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Clin Infect Dis. 2019 Apr 4. pii: ciz033. doi: 10.1093/cid/ciz033. [Epub ahead of print]

Risk Factors for Infant Colonization by Hypervirulent CC17 Group B Streptococcus: Toward the Understanding of Late-onset Disease.

Tazi A1,2,3,4, Plainvert C1,2,3, Anselem O2,4,5, Ballon M2,6, Marcou V2,4,7, Seco A2,6, El Alaoui F8, Joubrel C1,2,4, El Helali N9, Falloukh E10, Frigo A1,2, Raymond J1,2,4, Trieu-Cuot P11, Branger C8,12, Le Monnier A13, Azria E2,4,6,7, Ancel PY2,4,6,9, Jarreau PH2,4,14, Mandelbrot L2,15,16,12, Goffinet F2,4,5,6, Poyart C1,2,3,4.

Author information

1
Department of Bacteriology, University Hospitals Paris Centre-Cochin, French National Center for Streptococci, Assistance Publique - Hôpitaux de Paris (AP-HP).
2
Département Hospitalo-Universitaire Risks and Pregnancy.
3
Team Barriers and Pathogens of Cochin Institute, Institut National de la Santé et de la Recherche Médicale (INSERM) U1016 - Unité Mixte de Recherche Centre National de la Recherche Scientifique (UMR CNRS) 8104.
4
Paris Descartes University.
5
Department of Obstetrics and Gynecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP.
6
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epidémiologie Périnatale, Obstétricale et Pédiatrique), INSERM UMR 1153.
7
Maternity Unit, Paris Saint Joseph Hospital.
8
Department of Microbiology, Louis Mourier Hospital, AP-HP.
9
Unité de Recherche Clinique-Centre d'Investigation Clinique P1419, University Hospitals Paris Centre Cochin Port Royal, AP-HP.
10
Department of Neonatal Medicine, Louis Mourier Hospital, AP-HP.
11
Biology of Gram-Positive Bacterial Pathogens Unit, CNRS Equipe de Recherche Labellisée, Pasteur Institute, Paris.
12
Infection Antimicrobials Modelling Evolution, INSERM UMR1137, France.
13
Department of Microbiology, Saint Joseph Hospital, Paris.
14
Department of Neonatal Medicine, Cochin-Port Royal Hospital, AP-HP.
15
Department of Obstetrics and Gynecology, Louis Mourier Hospital, AP-HP.
16
Paris Diderot University.

Abstract

BACKGROUND:

In infants, the mode of acquisition of CC17 group B Streptococcus (GBS), the hypervirulent clone responsible for late-onset disease (LOD), remains elusive.

METHODS:

In a prospective multicenter study in France, we evaluated GBS colonization in mother-baby pairs with 2 months of follow-up between 2012 and 2015. Criteria included positivity for GBS colonization at antenatal screening or at delivery. Maternal vaginal samples and infant oral cavity and stool samples were analyzed at delivery, 21 ± 7 days (D21), and 60 ± 7 days (D60) post-delivery.

RESULTS:

A total of 890 mother-baby pairs were analyzed. GBS colonized 7%, 21%, and 23% of the infants at birth, D21, and D60, respectively, of which 10%, 11%, and 13% were identified as CC17 GBS. Concordance between maternal and infant GBS type was 96%. At D21, the main risk factors for infant colonization by GBS were simultaneous maternal colonization of the vagina (odds ratio [OR], 4.50; 95% confidence interval [CI], 1.69-15.61) and breast milk (OR, 7.93; 95% CI, 3.81-17.14). Importantly, 38% (95% CI, 23%-56%) of infants colonized by CC17 GBS appeared colonized for the first time at D60 vs 18% (95% CI, 14%-24%; P < .049) of infants colonized by non-CC17 GBS. Multivariate analysis showed a higher risk for de novo infant colonization by CC17 at D60 than by other GBS (OR, 2.45; 95% CI, 1.02-5.88).

CONCLUSIONS:

The high incidence of CC17 GBS in LOD is likely due to an enhanced post-delivery mother-to-infant transmission.

KEYWORDS:

CC17 clone; group B Streptococcus; infant colonization; late-onset disease

PMID:
30946447
DOI:
10.1093/cid/ciz033

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