Maternal colonization with group B Streptococcus and antibiotic resistance in China: systematic review and meta-analyses

Abstract

Background Maternal rectovaginal colonization with group B Streptococcus (GBS) or Streptococcus agalactiae is the most common pathway for this disease during the perinatal period. This meta-analysis aimed to summarize existing data regarding maternal colonization, serotype profiles, and antibiotic resistance in China. Methods Systematic literature reviews were conducted after searching 6 databases. Meta-analysis was applied to analyze colonization rate, serotype, and antimicrobial susceptibility of GBS clinical isolates in different regions of China. Summary estimates are presented using tables, funnel plots, forest plots, histograms, violin plots, and line plots. Results The dataset regarding colonization included 52 articles and 195 303 pregnant women. Our estimate for maternal GBS colonization in China was 8.1% (95% confidence interval [CI] 7.2%–8.9%). Serotypes Ia, Ib, III, and V account for 95.9% of identified isolates. Serotype III, which is frequently associated with the hypervirulent clonal complex, accounts for 46.4%. Among the maternal GBS isolates using multilocus sequence typing (MLST), ST19 (25.7%, 289/1126) and ST10 (25.1%, 283/1126) were most common, followed by ST12 (12.4%, 140/1126), ST17 (4.8%, 54/1126), and ST651 (3.7%, 42/1126). GBS was highly resistant to tetracycline (75.1% [95% CI 74.0–76.3%]) and erythromycin (65.4% [95% CI 64.5–66.3%]) and generally susceptible to penicillin, ampicillin, vancomycin, ceftriaxone, and linezolid. Resistance rates of GBS to clindamycin and levofloxacin varied greatly (1.0–99.2% and 10.3–72.9%, respectively). A summary analysis of the bacterial drug resistance reports released by the China Antimicrobial Resistance Surveillance System (CARSS) in the past 5 years showed that the drug resistance rate of GBS to erythromycin, clindamycin, and levofloxacin decreased slowly from 2018 to 2020. However, the resistance rates of GBS to all 3 antibiotics increased slightly in 2021. Conclusions The overall colonization rate in China was much lower than the global colonization rate (17.4%). Consistent with many original and review reports in other parts of the world, GBS was highly resistant to tetracycline. However, the resistance of GBS isolates in China to erythromycin and clindamycin was greater than in other countries. This paper provides important epidemiological information, to assist with prevention and treatment of GBS colonization in these women.

The current status of Group B Streptococcus infection in the reproductive tract of late-pregnancy women and its impact on pregnancy outcomes

“…This measure effectively reduces the incidence of GBS in newborns. Penicillin is recommended as the rst-choice drug for IAP in various countries [6][7].The global detection rate of GBS in pregnant women varies by region, and reports show that the colonization rate of GBS in pregnant women worldwide is approximately 17.4% (95% CI 16.3% -18.5%) [5].The overall colonization rate of GBS among pregnant women in China is 8.1% (95% CI, 7.2-8.9) [2], with the highest rate being 9.3% (95% CI 6.6-12.0) in the central region, followed by 8.3% (95% CI 5.5-11.0) in the eastern region, and the lowest rate being 6.8% (95% CI 5.4-8.3) in the western region [8].The GBS colonization rate of pregnant women in this study was 6.52%, which is lower than the domestic and global average. The differences in colonization rates among different studies or regions may be related to regional differences, detection methods (culture/PCR), sampling sites (vaginal/rectal sampling), and differences in sampling gestational weeks.…”

“…It is a conditional pathogen, mainly colonized in the lower digestive tract and urogenital tract of the human body. Occasional carriers in the normal population do not cause obvious symptoms, and physiological changes during pregnancy can affect the reproductive tract microenvironment, increasing the risk of GBS infection [1].GBS is listed as one of the main pathogenic bacteria for perinatal maternal and infant infections, and it is reported that the colonization rate of GBS in pregnant women in China is about 8.1% [2].GBS infection can increase the risk of late pregnancy abortion, premature rupture of membranes, Postpartum bleeding, puerperal infection, and other diseases, and also easily induce Neonatal infection, Neonatal jaundice and other diseases [3].The American College of Obstetricians and Gynecologists (ACOG) recommends GBS screening for all pregnant women aged 35-37 weeks, and intrauterine antibiotic prophylaxis (IAP) for pregnant women with GBS colonization or risk factors [4]. This measure signi cantly reduces the incidence of early onset GBS sepsis by 50% -80% [5], and penicillin is the preferred drug for IAP.…”

Dispersal history and bidirectional human-fish host switching of invasive, hypervirulent Streptococcus agalactiae sequence type 283

“…Additional study is needed to elucidate the phenotypic resistance profiles of ST283 and correlation with antimicrobial resistance genes. GBS phenotypic resistance to macrolides and fluoroquinolones vary regionally but remain concerning given the burden of invasive GBS infection globally [ 29 ]. Although the prevalence of multi-drug resistance gene carriage in ST283 is currently low, increasing use of medically important antimicrobials in the freshwater aquaculture industry [ 30 ] and in humans—particularly in low- and middle-income countries [ 31 ]—risks the generation of expanded resistance profiles.…”

A Review of the Impact of Streptococcal Infections and Antimicrobial Resistance on Human Health

“…Before 2020 it was between 11.5-14.3% for Japanese GAS isolates [86] and 11% for Iranian GBS isolates [47]. However, reports from China indicate that there has been a dramatic increase in quinolone-resistant GBS isolates in pregnant women, with rates increasing up to 72.9% in 2021 [95]. In Africa, the evolution of this resistance varied between 7.2% for Ethiopian GAS [51] to 24.56% for GBS in this region [69].…”