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Early neonatal group B streptococcal disease: degree of colonisation as an important determinant
Insights
Infants with moderate to heavy colonization of group B streptococci (GBS) at birth face a significantly higher risk of developing early-onset GBS disease or probable sepsis compared to lightly colonized infants.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Microbiology
Background:
- Group B streptococci (GBS) colonization is a significant concern in newborns.
- Vertical transmission of GBS from mother to infant occurs frequently.
- The severity of GBS colonization may influence disease development.
Purpose of the Study:
- To investigate the relationship between the degree of GBS colonization and the risk of early-onset GBS disease and probable sepsis in neonates.
- To determine the attack rates of GBS-related conditions based on colonization levels.
Main Methods:
- Retrospective analysis of 145 infants admitted with GBS colonization over a 5-year period (1977-1982).
- Assessment of vertical transmission and categorization of colonization degree (moderate to heavy vs. light).
- Calculation of attack rates for early-onset GBS disease and probable sepsis based on colonization levels.
Main Results:
- 60% of infants showed evidence of vertical GBS transmission.
- Infants with moderate to heavy GBS colonization had a significantly higher attack rate for early-onset GBS disease (44.2%) compared to lightly colonized infants (4.5%).
- Probable sepsis was also significantly more frequent in moderately to heavily colonized infants (34.9%) versus lightly colonized infants (9.1%).
Conclusions:
- Moderate to heavy GBS colonization at birth is a significant risk factor for developing serious early-onset GBS disease and probable sepsis.
- The degree of neonatal GBS colonization is critical in predicting disease severity.
- These findings highlight the importance of assessing colonization levels in at-risk infants.
Abstract:
During a period of 5 years (1 January 1977 to 1 January 1982) 145 infants colonised with group B streptococci (GBS) were admitted to the neonatal intensive care unit of the University Children's Hospital, Utrecht. In 87 of these infants (60%) vertical transmission of GBS was established; in 43 of these 87 infants (49%) the degree of colonisation was moderate to heavy. Early-onset (EO) GBS disease arose in 21 of 145 infants (attack rate: 14.5%). Of the 43 infants moderately to heavily colonised with GBS, however, 19 suffered from EO GBS disease (attack rate: 44.2%), whereas there were only two cases among the 44, lightly colonised infants (attack rate: 4.5%), a highly significant difference (P less than 0.0005). Similarly, probable sepsis (PS), defined as signs and symptoms of sepsis but without positive blood cultures, was observed significantly more often in moderately to heavily colonised infants (15/43, attack rate: 34.9%) compared with those lightly colonised (4/44, attack rate: 9.1%) (P less than 0.005). Infants moderately to heavily colonised with GBS at birth appear to have a significantly higher risk of developing serious GBS disease (EO or PS) than do infants only lightly colonised.