Disease burden and antimicrobial resistance of invasive group B streptococcus among infants in China: a protocol for a national prospective observational study

Abstract

BackgroundGroup B Streptococcus (GBS) is a cause of neonatal sepsis, pneumonia, and meningitis that can lead to neurological sequelae in infants less than 3 months of age. The GBS disease burden is not known in China, therefore it cannot receive major attention. The main objectives of this study are the evaluation of the incidence of neonatal GBS infection, GBS case-fatality ratio, its serotypes and genotypes, bacterial resistance, clinical treatment and outcomes in China.MethodsWe are conducting a nation-wide, population-based, multi-center, prospective, observational cohort study in China from May 2016 to December 2017. Eighteen large urban tertiary care hospitals from 16 provinces were selected that cover the eastern, southern, western, northern and central regions of China. Meanwhile, we retrospectively collected data and GBS strains from January 2015 to April 2016 from selected hospitals. The incidence rate per 1000 live births will be defined as the total number of confirmed GBS cases born in the selected hospitals divided by the number of live births in the hospitals during the study period. All GBS cases detected in selected hospitals will be used to calculate the case-fatality ratio and for the typing analysis. GBS isolates will be serotyped using the Strep-B-Latex® rapid latex agglutination test for serotyping of Group B streptococci. Multi-locus sequence typing (MLST) will be performed by sequencing the internal fragments of seven house-keeping genes. Antimicrobial susceptibility will be tested per interpretive standards established by the Clinical and Laboratory Standards Institute. The presence of the common resistance genes ermA, ermB, mefA, tetI, tetO and tetM will be tested by PCR.DiscussionWe are conducting the first national study to estimate the invasive GBS disease burden and antimicrobial resistance of GBS among infants in China. Study findings will provide important evidence for improving clinical practice to ensure timely diagnosis of GBS disease and decisions for preventive measures. Surveillance of antimicrobial resistance will promote the rational use of antimicrobials.Trial registrationThe study was retrospectively registered at http://clinicaltrials.gov on June 13, 2016. It was granted a registration number of “NCT02812576”.

Clinical and Molecular Epidemiology of Invasive Group BStreptococcusDisease among Infants, China

“…Participating hospitals met the following inclusion criteria ( 8 ): large, urban, tertiary-care center; adequate research capabilities and facilities to conduct the study, including laboratory facilities and the ability to identify, process, and store GBS isolates; investigators willing to devote time to the study; and location, to ensure > 1 hospital from each region. Trained site investigators in each participating hospital collected clinical data by using a standardized case report form.…”

A Solution to Antifolate Resistance in Group B Streptococcus : Untargeted Metabolomics Identifies Human Milk Oligosaccharide-Induced Perturbations That Result in Potentiation of Trimethoprim

“…In addition to structure-activity relationship (SAR) studies, we found that HMOs potentiate the activity of select intracellular targeting antibiotics (32). This included three antibiotics to which GBS has evolved resistance, aminoglycosides, macrolides, and tetracyclines (33)(34)(35)(36)(37)(38)(39)(40)(41)(42). At their 50% inhibitory concentration (IC 50 ), HMO extracts reduced the MICs of certain intracellular targeting antibiotics up to 32-fold (Table 1).…”

Inhibition of SIRT1 by microRNA-9, the key point in process of LPS-induced severe inflammation

“…Severe inflammation and MODS greatly threat patients' life. The increasing prevalence of drug resistant compels us to find new and effective approaches for the diagnosis and therapy of severe inflammation [26]. MicroRNAs such as miR-9 have been reported to be involved in inflammation and to play an important role in preventing inflammation developing to MODS, while the specific mechanism is still unclear [27][28][29][30].…”