Current status of group B Streptococcus infection in neonates: a multicenter prospective study
ZHU Yao, GAO Lei, HUANG Zhong-Ling, WU Jia-Yin, NI Yan, WANG Ya-Juan, JI Tong-Zhen, WEI Jin-Zhu, ZHANG Chun-Xiu, BA Rui-Hua, OU Fen-Fen, MA Si-Min, HE Ming-Yuan, LIN Rong, PENG Bin, LIN Xin-Zhu
Department of Neonatology, Women and Children's Hospital, School of Medcine, Xiamen University/Xiamen Maternal and Child Care Hospital/Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian 361003, China (Lin X-Z, Email: xinzhufj@163.com)
Abstract Objective To investigate the incidence of maternal group B Streptococcus (GBS) colonization and neonatal early-onset GBS disease (GBS-EOD), and to study the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization. Methods A total of 16 384 pregnant women and 16 634 neonates delivered by them were enrolled prospectively who had medical records in Xiamen Maternal and Child Care Hospital, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, and Zhangzhou Zhengxing Hospital from May 1, 2019 to April 30, 2020. Unified GBS screening time, culture method, and indication for intrapartum antibiotic prophylaxis (IAP) were adopted in the three hospitals. The incidence rates of maternal GBS colonization and neonatal GBS-EOD were investigated. A multivariate logistic regression analysis was used to identify the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization. Results In these three hospitals, the positive rate of GBS culture among the pregnant women in late pregnancy was 11.29% (1 850/16 384), and the incidence rate of neonatal GBS-EOD was 0.96‰ (16/16 634). The admission rate of live infants born to the GBS-positive pregnant women was higher than that of those born to the GBS-negative ones (P<0.05). The live infants born to the GBS-positive pregnant women had a higher incidence rate of GBS-EOD than those born to the GBS-negative ones [6.38‰ (12/1 881) vs 0.27‰ (4/14 725), P<0.05]. The multivariate logistic regression analysis showed that placental swabs positive for GBS and positive GBS in neonatal gastric juice at birth were independent predictive factors for the development of GBS-EOD (P<0.05), while adequate IAP was a protective factor (P<0.05) in the offspring of pregnant women with GBS colonization. Conclusions GBS colonization of pregnant women in late pregnancy has adverse effects on their offspring. It is important to determine prenatal GBS colonization status of pregnant women and administer with adequate IAP based on the indications of IAP to reduce the incidence of neonatal GBS-EOD. Citation:
ZHU Yao,GAO Lei,HUANG Zhong-Ling et al. Current status of group B Streptococcus infection in neonates: a multicenter prospective study[J]. CJCP, 2021, 23(9): 889-895.
ZHU Yao,GAO Lei,HUANG Zhong-Ling et al. Current status of group B Streptococcus infection in neonates: a multicenter prospective study[J]. CJCP, 2021, 23(9): 889-895.
3 Queensland Clinical Guidelines. Early onset group B Streptococcal disease[EB/OL]. (2020-04-20)[2020-12-25]. https://www.health.qld.gov.au/__data/assets/pdf_file/0026/626732/g-gbs.pdf.
Zhu Y, Huang J, Lin XZ, et al. Group B Streptococcus colonization in late pregnancy and invasive infection in neonates in China: a population-based 3-year study[J]. Neonatology, 2019, 115(4): 301-309. PMID: 30808831. DOI: 10.1159/000494133.
6 Garg S, Tin W. Remington and Klein's infectious diseases of the fetus and newborn infant[J]. Semin Fetal Neonatal Med, 2015, 20(6): 442. DOI: 10.1016/j.siny.2015.09.002.
Puopolo KM, Lynfield R, Cummings JJ, et al. Management of infants at risk for group B Streptococcal disease[J]. Pediatrics, 2019, 144(2): e20191881. PMID: 31285392 DOI: 10.1542/peds.2019-1881.
Lu B, Li D, Cui Y, et al. Epidemiology of group B Streptococcus isolated from pregnant women in Beijing, China[J]. Clin Microbiol Infect, 2014, 20(6): O370-O373. PMID: 24118553. DOI: 10.1111/1469-0691.12416.
Lawn JE, Bianchi-Jassir F, Russell NJ, et al. Group B Streptococcal disease worldwide for pregnant women, stillbirths, and children: why, what, and how to undertake estimates?[J]. Clin Infect Dis, 2017, 65(suppl_2): S89-S99. PMID: 29117323. PMCID: PMC5850012. DOI: 10.1093/cid/cix653.
Wu BQ, Su JZ, Li L, et al. Phenotypic and genetic differences among group B Streptococcus recovered from neonates and pregnant women in Shenzhen, China: 8-year study[J]. BMC Microbiol, 2019, 19(1): 185. PMID: 31395013. PMCID: PMC6688368. DOI: 10.1186/s12866-019-1551-2.
Nanduri SA, Petit S, Smelser C, 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[J]. JAMA Pediatr, 2019, 173(3): 224-233. PMID: 30640366. PMCID: PMC6439883. DOI: 10.1001/jamapediatrics.2018.4826.
Matsubara K, Hoshina K, Kondo M, et al. Group B Streptococcal disease in infants in the first year of life: a nationwide surveillance study in Japan, 2011-2015[J]. Infection, 2017, 45(4): 449-458. PMID: 28236250. DOI: 10.1007/s15010-017-0995-2.
Royal College of Obstetricians and Gynaecologists. Prevention of early-onset neonatal group B Streptococcal disease: green-top guideline No. 36[J]. BJOG, 2017, 124(12): e280-e305. PMID: 28901693. DOI: 10.1111/1471-0528.14821.
He Y, Du WX, Jiang HY, et al. Multiplex cytokine profiling identifies interleukin-27 as a novel biomarker for neonatal early onset sepsis[J]. Shock, 2017, 47(2): 140-147. PMID: 27648693. DOI: 10.1097/SHK.0000000000000753.