Changes in the Incidence and Epidemiology of Neonatal Group B Streptococcal Disease over the Last Two Decades in Crete, Greece

Vergadi, Eleni; Manoura, Antonia; Chatzakis, Emmanouil; Karavitakis, Emmanouil; Maraki, Sofia; Galanakis, Emmanouil

doi:10.4081/idr.2018.7744

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…In the present study, the overall incidence of invasive GBS infections in infants (0.18 per 1000 live births) was estimated to be more than 2.5 fold lower than the global burden of invasive GBS disease in newborns (0.49-0.53 www.nature.com/scientificreports/ per 1000 live births) 22 . However, the evaluated incidence is similar to that inferred for Crete (Greece) over a 22-year period where overall GBS incidence was 0.17 per 1000 live births 23 . In the present study, a slight decline in the incidence of both EOD and LOD cases was registered during the observed 5-year period.…”

Section: Discussionsupporting

confidence: 76%

Trends in molecular characteristics and antimicrobial resistance of group B streptococci: a multicenter study in Serbia, 2015–2020

Kekić

Gajić

Opavski

et al. 2021

Sci Rep

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Group B Streptococcus (GBS) is a major cause of neonatal morbidity and mortality. Serbia has not fully implemented preventive measures against GBS neonatal diseases. Therefore, we aimed to assess the maternal GBS colonisation and invasive neonatal disease rate, to reveal the trends of antimicrobial resistance and serotype distribution of GBS from various patient groups. Randomly selected non-invasive (n = 991) and all invasive GBS (n = 80) collected throughout Serbia from 2015 to 2020 were tested for antimicrobial susceptibility, capsular typing, and hvgA detection. Overall, 877/5621 (15.6%) pregnant women were colonised with GBS. Invasive GBS infections incidence in infants (0.18/1000 live births) showed a decreasing trend (0.3 to 0.1/1000 live births). Type III was overrepresented in infants with invasive infections (n = 35, 58.3%), whereas type V predominated among colonised adults (n = 224, 25.5%) and those with noninvasive (n = 37, 32.5%) and invasive infections (n = 8, 40%). The hypervirulent clone III/ST17 was highly associated with invasive infections (n = 28, 35%), particularly late-onset disease (n = 9, 47.4%), showing an increase from 12.3 to 14.8%. The GBS resistance to erythromycin and clindamycin was 26.7% and 22.1%, respectively, with an upward trend. The emergence of the hypervirulent clone III/ST17 and the escalation in GBS resistance highlight an urgent need for continuous monitoring of GBS infections.

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Section: Discussionsupporting

confidence: 76%

Trends in molecular characteristics and antimicrobial resistance of group B streptococci: a multicenter study in Serbia, 2015–2020

Kekić

Gajić

Opavski

et al. 2021

Sci Rep

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“…First, the GBS colonization rate calculated may be underestimated for the following reasons: (a) a significant number of participants did not undergo screening; (b) most screening samples were only vaginal; (c) the timing of the cultures obtained, and culture conditions were not found in the medical records reviewed. Indeed, omission of the vaginal-rectal sampling, the timing of cultures more than five weeks prior to delivery, and lack of culture enrichment with selective broths may lead to increased false-negative results [ 7 , 21 , 22 , 23 , 28 ]. However, an increased rate in GBS colonization in the Greek population of women compared to the previously known rate was highlighted.…”

Section: Discussionmentioning

confidence: 99%

“…However, the mortality rate appears to be relatively high at 6.9% [ 6 ]. In Greece, a recent study revealed a lower incidence at approximately 0.17 cases per 1000 live births with a similar mortality rate [ 7 ]. According to the Center for Disease Control and Prevention (CDC) guidelines, the administration of intrapartum antimicrobial prophylaxis (IAP) to colonized pregnant women has been shown to reduce the EOD incidence in neonates [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The second approach is based on universal antepartum screening, in which vaginal-rectal cultures are obtained from all pregnant women between 36 0/7 and 36 6/7 weeks’ gestation; this specific timing for screening provides a 5-week frame, in which the culture results are considered valid, and includes births up to 41 gestation weeks. A swab from the lower vagina near the introitus and then from the rectum without the use of a speculum is obtained [ 5 , 7 , 8 , 13 ]. Therefore, in many countries, including the USA, Greece, as well as most other European countries, IAP is offered according to the screening results.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…As a result of preventive efforts, the overall incidence of invasive neonatal GBS infection has declined significantly over the past few years. 6 Streptococcus agalactiae has a rhamnose-glucosamine polymer bound to the peptidoglycan layer, an antigen combination that characterizes it as the only member of group B. Classification within the 10 existing serotypes (Ia, Ib, II, III, IV, V, VI, VII, VIII, and IX) is due to the different capsular dispositions of glucose, galactose, N-acetylglucosamine, and acid N-acetylneuraminic acid.…”

Section: Introductionmentioning

confidence: 99%

Phenotypic and Genotypic Characterization of Resistance to Macrolides and Lincosamides inStreptococcus agalactiaeIsolated from Pregnant Women in Misiones, Argentina

Novosak

Bobadilla

Delgado

et al. 2020

Microbial Drug Resistance

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The aim of this work was to determine the susceptibility, molecular profile, and clonal relationship in Streptococcus agalactiae (group B Streptococcus [GBS]) isolated from vaginal-rectal swab samples. We worked with 200 isolates collected from pregnant women between 35 and 37 weeks of gestation. The macrolidelincosamide-streptogramin B (MLS B ) resistance phenotypes were determined using the double-disc assay. Susceptibility to erythromycin (ERI) and clindamycin (CLI) was performed with the E-test. Resistance genes ermB and ermTR were detected by polymerase chain reaction. Clonal studies were performed using the random amplification of polymorphic DNA. Twelve (6%) of the isolates were resistant to ERI and 10 (5%) of them to CLI. Fifty percent of the resistant strains corresponded to serotype III, 25% to serotype V, and the remaining 25% to serotype Ia, II, and nontypeable strains. The cMLS B phenotype was detected in eight strains (66.67%) and the iMLS B phenotype in four (33.33%). The minimum inhibitory concentration values were between 1.5 and 16 mg/mL for ERI, and between 1 and 32 mg/mL for CLI. Out of the 25 strains susceptible to ERI and CLI, the presence of the ermB gene was detected in eight of them and the ermTR gene in one strain. The ermB gene was detected in the 12 strains that initially had some macrolide resistance phenotype. The ermTR gene was detected in three out of the four strains with the iMLS B phenotype. The resistance to macrolides in the province of Misiones is due to multiclonal spread. The phenotypic and genotypic characterization of macrolide resistance in GBS strains are crucial to contribute to the correct intrapartum prophylactic antibiotic therapy of allergic pregnant women and the epidemiological surveillance of these strains.

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Changes in the Incidence and Epidemiology of Neonatal Group B Streptococcal Disease over the Last Two Decades in Crete, Greece

Cited by 11 publications

References 27 publications

Trends in molecular characteristics and antimicrobial resistance of group B streptococci: a multicenter study in Serbia, 2015–2020

Trends in molecular characteristics and antimicrobial resistance of group B streptococci: a multicenter study in Serbia, 2015–2020

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

Phenotypic and Genotypic Characterization of Resistance to Macrolides and Lincosamides inStreptococcus agalactiaeIsolated from Pregnant Women in Misiones, Argentina

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