Late-Onset Group B Streptococcal Infection in Identical Twins: Insight to Disease Pathogenesis

Objectives To describe and compare incidence of late-onset sepsis (LOS) and demographic and clinical characteristics associated with LOS in very low birth weight (VLBW) infants from singleton and multiple births and to examine the heritability in susceptibility to LOS among VLBW twins by comparing same-sex with unlike-sex twin pairs. Study design We studied infants with birth weight 401–1500 grams cared for at clinical centers of the NICHD Neonatal Research Network 2002–2008. Only the first episode of LOS was examined. Stepwise logistic regression models were fitted separately for singleton and multiple pregnancies to examine the maternal and neonatal factors associated with LOS. LOS due to only gram-negative bacteria among singleton and multiple pregnancies was also examined in separate models. The heritability of LOS was estimated by examining concordance of LOS between twins from same-sex and unlike-sex pairs. Results LOS occurred in 25.0% (3797/15,178) of singleton and 22.6% (1196/5294) of multiple VLBW infants. Coagulase-negative staphylococci were the most common infecting organisms, accounting for 53.2% of all LOS episodes in singletons and 49.2% in multiples. E. coli and Klebsiella species were the most commonly isolated gram-negative organisms, and Candida albicans was the most commonly isolated fungus. Concordance of LOS was not significantly different between same-sex and unlike-sex twin pairs. Conclusions LOS remains a common problem in VLBW infants. The incidence of LOS is similar for singleton and multiple infants. Similar concordance of LOS in same-sex and unlike-sex twin pairs provided no evidence that susceptibility to LOS among VLBW infants is genetically determined.

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“…Our cohort however, did not demonstrate the increased risk of group B streptococcus co-sepsis in twins as described by others. 8–11 …”

Section: Discussionmentioning

confidence: 99%

Late-Onset Sepsis in Very Low Birth Weight Infants from Singleton and Multiple-Gestation Births

Boghossian

Page

Bell

et al. 2013

The Journal of Pediatrics

227

162

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“…Edwards and associates [381] studied group B streptococcal infection in 12 index cases of multiple gestations. GBS isolates proved to be genetically identical; clinical variables associated with the adverse outcome in twin A were longer duration of fever before antibiotics and the development of neutropenia [382]. Cases of lateonset group B streptococcal disease in twin pairs occurred closely in time to one another: 19 and 20 days of age in one set and 28 and 32 days of age in the other set.…”

Section: Infection In Twinsmentioning

confidence: 95%

Bacterial Sepsis and Meningitis

Nizet¹,

Klein²

2011

Infectious Diseases of the Fetus and Newborn

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“…This case may have failed to prevent the occurrence of delayed infection because of persistent mucosal colonisation and/or persistence of the environmental source. A prolonged delay in the diagnosis and administration of antibiotics when GBS is identified seems associated with poor prognosis,20 which is consistent with other causes of sepsis and time-to-antibiotics 31 32. The extremely variable durations between episodes of infection in each twin, ranging from 0 hour to 52 days, precludes hospitalisation, but careful parental surveillance is needed.…”

Section: Commentarymentioning

confidence: 53%

What is the optimal management for the asymptomatic twin after diagnosis of late-onset group B streptococcal disease?

et al. 2018

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Late-Onset Group B Streptococcal Infection in Identical Twins: Insight to Disease Pathogenesis

Cited by 26 publications

References 27 publications

Late-Onset Sepsis in Very Low Birth Weight Infants from Singleton and Multiple-Gestation Births

Late-Onset Sepsis in Very Low Birth Weight Infants from Singleton and Multiple-Gestation Births

Bacterial Sepsis and Meningitis

What is the optimal management for the asymptomatic twin after diagnosis of late-onset group B streptococcal disease?

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