Neonatologia
Le infezioni neonatali tardive da streptococco di gruppo B: cosa dobbiamo sapere?
Late-onset group B streptococcal infections: what do paediatricians need to know?
Laura Riccipetitoni1, Francesca Miselli2, Martina Buttera1, Carolina Bondi1, Sofia Mazzotti1, Niccolò baraldi3, Luca Bedetti2, Licia Lugli2, Alberto Berardi2
1Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia
2Unità di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena
3Facoltà di Medicina e Chirurgia, Università di Modena e Reggio Emilia
Ottobre 2024 - pagg. 509 -514 | DOI: 10.53126/MEB43509
Abstract
In some high-income countries, the widespread use of intrapartum antibiotic prophylaxis has reduced the incidence of early-onset infections (onset from 0 to 6 days of life) with Group B Streptococcus (GBS) and late-onset infections (LOD, Late-Onset Disease, from 7 to 90 days of life) have become the most frequent invasive GBS infections. LODs may result in severe sepsis and meningitis that may lead to neurodevelopmental impairment or death; pathogenesis and mode of transmission of LOD remain poorly understood. Preterm infants, often with prolonged hospital stay in intensive care units, are particularly vulnerable to LOD. The primary goal of contemporary research is to increase knowledge of pathogenetic and transmission mechanisms to improve prevention and reduce the severity of these infections.
Riassunto
In alcuni Paesi ad alto reddito l’estesa diffusione della profilassi antibiotica intrapartum ha ridotto l’incidenza delle infezioni precoci (che esordiscono da 0 a 6 giorni di vita) da Streptococco di gruppo B (GBS) e le infezioni tardive (LOD, Late-Onset Disease, da 7 a 90 giorni di vita) sono diventate la più frequente infezione invasiva da GBS. Le LOD possono determinare gravi sepsi e meningiti che non raramente hanno esiti a lungo termine o sono talvolta mortali; patogenesi e modalità di trasmissione di queste infezioni rimangono ancora poco conosciute. I pretermine, spesso ricoverati a lungo nelle terapie intensive neonatali, sono particolarmente vulnerabili alle LOD. Obiettivo primario della ricerca contemporanea è quello di aumentare la conoscenza dei meccanismi patogenetici e di trasmissione per migliorare la prevenzione e ridurre la gravità di queste infezioni.
Classificazione MeSH
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Bibliografia
1. American Academy of Pediatrics. Red book: 2021-2024 report of the committee on infectious diseases.
2. Coggins SA, Puopolo KM. Neonatal Group B Streptococcus Disease. Pediatrics in Review 2024;45(2):63-73. doi:10.1542/pir.2023-006154.
3. Nanduri SA, Petit S, Smelser C, et al. Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA Pediatr 2019;173(3):224. doi:10.1001/jamapediatrics.2018.4826.
4. Miselli F, Frabboni I, Di Martino M, et al. Transmission of Group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence. Therapeutic Advances in Infection 2022;9:204993612211427. doi: 10.1177/20499361221142732.
5. Zangwill KM, Schuchat A, Wenger JD. Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR CDC Surveill Summ 1992;41(6):25-32.
6. Miselli F, Creti R, Lugli L, Berardi A. Group B Streptococcus Late-onset Neonatal Disease: An Update in Management and Prevention. Pediatric Infectious Disease Journal 2022;41(6):e263-e266. doi: 10.1097/INF. 0000000000003517.
7. Dangor Z, Khan M, Kwatra G, et al. The Association Between Breast Milk Group B Streptococcal Capsular Antibody Levels and Late-onset Disease in Young Infants. Clinical Infectious Diseases. Published online May 6, 2019:ciz360. doi: 10.1093/cid/ciz360.
8. Karampatsas K, Davies H, Mynarek M, Andrews N, Heath PT, Le Doare K. Clinical Risk Factors Associated With Late-Onset Invasive Group B Streptococcal Disease: Systematic Review and Meta-Analyses. Clinical Infectious Diseases 2022;75(7):1255-64. doi: 10.1093/cid/ciac206.
9. Berardi A, Spada C, Creti R, et al. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerg Infect Dis. 2021;27(9):2279-87. doi: 10.3201/eid2709. 210049.
10. Edwards MS, Nizet V, Baker CJ. Group B streptococcal infections. 8th ed. Philadelphia, PA: Elsevier, 2016.
11. Berardi A, Rossi C, Lugli L, et al. Group B Streptococcus Late-Onset Disease: 2003–2010. Pediatrics 2013;131(2):e361-e368. doi: 10.1542/peds.2012-1231.
12. Tazi A, Plainvert C, Anselem O, et al. Risk Factors for Infant Colonization by Hypervirulent CC17 Group B Streptococcus: Toward the Understanding of Late-onset Disease. Clinical Infectious Diseases 2019;69(10):1740-8. doi: 10.1093/cid/ciz033.
13. Berardi A, Rossi C, Creti R, et al. Group B Streptococcal Colonization in 160 Mother-Baby Pairs: A Prospective Cohort Study. The Journal of Pediatrics 2013;163(4):1099-104.e1. doi: 10.1016/j.jpeds.2013.05.064.
14. Zimmermann P, Gwee A, Curtis N. The controversial role of breast milk in GBS late-onset disease. J Infect 2017;74: S34-S40. doi: 10.1016/S0163-4453(17)30189-5.
15. Ager EPC, Steele ED, Nielsen LE, Nestander MA, Mende K, Spencer SE. Hypervirulent Streptococcus agalactiae septicemia in twin ex-premature infants transmitted by breast milk: report of source detection and isolate characterization using commonly available molecular diagnostic methods. Ann Clin Microbiol Antimicrob 2020;19(1):55. doi: 10.1186/s12941-020-00396-6.
16. Davanzo R, De Cunto A, Travan L, Bacolla G, Creti R, Demarini S. To Feed or Not to Feed? Case Presentation and Best Practice Guidance for Human Milk Feeding and Group B Streptococcus in Developed Countries. J Hum Lac 2013;29(4):452-7. doi: 10.1177/0890334413480427.
17. Ackerman DL, Craft KM, Doster RS, et al. Antimicrobial and Antibiofilm Activity of Human Milk Oligosaccharides against Streptococcus agalactiae, Staphylococcus aureus, and Acinetobacter baumannii. ACS Infect Dis 2018;4(3):315-24. doi: 10.1021/acsinfecdis. 7b00183.
18. Le Doare K, Bellis K, Faal A, et al. SIgA, TGF-β1, IL-10, and TNFα in Colostrum Are Associated with Infant Group B Streptococcus Colonization. Front Immunol 2017;8: 1269. doi: 10.3389/fimmu.2017.01269.
19. Collin SM, Lamb P, Jauneikaite E, et al. Hospital clusters of invasive Group B Streptococcal disease: A systematic review. J Infect 2019; 79 (6):521-7. doi: 10.1016/j.jinf.2019. 11.008.
20. Jauneikaite E, Kapatai G, Davies F, et al. Serial Clustering of Late-Onset Group B Streptococcal Infections in the Neonatal Unit: A Genomic Re-evaluation of Causality. Clinical Infectious Diseases 2018;67(6):854-860. doi: 10.1093/cid/ciy174.
21. Berardi A, Guidotti I, Creti R, et al. Two Overlapping Clusters of Group B Streptococcus Late-onset Disease in a Neonatal Intensive Care Unit. Pediatr Infect Dis J 2018;37(11):1160-4. doi: 10.1097/INF. 0000000000001987.
22. Puopolo KM, Lynfield R, Cummings JJ, et al. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics 2019;144(2):e20191881. doi: 10.1542/peds. 2019-1881.
23. Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, eds. Remington and Klein’s Infectious Diseases of the Fetus and Newborn Infant. Eighth edition. Elsevier, Saunders; 2016.
24. Levent, F. The Pediatric Infectious Disease Journal® Newsletter: November 2010. Pediatr Infect Dis J 2010;29(11):A11-A12. doi: 10.1097/01.inf.0000390047.75612.f1.
25. Tibussek D, Sinclair A, Yau I, et al. Late-Onset Group B Streptococcal Meningitis Has Cerebrovascular Complications. J Pediatr 2015;166(5):1187-1192.e1. doi: 10.1016/j. jpeds.2015.02.014.
26. Yaacobi N, Bar-Meir M, Shchors I, Bromiker R. A Prospective Controlled Trial of the Optimal Volume for Neonatal Blood Cultures. Pediatr Infect Dis J 2015; 34(4):351-4. doi: 10.1097/INF. 0000000000000594.
27. Keij F, Kornelisse R, Tramper-Stranders G, Allegaert K. Improved pathogen detection in neonatal sepsis to boost antibiotic stewardship. Future Microbiology 2020;15(7):461-4. doi: 10.2217/fmb-2019-0334.
28. Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker JN. Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children. Paediatr Int Child Health 2018;38(sup1):S3-S15. doi: 10.1080/ 20469047.2017.1408738.
29. American Academy of Pediatrics, Nelson JD. 2023 Nelson’s Pediatric Antimicrobial Therapy. 29th ed. (Bradley JS, ed.). American Academy of PediatricsItasca, IL; 2023. doi: 10.1542/9781610026512.
30. Boscarino G, Romano R, Iotti C, Tegoni F, Perrone S, Esposito S. An Overview of Antibiotic Therapy for Early- and Late-Onset Neonatal Sepsis: Current Strategies and Future Prospects. Antibiotics 2024;13(3):250. doi: 10.3390/antibiotics13030250.
31. Lim SY, Miller JL. Ampicillin Dose for Early and Late-Onset Group B Streptococcal Disease in Neonates. Am J Perinatol 2022; 39(07):717-25. doi: 10.1055/s-0040-1718880.
32. Gonçalves BP, Procter SR, Paul P, et al. Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden. Lancet Glob Health 2022; 10:e807-e819.
33. Freudenhammer M, Karampatsas K, Le Doare K, et al. Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS Late-Onset Sepsis. Front Immunol 2021;12: 617925. doi: 10.3389/fimmu.2021. 617925.
34. Ching NS, Buttery JP, Lai E, et al. Breastfeeding and Risk of Late-Onset Group B Streptococcal Disease. Pediatrics 2021; 148(3): e2020049561. doi: 10.1542/peds.2020-049561.
35. Berardi A, Trevisani V, Di Caprio A, et al. Understanding Factors in Group B Streptococcus Late-Onset Disease. IDR 2021; 14:3207-18. doi:10.2147/IDR.S291511.
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