Epidemiological observations of invasive group B Streptococcus infections in six major hospitals in Peninsular Malaysia

Objective:To address the lack of research on invasive group B Streptococcus(GBS)infections in Malaysia and Southeast Asia through a comprehensive analysis of GBS isolates obtained from hospitals.Methods:Medical records from patients with GBS infection isolated from the sterile site,such as blood and cerebrospinal fluid from 14 July 2019 to 15 December 2020,were reviewed from six major hospitals in Peninsular Malaysia.Inclusion criteria were invasive GBS,sterile sites and non-repeated GBS isolated from the same patients in the same admission.Viable isolates were re-identified for GBS and serotyped.Results:A total of 118 patients were eligible,with a majority of non-pregnant adults(76.3%).Over half of the patients(62.7%)had underlying medical conditions,with diabetes as the most common disease,followed by respiratory disease,renal disease,cardiovascular disease and skin and soft tissue disease.The most common manifestations were sepsis,followed by soft tissue abscess,diabetic foot ulcer,wet gangrene and cellulitis.The overall mortality was 7.6%.The most common serotype was serotype桋.Conclusions:Invasive GBS infection among non-pregnant adults showed a rising trend,particularly among diabetic individuals.The study underscores the importance of reducing risk factors and highlights the necessity of developing GBS vaccination as a preventive strategy for both infants and adults.

Disease burden,antimicrobial resistance and molecular characterization of invasive group B Streptococcus among non-pregnant adults in Malaysia:A protocol study

and pili genes are also investigated.Methods:This multicentre,prospective,observational study is conducted in seven major tertiary hospitals in Malaysia among non-pregnant adults.Simultaneously,a retrospective study is conducted in the selected hospitals with similar approaches.GBS isolates are subjected to phenotyping,serotyping by multiplex PCR,antimicrobial susceptibility testing and PCR-detection of GBS virulence and pilus genes.Seven housekeeping genes are amplified and sequenced for multi-locus sequence typing.Discussion:Findings from the study may contribute to the management of clinical practice to diagnose and prevent GBS related diseases in a timely manner.Prudent use of antibiotics is encouraged by monitoring antimicrobial resistance.

Vaginal Carriage of Group B Streptococcus in Pregnant Women in Rural Areas in Senegal

Vaginal carriage of Group B Streptococcus (GBS) is a maternal and child health issue. Our objective was to determine the prevalence of GBS carriage;identify the factors associated with this carriage and determine the antibiotic sensitivity of the isolated strains. We conducted a cross-sectional and prospective study in rural Senegal (in the health district of Sokone). Socio-demographic, clinical and gynaeco-obstetrical data were collected. Vaginal swabs were taken by the midwives on specific settings in order to test for GBS and other High Risk Vaginal Bacteria (HRVB). Antibiotic susceptibility testing was done according to the recommendations of the CA SFM/EUCAST 2020. In total, 100 pregnant women were targeted and 97 pregnant women were included. Their age ranged from 18 to 40 years with 64.9% (63/97) of participants belonging to the “20 - 30” age group. The overall prevalence of Group B Streptococcus carriage was 15.5% (15/97). However, the proportion of women with at least one high risk infectious bacteria was 29.89% (29/97). No statistically significant differences were found between GBS carriage and the potential factors studied. However, the study also looked for the presence of other high-risk bacteria and coinfections were indeed found between GBS and E. coli and Staphylococcus aureus. Antibiotic susceptibility testing shows that GBS strains were fully susceptible to penicillin G, erythromycin, clindamycin, chloramphenicol, rifampicin and vancomycin. Sensitivities to norfloxacin and gentamycin were 73.3% and 86.7% respectively. In contrast, high resistance to tetracycline (86.7%) was observed. GBS carriage remains a major public health issue because of its consequences for the mother and the newborn. Correct screening and proper monitoring of strain susceptibility remain one of the most effective means of patient management and care.

Influence of group B streptococcus and vaginal cleanliness on the vaginal microbiome of pregnant women

BACKGROUND The vaginal microbiome plays a critical role in the health of pregnant women and their newborns.Group B Streptococcus(GBS)and vaginal cleanliness significantly affect the vaginal microecosystem and are closely associated with vaginal diseases.AIM To explore the effects of GBS status and vaginal cleanliness on vaginal microecosystems.METHODS We collected 160 vaginal swabs from pregnant women and divided them into the following four groups based on GBS status and vaginal cleanliness:GBS-positive+vaginal cleanliness I–II degree,GBS-negative+vaginal cleanliness I–II degree,GBS-positive+vaginal cleanliness III–IV degree,and GBS-negative+vaginal cleanliness III–IV degree.Samples were subjected to 16S rRNA gene amplicon sequencing.RESULTS Alpha diversity analysis showed that the Shannon index did not significantly differ between the four groups.We identified significant variation in taxa abundance between the GBS-positive and GBS-negative groups and between the vaginal cleanliness I–II degree and III–IV degree groups.Principal coordinate analysis and non-metric multidimensional scaling analysis further confirmed the microbial diversity of the four groups.Moreover,the linear discriminant analysis demonstrated that Lactobacillus jensenii and Actinobacteria were strongly associated with GBS-positive status,and Lactobacillus iners,Lactobacillaceae,Lactobacillus,Lactobacillales,Bacilli and Firmicutes were closely correlated with GBS-negative status.CONCLUSION GBS status and vaginal cleanliness significantly affect vaginal microbiome differences in pregnant women.Our findings provide instructional information for clinical antibiotic treatment in pregnant women with different GBS statuses and vaginal cleanliness degrees.

Group B Streptococcal Chorioamnionitis with Intact Amniotic Membranes. A Rare?

Group B streptococcus infection (GBS) is an important cause of perinatal infection. Maternal colonization by GBS can cause amniotic infection and thus fetal infection, sometimes causing fetal death. This infection generally occurs in association with premature rupture of membranes. We present here an infrequent case of GBS chorioamnionitis in full-term gestation with intact amniotic membranes. The curiosity of the case lies in the integrity of the amniotic membranes, the asymptomatic clinical presentation, and the adverse result (term fetal death).

Topical delivery of nerve growth factor for treatment of ocular and brain disorders

Neurotrophins are a family of proteins that support neuronal proliferation, survival, and differentiation in the central and peripheral nervous systems, and are regulators of neuronal plasticity. Nerve growth factor is one of the best-described neurotrophins and has advanced to clinical trials for treatment of ocular and brain diseases due to its trophic and regenerative properties. Prior trials over the past few decades have produced conflicting results, which have principally been ascribed to adverse effects of systemic nerve growth factor administration, together with poor penetrance of the blood-brain barrier that impairs drug delivery. Contrastingly, recent studies have revealed that topical ocular and intranasal nerve growth factor administration are safe and effective, suggesting that topical nerve growth factor delivery is a potential alternative to both systemic and invasive intracerebral delivery. The therapeutic effects of local nerve growth factor delivery have been extensively investigated for different ophthalmic diseases, including neurotrophic keratitis, glaucoma, retinitis pigmentosa, and dry eye disease. Further, promising pharmacologic effects were reported in an optic glioma model, which indicated that topically administered nerve growth factor diffused far beyond where it was topically applied. These findings support the therapeutic potential of delivering topical nerve growth factor preparations intranasally for acquired and degenerative brain disorders. Preliminary clinical findings in both traumatic and non-traumatic acquired brain injuries are encouraging, especially in pediatric patients, and clinical trials are ongoing. The present review will focus on the therapeutic effects of both ocular and intranasal nerve growth factor delivery for diseases of the brain and eye.

Are Mikvehs Responsible for GBS Carriers among Orthodox Jewish Women?—A Prospective Observational Study

Background: Maternal colonization with group B streptococcus (GBS) is an important risk factor for neonatal sepsis. A “mikveh” is a pool of water for ritual immersion by Jewish women. It had been reported to be a risk factor for GBS colonization. Objective: To determine whether there is an association between ritual immersion in the mikveh pools and GBS carriership. Methods: Water samples and bacterial swabs were taken from eight mikveh pools centers at two separate occasions and tested for GBS growth. For determination of the total number of live, aerobic bacteria, each sample was grown on strep selective agar for 48 hours at 37°C and CO2 5%. Results: All the samples were tested. No trace of GBS was found in any of the samples. Conclusions: The findings of this study refute earlier findings and suggest that there is no association between ritual immersion in mikvehs and GBS carriership.

Prevalence, Antimicrobial Susceptibility Pattern and Factors Associated with GBS Colonization in Pregnant Women at the Regional Hospital Bamenda (RHB)

Introduction: Maternal asymptomatic colonization with GBS (Group-B Streptococcus) has become a major cause of sepsis, meningitis and encephalopathy in neonates alongside premature births, stillbirths and post-natal infections. Routine screening of pregnant women for GBS carriage and antimicrobial susceptibility are therefore necessary. This study was aimed at evaluating the prevalence, antimicrobial susceptibility pattern and factors associated with GBS colonization in pregnant women at the Regional Hospital Bamenda (RHB). Materials and Methods: Vaginal and rectal swab samples were collected from 121 pregnant women in the 3rd trimester at the RHB from December 2017 to May 2018. Sociodemographic, obstetric and neonatal history and some clinical parameters were obtained through a questionnaire approach. Cultures for the isolation and identification of GBS from the samples were done and grouping as well as susceptibility testing of GBS isolates was done. Results: The colonisation rates were 5.8% (7), 1.7% (2) and 5.8% (7) for rectal, vaginal and concomitant recto-vaginal carriage. GBS was isolated in the vagina/rectum of 16 participants (13.2% prevalence). Of the 16 GBS strains used for in vitro susceptibility test, no resistance to ampicillin, oxacillin, amoxicillin-clavulanate, ceftriaxone, erythromycin, imipenem, aztreonam and clindamycin was recorded. 6.3% (1) of the strains had intermediate susceptibility to ampicillin and amoxicillin-clavulanic acid. Of the isolates examined, 37.5% (6), and 12.5% (2) were respectively sensitive to gentamycin and levofloxacin. Maternal overweight, HIV positive status, history of PROM and spontaneous abortion, presence of Gardnerella vaginalis and Candida albicans had a high rate of GBS colonization but only HIV positive status had a statistical significance (p = 0.01). Other microbes isolated were Gardnerella vaginalis (55.4%, 67), Candida albicans (40.5%, 49), and Candida spp (12.4%, 15). Conclusion: GBS prevalence was 13.2%. GBS had decreased susceptibility to some antibiotics. Only HIV positive status was significantly associated with GBS colonization.

Experimental study on distribution of serotypes and antimicrobial patterns of Group B streptococcus strains

Objective To obtain information on the distribution of serotypes and antimicrobial agent susceptibilities to group B streptococcus (GBS) strains isolated in Beijing area from 1991 to 1996. Methods Bacterial isolates of GBS were obtained from vaginal and cervical tract of pregnant and nonpregnant women in Beijing Tian Tan Hospital by culture. A total of 76 GBS strains were identified finally by coagglutination. Serotyping was determined by Standard Lancefield method. Susceptibility to test agents was assessed by determining the minimal inhibitory concentrations (MICs) with agar dilution method that was established by the National Committee for Clinical Laboratory Standards (NCCLS). Results Seven serotypes were identified among 76 GBS strains isolates. Types Ⅱ (33%), Ⅲ (23%) and Ⅰa (16%) were the predominant serotypes in pregnant and nonpregnant women. MICs of penicillin G and ampicillin were ≤0.06 μg/ml. MICs of cephazolin, cefuroxime and cefoperozone were 0.003 μg/ml 0.06 μg/ml. MICs of erythromycin were 0.003 μg/ml 0.03 μg/ml. MICs of gentamycin were 1 μg/ml 32 μg/ml. MICs of amikacin were 4 μg/ml ≥64 μg/ml, nearly 12.8% and 40.4% of the strains were resistant to gentamycin and amikacin, respectively. Conclusions Our study provides useful epidemiologic data for preparation of GBS type specific vaccines which can prevent GBS infections and antimicrobial agents susceptibility patterns in China. Routine reports on GBS susceptibilities by clinical laboratories and continuous surveillance for changes in the susceptibility are of considerable clinical importance.

Late and very late onset group B Streptococcus sepsis:one and the same?

Background:This study aimed to describe the clinical characteristics of group B Streptococcus(GBS)sepsis in infants aged 4–90 days[late onset(LO)]compared to infants>90 days of age[very late onset(VLO)].Methods:Microbiology records at Children’s Medical Center Dallas were screened.Demographic,clinical,and outcome data were collected for infants with GBS recovered from blood or cerebrospinal fluid culture from January 1,2006 to July 1,2012.Results:Totally 48 infants were identified(42 LO,6 VLO).Infants with VLO sepsis had lower median gestational age(28.5 vs.39 weeks gestation,P<0.001)and longer median nursery admissions(8.8 vs.0.5 weeks,P=0.004).When gestational age was controlled for,there were no differences in clinical presentation,intensive care unit admission,length of stay,neurodevelopmental outcome,and mortality.Infants with VLO sepsis were more likely to receive vancomycin(83%vs.33%,P=0.02)or third-generation cephalosporins(83%vs.24%,P=0.009),and more likely to continue on those agents even after GBS was identified.Conclusions:Infants with VLO sepsis had lower gestational ages and longer nursery stays than infants with LO sepsis.Beyond age at presentation,there were no significant differences in clinical presentations,hospital course,frequency of neurodevelopmental sequelae,and mortality in infants presenting with LO vs.VLO GBS sepsis.Infants with VLO sepsis were more likely to receive empiric broad spectrum antimicrobials and more likely to continue receiving broad therapy even following GBS identification.