Group B Streptococcus Infections in Non-Pregnant Adults, Italy, 2015-2019

Overview

Journal Pathogens

Date 2024 Sep 28

PMID 39338998

Authors

Monica Imperi

Giovanni Gherardi

Giovanna Alfarone

Roberta Creti

Affiliations

Soon will be listed here.

Abstract

Group B Streptococcus (GBS, ) is a pathogen of increasing importance in adults. Severe and invasive cases in non-pregnant adults were collected during the period 2015-2019 by voluntary-based surveillance. In total, 108 GBS strains were phenotypically and genotypically characterized for the serotype, antimicrobial resistance, pili, surface protein genes, and the hyper-virulent adhesin . Patients were divided into two age groups: adults (18-64 years; = 32) and older adults (≥65 years; = 72). The average age was 70.8 years, with a male/female ratio of 1.7. Most isolates were recovered from cases of bacteremia (blood, = 93), and a higher frequency of invasive GBS infections (iGBS) was found among older adults (66.7%). Serotype III was the most frequent ( = 41, 38%), followed by type Ia and type V ( = 20 each, 18.5%). Serotypes Ia, Ib, II, III, IV, and V accounted for all but one isolates (99.1%). The iGBS isolates were universally susceptible to penicillin, while the prevalence of resistance to clindamycin, erythromycin, tetracycline, and high-level gentamicin resistance was 26.8%, 24.1%, 85.2%, and 5.5%, respectively, with the predominance of the (B) gene for macrolide resistance and the (M) gene for tetracycline resistance. The associations between the serotypes/antimicrobial resistance/virulence traits underlined the increasing importance of serotype III and its contribution to antimicrobial resistance as well as the steady increase over time of serotype IV. This nationwide study confirmed the need for monitoring the GBS epidemiology in non-pregnant adults through continuous surveillance of GBS infections.

References

Kong F, Martin D, James G, Gilbert G . Towards a genotyping system for Streptococcus agalactiae (group B streptococcus): use of mobile genetic elements in Australasian invasive isolates. J Med Microbiol. 2003; 52(Pt 4):337-344. DOI: 10.1099/jmm.0.05067-0. View

Afshar B, Broughton K, Creti R, Decheva A, Hufnagel M, Kriz P . International external quality assurance for laboratory identification and typing of Streptococcus agalactiae (Group B streptococci). J Clin Microbiol. 2011; 49(4):1475-82. PMC: 3122801. DOI: 10.1128/JCM.02365-10. View

Flores A, Galloway-Pena J, Sahasrabhojane P, Saldana M, Yao H, Su X . Sequence type 1 group B Streptococcus, an emerging cause of invasive disease in adults, evolves by small genetic changes. Proc Natl Acad Sci U S A. 2015; 112(20):6431-6. PMC: 4443349. DOI: 10.1073/pnas.1504725112. View

Schrag S, Zywicki S, Farley M, Reingold A, Harrison L, Lefkowitz L . Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med. 2000; 342(1):15-20. DOI: 10.1056/NEJM200001063420103. View

Gonzalez-Miro M, Pawlowski A, Lehtonen J, Cao D, Larsson S, Darsley M . Safety and immunogenicity of the group B vaccine AlpN in a placebo-controlled double-blind phase 1 trial. iScience. 2023; 26(3):106261. PMC: 10005905. DOI: 10.1016/j.isci.2023.106261. View

Le Doare K, Heath P . An overview of global GBS epidemiology. Vaccine. 2013; 31 Suppl 4:D7-12. DOI: 10.1016/j.vaccine.2013.01.009. View

Ballard M, Schonheyder H, Knudsen J, Lyytikainen O, Dryden M, Kennedy K . The changing epidemiology of group B streptococcus bloodstream infection: a multi-national population-based assessment. Infect Dis (Lond). 2016; 48(5):386-91. DOI: 10.3109/23744235.2015.1131330. View

Teatero S, McGeer A, Low D, Li A, Demczuk W, Martin I . Characterization of invasive group B streptococcus strains from the greater Toronto area, Canada. J Clin Microbiol. 2014; 52(5):1441-7. PMC: 3993709. DOI: 10.1128/JCM.03554-13. View

Munoz P, Llancaqueo A, Rodriguez-Creixems M, Pelaez T, Martin L, Bouza E . Group B streptococcus bacteremia in nonpregnant adults. Arch Intern Med. 1997; 157(2):213-6. DOI: 10.1001/archinte.1997.00440230087011. View

10.

Creti R, Imperi M, Berardi A, Lindh E, Alfarone G, Pataracchia M . Invasive Group B Streptococcal Disease in Neonates and Infants, Italy, Years 2015-2019. Microorganisms. 2021; 9(12). PMC: 8708122. DOI: 10.3390/microorganisms9122579. View

11.

Slotved H, Hoffmann S . Evaluation of procedures for typing of group B : a retrospective study. PeerJ. 2017; 5:e3105. PMC: 5357338. DOI: 10.7717/peerj.3105. View

12.

Slotved H, Kong F, Lambertsen L, Sauer S, Gilbert G . Serotype IX, a Proposed New Streptococcus agalactiae Serotype. J Clin Microbiol. 2007; 45(9):2929-36. PMC: 2045254. DOI: 10.1128/JCM.00117-07. View

13.

Pitts S, Maruthur N, Langley G, Pondo T, Shutt K, Hollick R . Obesity, Diabetes, and the Risk of Invasive Group B Streptococcal Disease in Nonpregnant Adults in the United States. Open Forum Infect Dis. 2018; 5(6):ofy030. PMC: 6016410. DOI: 10.1093/ofid/ofy030. View

14.

Lamy M, Dramsi S, Billoet A, Reglier-Poupet H, Tazi A, Raymond J . Rapid detection of the "highly virulent" group B Streptococcus ST-17 clone. Microbes Infect. 2006; 8(7):1714-22. DOI: 10.1016/j.micinf.2006.02.008. View

15.

Ferrieri P, Lynfield R, Creti R, Flores A . Serotype IV and invasive group B Streptococcus disease in neonates, Minnesota, USA, 2000-2010. Emerg Infect Dis. 2013; 19(4):551-8. PMC: 3647718. DOI: 10.3201/eid1904.121572. View

16.

Slotved H, Hoffmann S . The Epidemiology of Invasive Group B in Denmark From 2005 to 2018. Front Public Health. 2020; 8:40. PMC: 7076979. DOI: 10.3389/fpubh.2020.00040. View

17.

Eskandarian N, Neela V, Ismail Z, Puzi S, Hamat R, Desa M . Group B streptococcal bacteremia in a major teaching hospital in Malaysia: a case series of eighteen patients. Int J Infect Dis. 2013; 17(9):e777-80. DOI: 10.1016/j.ijid.2013.01.011. View

18.

Farley M, Harvey R, Stull T, Smith J, Schuchat A, Wenger J . A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med. 1993; 328(25):1807-11. DOI: 10.1056/NEJM199306243282503. View

19.

Tyrrell G, Senzilet L, Spika J, Kertesz D, Alagaratnam M, Lovgren M . Invasive disease due to group B streptococcal infection in adults: results from a Canadian, population-based, active laboratory surveillance study--1996. Sentinel Health Unit Surveillance System Site Coordinators. J Infect Dis. 2000; 182(1):168-73. DOI: 10.1086/315699. View

20.

Bergseng H, Rygg M, Bevanger L, Bergh K . Invasive group B streptococcus (GBS) disease in Norway 1996-2006. Eur J Clin Microbiol Infect Dis. 2008; 27(12):1193-9. DOI: 10.1007/s10096-008-0565-8. View