopressors and amphotericin. To adjust for confounders, a logistic regression analysis was conducted with AKI as the dependent variable. Use of vasopressors and vancomycin plus piperacillin-tazobactam were the only risk factors associated with AKI with an adjusted OR (95%CI) of 4.08 (1.90–8.74), p <  0.001; and 2.87 (1.26–6.53), p = 0.01 respectively. CONCLUSION: The use of vancomycin plus piperacillin-tazobactam in ELBW infants is associated with an increased risk for AKI.

scholarly journals Neonatal Sepsis: Clinical Considerations

2017 ◽  
Vol 07 (01) ◽  
pp. e54-e59 ◽  
Author(s):  
S. Blatt ◽  
M. Schroth
Keyword(s):  
Neonatal Sepsis ◽  
Late Onset ◽  
Rapid Development ◽  
Group B Streptococcus ◽  
Neonatal Morbidity ◽  
Screening Tests ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Clinical Considerations ◽  
Group B

AbstractUnspecific symptoms and rapid development of sepsis up to septic shock from systemic inflammatory response syndrome (SIRS) are well-known, important issues in neonatology. A common cause is the infection by Streptococcus agalactiae (Group B Streptococcus [GBS]) or Escherichia coli, which contributes significantly to neonatal morbidity and mortality. Whereas early-onset sepsis is normally derived from mother during birth, late-onset sepsis can be transmitted by the environment. Management of neonatal sepsis includes the maintenance of cardiovascular and pulmonary function besides antibiotic therapy. Due to the fact that until today, there are no reliable screening tests for detecting early sepsis, clinical assessment is considered to be of utmost importance.

Risk Factors for Infant Colonization by Hypervirulent CC17 Group B Streptococcus: Toward the Understanding of Late-onset Disease

2019 ◽  
Vol 69 (10) ◽  
pp. 1740-1748 ◽  
Author(s):  
Asmaa Tazi ◽  
Céline Plainvert ◽  
Olivia Anselem ◽  
Morgane Ballon ◽  
Valérie Marcou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Late Onset ◽  
Group B Streptococcus ◽  
High Incidence ◽  
Group B

The hypervirulent group B Streptococcus clone CC17 accounts for the majority of infant late-onset disease (LOD). We provide evidence that the high incidence of CC17 in LOD is likely due to an enhanced post-delivery mother-to-infant transmission.

Group B streptococcus sepsis in an infant presented with cellulitis of soft tissue of neck

2021 ◽  
Vol 14 (8) ◽  
pp. e241683
Author(s):  
Muhammad Moazzam Gulzar ◽  
Andrea Roman ◽  
Rizwan Gul ◽  
Nagabathula Ramesh
Keyword(s):  
Soft Tissue ◽  
Lymph Nodes ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Late Onset Sepsis ◽  
Intravenous Antibiotics ◽  
Early Onset Sepsis ◽  
History Of ◽  
Group B ◽  
Tissue Oedema

We report a case of cellulitis of the soft tissue of the neck with group B streptococcus (GBS) sepsis in a 4-week-old baby boy presented with a 1-day history of fever, irritability and feed refusal. While in the hospital, a left-sided submandibular swelling extending to preauricular area started emerging, which progressed dramatically. Ultrasound scan of the neck confirmed inflammation of the underlying soft tissue while revealing multiple enlarged lymph nodes without any abscess formation and overlying soft tissue oedema. Blood cultures were flagged positive at 9 hours for GBS. The infant was treated with intravenous antibiotics for 2 weeks. GBS is considered a common cause of early-onset sepsis in neonates. However, it can also lead to late-onset sepsis in infancy with variable presentations. In our case, GBS sepsis manifested with cellulitis of the soft tissue of the neck along with swelling of local lymph nodes.

scholarly journals The prevention of neonatal group B streptococcal disease: a report by a working group of the Medical Screening Society

2005 ◽  
Vol 12 (2) ◽  
pp. 60-68 ◽  
Author(s):  
MR Law ◽  
G Palomaki ◽  
Z Alfirevic ◽  
R Gilbert ◽  
P Heath ◽  
...  
Keyword(s):  
Late Onset ◽  
Effective Means ◽  
Group B Streptococcus ◽  
Neonatal Meningitis ◽  
Screening Performance ◽  
Alternative Means ◽  
Neonatal Group ◽  
Group B Streptococcal Disease ◽  
Group B ◽  
The Uk

Streptococcus agalactiae, or Lancefield group B streptococcus (GBS), is the most frequent cause of serious bacterial sepsis, including neonatal meningitis, in UK neonates. Early-onset neonatal GBS infection, but not late-onset, can be prevented by screening to identify high-risk pregnancies and administering penicillin during delivery. A vaccine has been developed as an alternative means of prevention but it is awaiting a randomized trial before being available for general use. In this review we examine the published literature to assess the morbidity and mortality attributable to neonatal GBS infection, quantify the screening performance of the two alternative modes of screening (microbiological and risk factor based), review the evidence on the efficacy of the vaccine, and estimate the numbers of deaths and cases of serious disability that each strategy in turn might prevent in the UK, in order to assess the most effective means of prevention for the UK.

scholarly journals Aetiologies and risk factors for neonatal sepsis and pneumonia mortality among Alaskan infants

2005 ◽  
Vol 133 (5) ◽  
pp. 877-881 ◽  
Author(s):  
B. D. GESSNER ◽  
L. CASTRODALE ◽  
M. SORIANO-GABARRO
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Rate Ratio ◽  
Neonatal Period ◽  
Group B Streptococcus ◽  
Sepsis Mortality ◽  
Term Infants ◽  
Gram Positive Bacteria ◽  
Increased Risk ◽  
Group B

We evaluated all fatal neonatal sepsis and pneumonia cases occurring in Alaska during 1992–2000. Risk factors were evaluated using a database of all births occurring during the study period. Of 32 cases, group B streptococcus (GBS) was isolated from 21% (all <7 days of age), Candida spp. from 19% (all >7 days of age), non-GBS Gram-positive bacteria from 50% (53% <7 days of age), and Gram-negative infections from 38% (58% <7 days of age). Infants born at <37 weeks gestation accounted for 72% of cases and had an increased risk of GBS [rate ratio (RR) 9·1, 95% confidence interval (CI) 2·0–41] and non-GBS (RR 40, 95% CI 16–101) disease. Neonatal sepsis mortality has become an outcome concentrated among pre-term infants. Aetiologies include GBS during the early neonatal period, Candida spp. during the late neonatal period, and other bacteria during both periods.

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