Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes

Chih Lin; Shih-Ming Chu; Hsiao-Chin Wang; Peng-Hong Yang; Hsuan-Rong Huang; Ming-Chou Chiang; Ren-Huei Fu; Ming-Horng Tsai; Jen-Fu Hsu

doi:10.3390/microorganisms9102094

Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes

Microorganisms. 2021 Oct 3;9(10):2094. doi: 10.3390/microorganisms9102094.

Authors

Chih Lin^{1

2}, Shih-Ming Chu^{1

2}, Hsiao-Chin Wang^{1

2}, Peng-Hong Yang^{2

3}, Hsuan-Rong Huang^{1

2}, Ming-Chou Chiang^{1

2}, Ren-Huei Fu^{1

2}, Ming-Horng Tsai^{2

4}, Jen-Fu Hsu^{1

2

5}

Affiliations

¹ Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
² College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
³ Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 614, Taiwan.
⁴ Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan.
⁵ Division of Neonatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.

Abstract

Background: Streptococcus agalactiae (also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases.

Methods: From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia.

Results: During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, n = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes.

Conclusions: a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.

Keywords: bacterial meningitis; group B streptococcus; intrapartum antibiotic prophylaxis; late-onset sepsis; neurological sequelae.

Grants and funding

CMRPG3E1491/Chang Gung Memorial Hospital, Linkou