Neonatal Nasopharyngeal Colonization with Group B Streptococcus and its Association with Clinical Sepsis

Malik, Anuj; Kothari, Chetna; Paulose, Ammukutty; Fogel, Joshua; Boxer, Harriet; Doraiswamy, Brinda

doi:10.1055/s-0036-1572432

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…GBS is part of the normal gut and genital microbiota, and though GBS nasopharyngeal colonization has been reported, it is poorly understood [13, 17]; no clearance protocol has been shown to be reliable. Therefore, reinforcement of hand and environmental hygiene seemed the most suitable option to manage the outbreaks.…”

Section: Discussionmentioning

confidence: 99%

Serial Clustering of Late-Onset Group B Streptococcal Infections in the Neonatal Unit: A Genomic Re-evaluation of Causality

Jauneikaite

Kapatai

Davies

et al. 2018

Clinical Infectious Diseases

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BackgroundInvasive Group B streptococcus (GBS) is a major cause of serious neonatal infection. Current strategies to reduce early-onset GBS disease have no impact on late-onset disease (LOD). Although GBS LOD is viewed as a sporadic event in the community, LOD arising within the neonatal intensive care unit (ICU) raises questions about mode of acquisition.MethodsFollowing a cluster of 4 GBS LOD cases, enhanced surveillance for all GBS LOD was undertaken over 2 years in the neonatal ICU supported by neonatal rectal screening. GBS isolates were serotyped and genome-sequenced.ResultsTwelve late -onset invasive GBS episodes were identified (incidence 0.6/1000 live births). Genomic analysis revealed that 11/12 GBS isolates (92%) were linked to at least one other LOD isolate. Isolates from the first cluster were serotype V, resistant to macrolides and lincosamides, and sequencing confirmed isolates were indistinguishable, or distinguishable by only one SNP difference, from each other. Rectal carriage was rare. Prospective surveillance identified three further clusters of LOD due to serotypes Ia (3 cases), Ib (2 cases), and III (2 cases), that would not have been identified without surveillance and genome sequencing, leading to a re-evaluation of interventions required to prevent GBS LOD.ConclusionAcquisition routes for LOD GBS in the neonatal ICU are poorly understood; cases may not necessarily be sporadic. Within this neonatal ICU, our data suggest that a single case of LOD GBS sepsis should be considered a potential nosocomial transmission event warranting prompt investigation, heightened infection prevention vigilance and action where required.

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Section: Discussionmentioning

confidence: 99%

Serial Clustering of Late-Onset Group B Streptococcal Infections in the Neonatal Unit: A Genomic Re-evaluation of Causality

Jauneikaite

Kapatai

Davies

et al. 2018

Clinical Infectious Diseases

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“…However, some studies have demonstrated that nasopharyngeal culture has the highest positive predictive value among cultures of other body surfaces (25,26). One study showed that the probability of clinical sepsis in colonized infants was significantly higher than that in non-colonized infants (27).…”

Section: Discussionmentioning

confidence: 99%

“…Out of these isolates, 37.5% were resistant to ampicillin, and 100% were sensitive to vancomycin. The prevalence of CoNS in the development of early-onset sepsis ranges from 22.5 to 72.7% (27)(28)(29). This may be partly due to contamination during sampling for culture or due to the widespread presence of this group of bacteria on human skin.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Nasopharyngeal Bacterial Colonization: Prevalence, Antimicrobial Resistance, and Concomitant Early-onset Sepsis

Dehdashtian

Moosavian

Boghrati

et al. 2021

Jundishapur J Microbiol

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Background: Early-onset neonatal sepsis (ENOS) is one of the most common causes of mortality in neonates. The bacteria causing ENOS are generally transferred from the mother to the infant before or during labor. Objectives: This study aimed to determine the prevalence rate of nasopharyngeal colonization with common bacterial agents causing ENOS and their relationship with blood culture outcomes in neonates. Methods: All neonates transferred to the neonatal intensive care unit were included in the study. Posterior pharynx secretions were swabbed and cultured in blood agar and MacConkey agar. Also, a blood specimen from each neonate was inoculated into a blood culture bottle. The grown bacteria were identified by biochemical standard tests. The antibiotic sensitivity test was performed by the disk diffusion method using Mueller-Hinton agar, and the results were evaluated according to the CLSI guidelines. Results: The pharyngeal specimens collected from 114 newborns were positive in 83 (72.8%) cases. Staphylococcus epidermidis was the most common bacterium in all weight groups. However, the isolates of Klebsiella, Escherichia coli, S. aureus, and Streptococcus agalactiae were also high. Thirteen newborns died. Neonates’ pharyngeal specimens were positive among 11 (84.6%) cases who died and 101 (71.2%) neonates who survived. Twelve neonates had positive blood cultures. Simultaneous positive blood and pharyngeal cultures were reported in eight (7%) cases, in which the bacterial isolates from blood and pharyngeal samples were similar in three cases (37.5%). Among pharyngeal isolates, E. coli was resistant to ampicillin in 100% and gentamicin, cefotaxime, and ceftazidime in 50% of the cases. Also, S. epidermidis and Acinetobacter isolates from blood samples were resistant to ampicillin in 100% of the cases. Conclusions: S. epidermidis accounted for 38.6% of bacteria cultured from pharyngeal swabs and 66.7% of bacteria cultured from blood samples, 37.5% of which were resistant to ampicillin and 100% were sensitive to vancomycin. One-hundred percent of E. coli cultures from neonatal pharynges were resistant to ampicillin and about 50% of them were resistant to gentamicin, cefotaxime, and ceftriaxone.

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“…9 In addition, another study stated that nasopharyngeal cultures positive for GBS in newborns can be used as an indicator for diagnosis and management of presumed GBS sepsis. 15 Variations on bacterial colonization in nasopharynx represent local bacterial colonization. Bacteria found in the nasopharynx of our subjects were opportunistic, with a predominance of Gram-negative bacteria, including Alcaligenes faecalis.…”

Section: Discussionmentioning

confidence: 99%

Nasopharyngeal colonization at birth and the development of early-onset neonatal sepsis

Febriani

Putri

Alasiry

et al. 2020

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Background Neonatal sepsis is one of the major causes of morbidity and mortality in neonates. Exposure to maternal bacteria during pregnancy or delivery allows for colonization of the normal upper airway. Such bacteria become the major ecological species in the infant. If the colonizing bacteria invade the bloodstream, early-onset neonatal sepsis (EONS) could occur. Objective To evaluate for an association between colonization of the newborn nasopharynx and EONS, as well as for agreement between nasopharyngeal swab culture and blood culture isolate results. Methods This prospective cohort study was conducted in Dr. Wahidin Sudirohusodo General Hospital and Ibnu Sina Hospital, Makassar, South Sulawesi. Nasopharyngeal swab culture was taken within 2 hours of life from newborns who met the inclusion criteria, then they were followed up for signs of EONS. Blood culture was taken from subject with EONS. Results Of the 100 newborns, 69 (69%) had nasopharyngeal bacterial colonization, of whom 5.8% (4/69) experienced EONS. Of the remaining 31 (31%) without colonization, 9.7% (3/31) experienced EONS. There was no significant difference in frequency of EONS between newborns with and without nasopharyngeal colonization. Although Gram-negative bacteria were predominant among colonized newborns, there was no significant difference to numbers of Gram-positive bacteria as a causative agent of EONS. Only one patient with EONS had the same bacterial species in both the nasopharynx and blood culture isolate. Conclusion Newborn nasopharyngeal colonization at birth is not associated with EONS.

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Neonatal Nasopharyngeal Colonization with Group B Streptococcus and its Association with Clinical Sepsis

Cited by 6 publications

References 20 publications

Serial Clustering of Late-Onset Group B Streptococcal Infections in the Neonatal Unit: A Genomic Re-evaluation of Causality

Serial Clustering of Late-Onset Group B Streptococcal Infections in the Neonatal Unit: A Genomic Re-evaluation of Causality

Neonatal Nasopharyngeal Bacterial Colonization: Prevalence, Antimicrobial Resistance, and Concomitant Early-onset Sepsis

Nasopharyngeal colonization at birth and the development of early-onset neonatal sepsis

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