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[Neonatal digestive implantation of streptococcus group B. Influence of antibiotic therapy]
Insights
Antibiotics disrupt Group B Streptococcus (GBS) gut colonization in neonates, but GBS reappears after treatment. Non-intervention shows higher GBS implantation rates without increased infection risk.
Area of Science:
- Neonatal infectious diseases
- Microbiome research
- Bacterial colonization dynamics
Context:
- Group B Streptococcus (GBS) is a significant cause of neonatal infections, with early-onset disease linked to perinatal exposure.
- The epidemiology of late-onset GBS infections and the role of neonatal gut colonization remain less understood.
- Maternal colonization is a potential source for neonatal GBS, influencing gut colonization patterns.
Purpose:
- To prospectively analyze the kinetics of gut colonization by GBS in neonates over three years.
- To investigate the influence of antibiotic therapy on GBS gut colonization and implantation rates.
- To explore the relationship between neonatal GBS colonization and the development of late-onset GBS disease.
Summary:
- A 3-year prospective study included 119 infants under one month with GBS in gastric aspirates or GBS infection, divided into three antibiotic treatment groups.
- Antibiotic use led to rapid GBS gut clearance, but strains reappeared in 13.5% of cases post-treatment. Infants without antibiotics showed a statistically significant higher GBS implantation rate (33%).
- GBS adhesion was the only factor correlated with implantation; no GBS infections occurred during 6 months to 2 years of follow-up, suggesting therapeutic abstention may be viable for colonized infants without infection.
Impact:
- Findings challenge standard antibiotic protocols for neonatal GBS, suggesting potential benefits of therapeutic abstention in colonized, non-infected infants.
- This research provides crucial data on GBS gut colonization kinetics and the long-term outcomes of different antibiotic strategies.
- The study highlights the importance of understanding the neonatal microbiome and GBS interactions to refine infection prevention and treatment approaches.
Abstract:
Group B streptococcus (GBS) is an important cause of neonatal infection. Early-onset diseases are due to perinatal contamination. The epidemiology of late-onset infections is poorly known. Maternal colonization may be responsible for some of them. The relationships between neonatal colonization and late disease could be a colonization of the gut. The purpose of this 3 year-prospective study was to analyse the kinetics of gut colonization in neonates and the influence of antibiotherapy. One hundred and nineteen infants less than one month of age were included because of the presence of GBS in their gastric aspirates or GBS infection. Depending on the therapeutic strategy, the infants were separated into 3 groups: 1) amoxicillin plus aminoside greater than or equal to 10 days because of neonatal infection (28 infants), 2) same combination less than or equal to 5 days because a GBS infection was suspected but not confirmed (17 infants), 3) no antibiotics (77 infants). Fecal flora was regularly analysed by differential count. Antibiotics caused rapid disappearance of GBS from the gut. However, the same strain reappeared after stopping the antibiotics at a rate of 13.5%. Without antibiotics, GBS was implanted in 33% of cases. This difference of implantation rate is statistically significant (p less than 0.05). No GBS infection was observed in any infant after a follow-up examination of 6 months to 2 years. Among the clinical and bacteriological factors studied, adhesion only was correlated with the GBS implantation. These results allow to discuss therapeutic abstention in colonized infants without any signs of infection.