Group B Streptococcal Infections in a Northern Region of Italy

Berardi, Alberto; Lugli, Licia; Baronciani, Dante; Creti, Roberta; Rossi, Katia; Ciccia, Matilde; Gambini, Lucia; Mariani, Simone; Papa, Irene; Serra, Laura; Tridapalli, Elisabetta; Ferrari, Fabrizio

doi:10.1542/peds.2006-3246

Cited by 53 publications

(34 citation statements)

References 29 publications

(24 reference statements)

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“…In this report, 36% of cases were EOD. For 71% of EOD cases, maternal vaginal screening before delivery had not been conducted or was negative for GBS, thus likely explaining the persistence of EOD, as already suggested by others (12,13). In our study, LOD represents the majority of cases (64%), which is consistent with fi ndings in countries where a screening approach, together with IAP, was adopted (2,11,13).…”

Section: Discussionsupporting

confidence: 90%

“…For 71% of EOD cases, maternal vaginal screening before delivery had not been conducted or was negative for GBS, thus likely explaining the persistence of EOD, as already suggested by others (12,13). In our study, LOD represents the majority of cases (64%), which is consistent with fi ndings in countries where a screening approach, together with IAP, was adopted (2,11,13).Clinical symptoms were signifi cantly associated with the time of infection onset: EOD was mostly associated with sepsis (72%), whereas LOD was more frequently responsible for meningitis (65.7%) (p<0.01). Deaths, all associated with meningitis, were higher in LOD (14.5%) than in EOD cases (2.5%).…”

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confidence: 89%

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Invasive Group B Streptococcal Infections in Infants, France

Poyart¹,

Réglier-Poupet²,

Tazi³

et al. 2008

Emerg. Infect. Dis.

109

107

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Clinical features and molecular characterization of 109 group B streptococci causing neonatal invasive infections were determined over an 18-month period in France. Sixtyfour percent of the strains were from late-onset infections, and 75% were capsular type III. The hypervirulent clone ST-17 was recovered in 80% of meningitis cases. G roup B Streptococcus (GBS)is the leading cause of infectious illness among newborns. Invasive infections in neonates can result in pneumonia, sepsis, or meningitis. Early-onset disease (EOD) occurs within the fi rst week. Lateonset disease (LOD) occurs after the fi rst week and accounts for most meningitis cases and deaths (1). Because recommendations for intrapartum antibioprophylaxis (IAP) for mothers in labor at risk for GBS infection have been widely implemented in many countries, the incidence of EOD has declined to <1/1,000 births, but the incidence of LOD has remained unchanged (2). To date, 10 capsular serotypes have been described (Ia, Ib, and II-IX). Among these, serotype III is of particular importance because it is responsible for a substantial proportion of EOD and most cases of . Different studies have suggested that most neonatal invasive diseases and almost all cases of meningitis are caused by a limited number of strains belonging to a homogeneous serotype III clone. This clone is defi ned by multilocus sequence typing (MLST) analyses as ST-17, the so-called highly virulent clone (4-8). However, data available in Europe are limited regarding the distribution of GBS genotypes among invasive isolates recovered from neonates.We describe clinical characteristics, capsular type, and MLST allelic and antimicrobial drug-susceptibility profi les of 109 nonredundant GBS isolates that caused neonatal invasive infections. These isolates were collected during an active surveillance performed in France from May 2006 through December 2007. The StudyClinical data on 109 infants up to 4 months of age were analyzed. Sepsis was defi ned as GBS bacteremia in the presence of consistent clinical signs and symptoms. Meningitis was diagnosed if GBS was recovered from cerebrospinal fl uid. GBS isolates were identifi ed by using a commercial Lancefi eld group-specifi c latex agglutination test. Capsular typing was performed by a multiplex PCR as described (9), and the hypervirulent ST-17 clone was detected by real-time PCR, as reported (6). Susceptibility testing, antibiograms, and MICs were performed according to Clinical and Laboratory Standards Institute recommendations (www.clsi.org). Antimicrobial drug-resistance genes were detected by using the multiplex PCR as described (10). Statistical analysis was performed according to the Fisher exact and χ 2 tests. A p value of <0.05 was used as the threshold for statistical signifi cance.We studied 109 GBS strains responsible for neonatal invasive infections; 36% (n = 39) and 64% (n = 70) were responsible for EOD and LOD, respectively (Table). Eighty percent of EOD cases occurred during the fi rst 24 hours after birth, with a male:female rati...

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Section: Discussionsupporting

confidence: 90%

supporting

confidence: 89%

Invasive Group B Streptococcal Infections in Infants, France

Poyart¹,

Réglier-Poupet²,

Tazi³

et al. 2008

Emerg. Infect. Dis.

109

107

View full text Add to dashboard Cite

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“…We also gathered data on potential explanatory variables (ie, variables that might explain variance in incidence or risk of group B streptococcus; 21 Andersen et al 22 Ekelund et al 23 Kuhn et al 24 Fluegge et al 25 Berardi et al 26 Trijbels-Smeulders et al 27 van den Hoogen et al 28 Hasseltvedt et al 29 Hajdu et al 30 Neto et al 31 Janek et al 32 Carbonell-Estrany et al 33 Lopez Sastre et al 34 Andreu et al 35 Persson et al 36 Heath et al 37 Oddie et al 38 Weisner et al 39 Vergnano et al 40 Subtotal (I 2 =98·6%, p=0·000)…”

Section: Data Extractionmentioning

confidence: 99%

“…Strakova et al 21 Fluegge et al 25 Berardi et al 26 Trijbels-Smeulders et al 27 Hasseltvedt et al 29 Hajdu et al 30 Neto et al 31 Carbonell-Estrany et al 33 Persson et al 36 Heath et al 37 Oddie et al 38 Weisner et al 39 Subtotal (I 2 =87·8%, p=0·000)…”

Section: Year Europementioning

confidence: 99%

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

Edmond¹,

Kortsalioudaki²,

Scott³

et al. 2012

The Lancet

526

457

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SummaryBackground Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mortality in infants in Europe, the Americas, and Australia. However, estimates of disease burden in many countries outside of these regions is not available. We aimed to examine the current global burden of invasive disease and the serotype distribution of group B streptococcus isolates.

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“…Strategies are not fully effective by themselves and have drawbacks which may result in non-adherence by both care providers and women. For example: over 40% of neonates who develop EOGBS are born to mothers without a risk factor [8,9] (risk-based strategy, combination strategy and Dutch guideline), the sensitivity of the methods to detect GBS in pregnant women is low and accounts for a consistent proportion of EOGBS cases [9][10][11][12] (riskbased strategy, screening strategy and the Dutch guideline), large numbers of women receiving antibiotics (screening strategy) with possible negative side-effects such as antibiotic resistance [9] (based on the difference between application of antibiotics to all GBS colonized women or to a selection of GBS colonized women with a risk factor) and premature cases are missed, because the current GBS screening starts from 35 weeks of gestation onward (screening strategy and combination strategy). Another problem with low adherence to the preventive strategies is that a substantial proportion of women will not receive the intended care or even receive unnecessary care and this affects outcomes in women and their children [13].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators related to the uptake of four strategies to prevent neonatal early-onset group B haemolytic streptococcus disease: a qualitative study

Kolkman

Fleuren

Wouters

et al. 2017

BMC Pregnancy Childbirth

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Background: Actions to prevent early onset disease in neonates are based on different strategies including administering antibiotic prophylaxis during labour in case of 1) maternal GBS colonisation (screening strategy), 2) identified risk factors (risk-based strategy) or 3) a combination of these two conditions (maternal GBS colonisation and identified risk factors: combination strategy and the Dutch guideline). Low adherence to guidelines preventing EOGBS has been reported. Each strategy has drawbacks and clinical outcomes are affected by care providers' and women's adherence. The actual impact of any preventive strategy is the product of efficacy of the strategy and the level of implementation. In order to reduce neonatal death due to EOGBS by developing the optimal guideline, we analysed barriers and facilitators of current used strategies.Methods: Focus group and personal interviews with care providers and women were performed. Impeding and enhancing factors in adherence to the preventive strategies were discussed and scored using the Measurement Instrument for Determinants of Innovations (MIDI) and analysed by two independent researchers.Results: Overall, care providers identified 3.6 times more factors that would impede (n = 116) rather than facilitate (n = 32) adherence to the preventive strategies. 28% facilitative factors were reported in relation to the combination strategy and 86% impeding factors in relation to the Dutch guideline. The most preferred strategy was the combination strategy by 74% of the care providers and by 86% of the women.Discussion: We obtained a detailed understanding of factors that influence adherence to preventive strategies. This insight can be used to develop implementation activities to improve the uptake of new strategies.Trial registration: The trial is registered in the Dutch Trial Register NTR3965.

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Group B Streptococcal Infections in a Northern Region of Italy

Cited by 53 publications

References 29 publications

Invasive Group B Streptococcal Infections in Infants, France

Invasive Group B Streptococcal Infections in Infants, France

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

Barriers and facilitators related to the uptake of four strategies to prevent neonatal early-onset group B haemolytic streptococcus disease: a qualitative study

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