1887

Abstract

Purpose. Group B Streptococcus (GBS) is one of the major pathogens in severe materno-neonatal infections. We aimed to describe the clinical and molecular characteristics of GBS isolates causing infections in 45 maternal and 50 neonatal subjects, collected from eight healthcare centres in mainland China over the period 2010– 2017.

Methodology. The phenotypic and genotypic features of the GBS isolates, including capsular polysaccharide (cps) serotypes, pilus island (PI) genes and antibiotic resistance profiles and genes, were characterized by both conventional and molecular methods. The clonal relationship between these strains was investigated using multilocus sequence typing (MLST).

Results. Of the 95 isolates, the predominant serotypes were III (51, 53.7 %), V (13, 13.7 %) and Ib (13, 13.7 %). All GBS strains carried at least one pilus island, with 32.6 % carrying PI-2b and 67.4 % PI-2a, singly or in combination. The most frequently-detected pilus island pattern was the combination of PI-1 and PI-2a, accounting for 56.8 % (54 isolates), followed by PI-1 combined with PI-2b (28, 29.5 %), PI-2a (10, 10.5 %) and PI-2b (3, 3.2 %). The strains were classified into 17 individual sequence types, and further clustered into six clonal complexes (CCs). A high prevalence of CC17/PI-1 and PI-2b (17, 34.0 %) was detected in 50 GBS isolates causing neonatal infections. No strain was resistant to penicillin, ampicillin, ceftriaxone or vancomycin, whereas 78.9, 76.8 and 81.5 % were resistant to erythromycin, clindamycin and tetracycline, respectively.

Conclusion. Our study highlights the high genotypic diversity of GBS strains causing materno-neonatal infections, and the CC17/PI-1 and PI-2b sublineages should be noted in neonatal infections.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000849
2018-09-28
2019-12-05
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/11/1551.html?itemId=/content/journal/jmm/10.1099/jmm.0.000849&mimeType=html&fmt=ahah

References

  1. 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;59:1–36[PubMed]
    [Google Scholar]
  2. Kwatra G, Cunnington MC, Merrall E, Adrian PV, Ip M et al. Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis. Lancet Infect Dis 2016;16:1076–1084 [CrossRef][PubMed]
    [Google Scholar]
  3. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev 2014;27:21–47 [CrossRef][PubMed]
    [Google Scholar]
  4. Joubrel C, Tazi A, Six A, Dmytruk N, Touak G et al. Group B streptococcus neonatal invasive infections, France 2007–2012. Clin Microbiol Infect 2015;21:910–916 [CrossRef][PubMed]
    [Google Scholar]
  5. Edmond KM, Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AKM et al. Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis. The Lancet 2012;379:547–556 [CrossRef]
    [Google Scholar]
  6. Seale AC, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ et al. Estimates of the burden of Group B Streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin Infect Dis 2017;65:S200–S219 [CrossRef][PubMed]
    [Google Scholar]
  7. Filleron A, Lombard F, Jacquot A, Jumas-Bilak E, Rodière M 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–F47 [CrossRef][PubMed]
    [Google Scholar]
  8. Zimmermann P, Gwee A, Curtis N. The controversial role of breast milk in GBS late-onset disease. J Infect 2017;74:S34–S40 [CrossRef][PubMed]
    [Google Scholar]
  9. Martins ER, Andreu A, Melo-Cristino J, Ramirez M. Distribution of pilus islands in Streptococcus agalactiae that cause human infections: insights into evolution and implication for vaccine development. Clin Vaccine Immunol 2013;20:313–316 [CrossRef][PubMed]
    [Google Scholar]
  10. Dangor Z, Lala SG, Kwatra G, Madhi SA. Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections. Curr Opin Infect Dis 2016;29:262–267 [CrossRef][PubMed]
    [Google Scholar]
  11. Yao K, Poulsen K, Maione D, Rinaudo CD, Baldassarri L et al. Capsular gene typing of Streptococcus agalactiae compared to serotyping by latex agglutination. J Clin Microbiol 2013;51:503–507 [CrossRef][PubMed]
    [Google Scholar]
  12. Lu B, Li D, Cui Y, Sui W, Huang L et al. Epidemiology of Group B streptococcus isolated from pregnant women in Beijing, China. Clin Microbiol Infect 2014;20:O370–O373 [CrossRef][PubMed]
    [Google Scholar]
  13. Vornhagen J, Adams Waldorf KM, Rajagopal L. Perinatal group B streptococcal infections: virulence factors, immunity, and prevention strategies. Trends Microbiol 2017;25:919–931 [CrossRef][PubMed]
    [Google Scholar]
  14. Margarit I, Rinaudo CD, Galeotti CL, Maione D, Ghezzo C et al. Preventing bacterial infections with pilus-based vaccines: the group B streptococcus paradigm. J Infect Dis 2009;199:108–115 [CrossRef][PubMed]
    [Google Scholar]
  15. Da Cunha V, Davies MR, Douarre PE, Rosinski-Chupin I, Margarit I et al. Streptococcus agalactiae clones infecting humans were selected and fixed through the extensive use of tetracycline. Nat Commun 2014;5:4544 [CrossRef][PubMed]
    [Google Scholar]
  16. Brochet M, Couvé E, Bercion R, Sire JM, Glaser P. Population structure of human isolates of Streptococcus agalactiae from Dakar and Bangui. J Clin Microbiol 2009;47:800–803 [CrossRef][PubMed]
    [Google Scholar]
  17. Back EE, O'Grady EJ, Back JD. High rates of perinatal group B Streptococcus clindamycin and erythromycin resistance in an upstate New York hospital. Antimicrob Agents Chemother 2012;56:739–742 [CrossRef][PubMed]
    [Google Scholar]
  18. Dutra VG, Alves VM, Olendzki AN, Dias CA, de Bastos AF et al. Streptococcus agalactiae in Brazil: serotype distribution, virulence determinants and antimicrobial susceptibility. BMC Infect Dis 2014;14:323 [CrossRef][PubMed]
    [Google Scholar]
  19. Imperi M, Gherardi G, Berardi A, Baldassarri L, Pataracchia M et al. Invasive neonatal GBS infections from an area-based surveillance study in Italy. Clin Microbiol Infect 2011;17:1834–1839 [CrossRef][PubMed]
    [Google Scholar]
  20. CLSI Performance Standards for Antimicrobial Susceptibility Testing, 27nd Informational Supplement M100-A27. Wayne, PA: Clinical and Laboratory Standards Institute; 2017
    [Google Scholar]
  21. Lu B, Wang D, Zhou H, Zhu F, Li D et al. Distribution of pilus islands and alpha-like protein genes of group B Streptococcus colonized in pregnant women in Beijing, China. Eur J Clin Microbiol Infect Dis 2015;34:1173–1179 [CrossRef][PubMed]
    [Google Scholar]
  22. Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: a systematic review and meta-analysis. BMC Infect Dis 2015;15:118 [CrossRef][PubMed]
    [Google Scholar]
  23. Tazi A, Disson O, Bellais S, Bouaboud A, Dmytruk N et al. The surface protein HvgA mediates group B streptococcus hypervirulence and meningeal tropism in neonates. J Exp Med 2010;207:2313–2322 [CrossRef][PubMed]
    [Google Scholar]
  24. Jones N, Bohnsack JF, Takahashi S, Oliver KA, Chan MS et al. Multilocus sequence typing system for group B streptococcus. J Clin Microbiol 2003;41:2530–2536 [CrossRef][PubMed]
    [Google Scholar]
  25. Lu B, Fang Y, Huang L, Diao B, du X et al. Molecular characterization and antibiotic resistance of clinical Streptococcus dysgalactiae subsp. equisimilis in Beijing, China. Infect Genet Evol 2016;40:119–125 [CrossRef][PubMed]
    [Google Scholar]
  26. Martins ER, Andreu A, Correia P, Juncosa T, Bosch J et al. Group B streptococci causing neonatal infections in barcelona are a stable clonal population: 18-year surveillance. J Clin Microbiol 2011;49:2911–2918 [CrossRef][PubMed]
    [Google Scholar]
  27. Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics 2011;128:e1155-63 [CrossRef][PubMed]
    [Google Scholar]
  28. Seale AC, Blencowe H, Bianchi-Jassir F, Embleton N, Bassat Q et al. Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2017;65:S125–S132 [CrossRef][PubMed]
    [Google Scholar]
  29. Manning SD, Springman AC, Lehotzky E, Lewis MA, Whittam TS et al. Multilocus sequence types associated with neonatal group B streptococcal sepsis and meningitis in Canada. J Clin Microbiol 2009;47:1143–1148 [CrossRef][PubMed]
    [Google Scholar]
  30. Lu B, Chen X, Wang J, Wang D, Zeng J et al. Molecular characteristics and antimicrobial resistance in invasive and noninvasive Group B Streptococcus between 2008 and 2015 in China. Diagn Microbiol Infect Dis 2016;86:351–357 [CrossRef][PubMed]
    [Google Scholar]
  31. Koenig JM, Keenan WJ. Group B streptococcus and early-onset sepsis in the era of maternal prophylaxis. Pediatr Clin North Am 2009;56:689–708 [CrossRef][PubMed]
    [Google Scholar]
  32. Huber CA, McOdimba F, Pflueger V, Daubenberger CA, Revathi G. Characterization of invasive and colonizing isolates of Streptococcus agalactiae in East African adults. J Clin Microbiol 2011;49:3652–3655 [CrossRef][PubMed]
    [Google Scholar]
  33. Seale AC, Koech AC, Sheppard AE, Barsosio HC, Langat J et al. Maternal colonization with Streptococcus agalactiae and associated stillbirth and neonatal disease in coastal Kenya. Nat Microbiol 2016;1:16067 [CrossRef][PubMed]
    [Google Scholar]
  34. Li L, Wang R, Huang Y, Huang T, Luo F et al. High Incidence of Pathogenic Streptococcus agalactiae ST485 Strain in Pregnant/Puerperal Women and Isolation of Hyper-Virulent Human CC67 Strain. Front Microbiol 2018;9:50 [CrossRef][PubMed]
    [Google Scholar]
  35. Teatero S, McGeer A, Low DE, Li A, Demczuk W et al. Characterization of invasive group B streptococcus strains from the greater Toronto area, Canada. J Clin Microbiol 2014;52:1441–1447 [CrossRef][PubMed]
    [Google Scholar]
  36. 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 [CrossRef][PubMed]
    [Google Scholar]
  37. Madzivhandila M, Adrian PV, Cutland CL, Kuwanda L, Madhi SA et al. Distribution of pilus islands of group B streptococcus associated with maternal colonization and invasive disease in South Africa. J Med Microbiol 2013;62:249–253 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000849
Loading
/content/journal/jmm/10.1099/jmm.0.000849
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error