Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes

Abstract

Background: Streptococcus agalactiae (also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases. Methods: From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia. Results: During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, n = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes. Conclusions: a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.

The Clinical and Genetic Characteristics of Streptococcus agalactiae Meningitis in Neonates

“…We found that GBS meningitis is associated with more severe clinical manifestations and worse long-term neurological outcomes in neonates. Most of the GBS isolates that caused neonatal meningitis in our cohort belong to the type III/CC17 and type Ib/CC12 strains, which is compatible with previous studies [4,6,[21][22][23][24]. WGS was used to investigate the genetic differences between the GBS isolates of neonatal meningitis and those that caused neonatal sepsis in our cohort, and we found the presence of BspC, HvgA, and PezT genes, as well as ICESag37, to be potentially associated with the occurrence of GBS meningitis.…”

Virulence Factor Genes and Cytotoxicity of Streptococcus agalactiae Isolated from Bovine Mastitis in Poland

“… Streptococcus agalactiae (group B Streptococcus ; GBS) is the main cause of infections in human neonates and young infants ( 1 ). It is also an important opportunistic pathogen which colonizes the gastrointestinal and genitourinary tracts, throat, and skin of healthy adults ( 2 ).…”

Prediction model of death risk in patients with sepsis and screening of biomarkers for prognosis of patients with myocardial injury

“…The secretion and release of natriuretic peptides increase rapidly after myocardial injury, left ventricular filling pressure, and wall tension, which has a specific diagnostic value for diastolic cardiac insufficiency and myocardial injury [ 23 ]. However, many factors such as age, renal insufficiency, and pulmonary hypertension may affect the secretion of natriuretic peptides, especially in sepsis patients, which may be related to the pathophysiological changes and volume resuscitation of sepsis [ 24 , 25 ]. Therefore, finding more reliable and accurate biomarkers in clinical work is necessary to promote the implementation of clinical decision-making.…”