Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS Late-Onset Sepsis

Abstract

Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.

Clinical Risk Factors Associated With Late-Onset Invasive Group B Streptococcal Disease: Systematic Review and Meta-Analyses

“…It is important to note that we compared rates of LOGBS in multiple-gestation pregnancies and singletons. Due to the use of aggregate data, we did not assess the risk of LOGBS for an infant with a twin sibling with iGBS disease (EOGBS or LOGBS), which is known to be significantly raised, since the multiples have the same mother, thus the same potential exposure to GBS colonization either vertically or horizontally [ 46 ].…”

Infants Younger Than 90 Days Admitted for Late-Onset Sepsis Display a Reduced Abundance of Regulatory T Cells

“…Additional risk factors may include higher exposure rate to antenatal antibiotics and Caesarean section as noted in the IBI subgroup of our cohort. The dynamics of GBS late-onset infections despite positive screening and intrapartum prophylaxis in some IBI infants also suggest fluctuations in host immunity that contribute to failure of natural niche occupation of pathobionts (31). On the other hand, infants with viral disease were most often younger siblings which is a known risk factor for household transmission of viruses.…”

Congenital Infection Influence on Early Brain Development Through the Gut-Brain Axis

“…A closer look at specific congenital infections resulting from III establishes the fetal response and adverse effects these infections can have on the fetal microbiome. For instance, Group B streptococcus (GBS) infection during labor or birth can lead to invasive GBS disease, encompassing a set of far-reaching sequelae on the neonatal organ systems, including alterations in neonatal intestinal composition, with reduction in Bifidobacteria or an increase of Firmicutes species ( Aloisio et al, 2014 ; Stearns et al, 2017 ; Freudenhammer et al, 2021 ). As described in the next section, exposure to antibiotics to treat infections such as GBS may create their own set of issues related to disruption of the developing fetal gut, which may have complex effects on early development.…”