Two Overlapping Clusters of Group B Streptococcus Late-onset Disease in a Neonatal Intensive Care Unit

Alberto Berardi, Isotta Guidotti, Roberta Creti, Giovanna Alfarone, Antonella Grottola, Claudia Venturelli, Giulia Fregni Serpini, Elisa Della Casa, Elena Vecchi, Alessandra Boncompagni, Carlotta Toffoli, Fabrizio Ferrari

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Current predominant routes of group B Streptococcus (GBS) transmission in preterm neonates admitted to neonatal intensive care unit (NICU) are poorly defined. We report 2 overlapping clusters of GBS late-onset disease (LOD) from June to September 2015 in an Italian NICU.

METHODS: During the outbreak, possible sources of transmission (equipment, feeding bottles and breast pumps) were swabbed. Specimens from throat and rectum were collected on a weekly basis from all neonates admitted to NICU. Colonized or infected neonates had cohorting. Bacterial isolates were characterized by serologic and molecular typing methods.

RESULTS: GBS was isolated in 2 full-term and 7 preterm neonates. Strains belonged to serotype III, with 3 different sequence types (ST17, ST182 and ST19). Full-term neonates were colonized with GBS strains unrelated to the clusters (ST182 and ST19). Two distinct ST17 strains caused 2 clusters in preterm neonates: a first cluster with 1 case of LOD and a second, larger cluster with 6 LOD in 5 neonates (one of them had recurrence). ST17 strains were isolated from vaginorectal and milk samples of 2 mothers. Two preterm neonates had no evidence of colonization for weeks, until they presented with LOD.

CONCLUSIONS: Molecular analyses identified the presence of multiclonal GBS strains and 2 clusters of 7 cases of GBS-LOD. The dynamics of transmission of GBS within the NICU were complex. Breast milk was suspected to be one of the possible sources. In a research setting, the screening of GBS carrier mothers who deliver very preterm could contribute to the tracking of GBS transmission.

Original languageEnglish
Pages (from-to)1160-1164
Number of pages5
JournalThe Pediatric infectious disease journal
Volume37
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

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Streptococcus agalactiae
Neonatal Intensive Care Units
Bottle Feeding
Late Onset Disorders
Molecular Typing
Human Milk
Pharynx
Breast Feeding
Rectum
Disease Outbreaks
Milk
Recurrence
Equipment and Supplies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Two Overlapping Clusters of Group B Streptococcus Late-onset Disease in a Neonatal Intensive Care Unit. / Berardi, Alberto; Guidotti, Isotta; Creti, Roberta; Alfarone, Giovanna; Grottola, Antonella; Venturelli, Claudia; Fregni Serpini, Giulia; Della Casa, Elisa; Vecchi, Elena; Boncompagni, Alessandra; Toffoli, Carlotta; Ferrari, Fabrizio.

In: The Pediatric infectious disease journal, Vol. 37, No. 11, 01.11.2018, p. 1160-1164.

Research output: Contribution to journalArticle

Berardi, A, Guidotti, I, Creti, R, Alfarone, G, Grottola, A, Venturelli, C, Fregni Serpini, G, Della Casa, E, Vecchi, E, Boncompagni, A, Toffoli, C & Ferrari, F 2018, 'Two Overlapping Clusters of Group B Streptococcus Late-onset Disease in a Neonatal Intensive Care Unit', The Pediatric infectious disease journal, vol. 37, no. 11, pp. 1160-1164. https://doi.org/10.1097/INF.0000000000001987
Berardi, Alberto ; Guidotti, Isotta ; Creti, Roberta ; Alfarone, Giovanna ; Grottola, Antonella ; Venturelli, Claudia ; Fregni Serpini, Giulia ; Della Casa, Elisa ; Vecchi, Elena ; Boncompagni, Alessandra ; Toffoli, Carlotta ; Ferrari, Fabrizio. / Two Overlapping Clusters of Group B Streptococcus Late-onset Disease in a Neonatal Intensive Care Unit. In: The Pediatric infectious disease journal. 2018 ; Vol. 37, No. 11. pp. 1160-1164.
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AU - Alfarone, Giovanna

AU - Grottola, Antonella

AU - Venturelli, Claudia

AU - Fregni Serpini, Giulia

AU - Della Casa, Elisa

AU - Vecchi, Elena

AU - Boncompagni, Alessandra

AU - Toffoli, Carlotta

AU - Ferrari, Fabrizio

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N2 - OBJECTIVES: Current predominant routes of group B Streptococcus (GBS) transmission in preterm neonates admitted to neonatal intensive care unit (NICU) are poorly defined. We report 2 overlapping clusters of GBS late-onset disease (LOD) from June to September 2015 in an Italian NICU.METHODS: During the outbreak, possible sources of transmission (equipment, feeding bottles and breast pumps) were swabbed. Specimens from throat and rectum were collected on a weekly basis from all neonates admitted to NICU. Colonized or infected neonates had cohorting. Bacterial isolates were characterized by serologic and molecular typing methods.RESULTS: GBS was isolated in 2 full-term and 7 preterm neonates. Strains belonged to serotype III, with 3 different sequence types (ST17, ST182 and ST19). Full-term neonates were colonized with GBS strains unrelated to the clusters (ST182 and ST19). Two distinct ST17 strains caused 2 clusters in preterm neonates: a first cluster with 1 case of LOD and a second, larger cluster with 6 LOD in 5 neonates (one of them had recurrence). ST17 strains were isolated from vaginorectal and milk samples of 2 mothers. Two preterm neonates had no evidence of colonization for weeks, until they presented with LOD.CONCLUSIONS: Molecular analyses identified the presence of multiclonal GBS strains and 2 clusters of 7 cases of GBS-LOD. The dynamics of transmission of GBS within the NICU were complex. Breast milk was suspected to be one of the possible sources. In a research setting, the screening of GBS carrier mothers who deliver very preterm could contribute to the tracking of GBS transmission.

AB - OBJECTIVES: Current predominant routes of group B Streptococcus (GBS) transmission in preterm neonates admitted to neonatal intensive care unit (NICU) are poorly defined. We report 2 overlapping clusters of GBS late-onset disease (LOD) from June to September 2015 in an Italian NICU.METHODS: During the outbreak, possible sources of transmission (equipment, feeding bottles and breast pumps) were swabbed. Specimens from throat and rectum were collected on a weekly basis from all neonates admitted to NICU. Colonized or infected neonates had cohorting. Bacterial isolates were characterized by serologic and molecular typing methods.RESULTS: GBS was isolated in 2 full-term and 7 preterm neonates. Strains belonged to serotype III, with 3 different sequence types (ST17, ST182 and ST19). Full-term neonates were colonized with GBS strains unrelated to the clusters (ST182 and ST19). Two distinct ST17 strains caused 2 clusters in preterm neonates: a first cluster with 1 case of LOD and a second, larger cluster with 6 LOD in 5 neonates (one of them had recurrence). ST17 strains were isolated from vaginorectal and milk samples of 2 mothers. Two preterm neonates had no evidence of colonization for weeks, until they presented with LOD.CONCLUSIONS: Molecular analyses identified the presence of multiclonal GBS strains and 2 clusters of 7 cases of GBS-LOD. The dynamics of transmission of GBS within the NICU were complex. Breast milk was suspected to be one of the possible sources. In a research setting, the screening of GBS carrier mothers who deliver very preterm could contribute to the tracking of GBS transmission.

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