Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Serotype Distribution of Invasive Group B Streptococcal Diseases in Infants at Two University Hospitals in Korea

영아에서의 침습 B군 사슬알균 감염증 및 혈청형 분석: 2개 대학병원 연구

  • Cho, Hye-Kyung (Department of Pediatrics, Gachon University College of Medicine) ;
  • Nam, Hye Na (Department of Pediatrics, Gachon University College of Medicine) ;
  • Cho, Hye Jung (Department of Pediatrics, Gachon University College of Medicine) ;
  • Son, Dong Woo (Department of Pediatrics, Gachon University College of Medicine) ;
  • Cho, Yong Kyun (Division of Infection, Department of Internal Medicine, Gachon University College of Medicine) ;
  • Seo, Yiel-Hea (Department of Laboratory Medicine, Gachon University College of Medicine) ;
  • Kim, Yae-Jean (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Eun, Byung Wook (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine)
  • 조혜경 (가천대학교 의학전문대학원 소아과학교실) ;
  • 남혜나 (가천대학교 의학전문대학원 소아과학교실) ;
  • 조혜정 (가천대학교 의학전문대학원 소아과학교실) ;
  • 손동우 (가천대학교 의학전문대학원 소아과학교실) ;
  • 조용균 (가천대학교 의학전문대학원 내과학교실) ;
  • 서일혜 (가천대학교 의학전문대학원 진단검사의학교실) ;
  • 김예진 (성균관대학교 의과대학 소아과학교실) ;
  • 은병욱 (을지대학교 의과대학 소아과학교실)
  • Received : 2016.11.14
  • Accepted : 2017.01.17
  • Published : 2017.08.25
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study was aimed at analyzing the serotypes of group B streptococcus (GBS) isolated from Korean infants with invasive disease and evaluating their association with disease manifestation. Methods: Data were retrospectively collected from invasive GBS infections at Gachon University Gil Medical Center from January 2006 to June 2012 and at Samsung Medical Center from April 2010 to November 2012. Serotypes were determined by slide agglutination test. Results: A total of 37 cases were identified, which included 22 full-term infants and 15 preterm infants. Fifteen cases (40.5%) were early-onset, 19 (51.4%) was late-onset, and three (8.1%) was very late-onset. Early-onset diseases among preterm infants were higher than those among full-term infants (60.0% [9/15] vs. 27.3% [6/22], P=0.17). The most common manifestation was bacteremia (70.3%), followed by meningitis and septic arthritis. Among 24 isolates retrievable for serotyping, serotype III (41.7%) was most common, followed by V (16.7%), Ia, Ib, and II (12.5%, respectively), and non-typeable (4.2%). Serotype III was more common in isolates from full-term infants (10/22) than from preterm infants (0/15), whereas serotype V was more common in isolates from preterm infants (4/15) than from full-term infants (0/22) (P=0.002). No penicillin-resistant strain was detected, and resistance to erythromycin and clindamycin were both 64.9%. Conclusions: GBS is an important pathogen in both preterm and full-term infants, and serotype distribution of GBS causing invasive diseases can differ between preterm and full-term infants. It is necessary to monitor the nationwide epidemiology of GBS diseases, including in preterm infants, in order to prepare preventive measures without underestimating early-onset diseases.

목적: 침습 B군 사슬알균(group B streptococcus [GBS]) 감염증에서 분리된 균의 혈청형과 임상적 특징의 관계를 분석하고자 하였다. 방법: 가천대 길병원과 삼성서울병원에 입원한 GBS 감염 환자 데이터를 후향적으로 수집하고 슬라이드 응집법으로 혈청형을 정하였다. 결과: 총 37명 중 만삭아 22명, 미숙아 15명이었고, 조발형 15명(40.5%), 지발형 19명(51.4%), 늦은 지발형 3명(8.1%)이었다. 조발형이 미숙아에서 더 많이 발생하였다(P=0.17). 임상 양상은 균혈증(70.3%)이 가장 흔했고, 수막염, 화농관절염 순이었다. 혈청형 분석이 가능했던 24 균주 중 III형이 가장 흔했고(41.7%), V (16.7%), Ia, Ib, II (각각 12.5%), non-typeable (4.2%)였다. III형은 만삭아에서 더 많았던 반면, V형은 미숙아에서 더 흔했다. 페니실린 내성균은 없었고 에리트로마이신과 클린다마이신 내성은 각각 64.9%였다. 결론: GBS는 미숙아와 만삭아에게 모두 중요한 병원체이며 혈청형 분포에서도 미숙아와 만삭아 간에 차이가 있을 수 있다. 조발형 질환의 발생을 과소평가하지 않고 적절한 예방 대책을 마련하기 위해 미숙아를 포함한 GBS 질환의 전국적인 역학을 감시하는 것이 필요하다.

Keywords

References

  1. Lachenauer CS, Wessels MR. Group B streptococcus. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier, 2015:1337-41.
  2. Kim KH, Sohn YM, Kang JH, Kim KN, Kim DS, Kim JH, et al. The causative organisms of bacterial meningitis in Korean children, 1986-1995. J Korean Med Sci 1998;13:60-4.
  3. Cho HK, Lee H, Kang JH, Kim KN, Kim DS, Kim YK, et al. The causative organisms of bacterial meningitis in Korean children in 1996-2005. J Korean Med Sci 2010;25:895-9. https://doi.org/10.3346/jkms.2010.25.6.895
  4. Edmond KM, Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AK, Cousens S, et al. Group B streptococcal disease in infants aged younger than 3 months: systematic review and metaanalysis. Lancet 2012;379:547-56. https://doi.org/10.1016/S0140-6736(11)61651-6
  5. Rivera L, Saez-Llorens X, Feris-Iglesias J, Ip M, Saha S, Adrian PV, et al. Incidence and serotype distribution of invasive group B streptococcal disease in young infants: a multicountry observational study. BMC Pediatr 2015;15:143. https://doi.org/10.1186/s12887-015-0460-2
  6. Centers for Disease Control and Prevention (CDC). Perinatal group B streptococcal disease after universal screening recommendations: United States, 2003-2005. MMWR Morb Mortal Wkly Rep 2007;56:701-5.
  7. Centers for Disease Control and Prevention (CDC). Trends in perinatal group B streptococcal disease: United States, 2000-2006. MMWR Morb Mortal Wkly Rep 2009;58:109-12.
  8. Puopolo KM. Current status of vaccine development for group B streptococcus. NeoReviews 2014;15:e430-8. https://doi.org/10.1542/neo.15-10-e430
  9. Melin P, Efstratiou A. Group B streptococcal epidemiology and vaccine needs in developed countries. Vaccine 2013;31 Suppl 4:D31-42. https://doi.org/10.1016/j.vaccine.2013.05.012
  10. Park KH, Kim KH, Kang JH, Kim KN, Kim DS, Kim YK, et al. Current status and clinical presentations of invasive neonatal group B streptococcal infections in Korea. Pediatr Int 2011;53:236-9. https://doi.org/10.1111/j.1442-200X.2010.03165.x
  11. Lee JH, Cho HK, Kim KH, Kim CH, Kim DS, Kim KN, et al. Etiology of invasive bacterial infections in immunocompetent children in Korea (1996-2005): a retrospective multicenter study. J Korean Med Sci 2011;26:174-83. https://doi.org/10.3346/jkms.2011.26.2.174
  12. Bekker V, Bijlsma MW, van de Beek D, Kuijpers TW, van der Ende A. Incidence of invasive group B streptococcal disease and pathogen genotype distribution in newborn babies in the Netherlands over 25 years: a nationwide surveillance study. Lancet Infect Dis 2014;14:1083-9. https://doi.org/10.1016/S1473-3099(14)70919-3
  13. Manning SD, Springman AC, Lehotzky E, Lewis MA, Whittam TS, Davies HD. Multilocus sequence types associated with neonatal group B streptococcal sepsis and meningitis in Canada. J Clin Microbiol 2009;47:1143-8. https://doi.org/10.1128/JCM.01424-08
  14. Matsubara K, Hoshina K, Suzuki Y. Early-onset and lateonset group B streptococcal disease in Japan: a nationwide surveillance study, 2004-2010. Int J Infect Dis 2013;17:e379-84. https://doi.org/10.1016/j.ijid.2012.11.027
  15. Benitz WE, Gould JB, Druzin ML. Risk factors for earlyonset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 1999;103:e77. https://doi.org/10.1542/peds.103.6.e77
  16. Allen U, Nimrod C, Macdonald N, Toye B, Stephens D, Marchessault V. Relationship between antenatal group B streptococcal vaginal colonization and premature labour. Paediatr Child Health 1999;4:465-9. https://doi.org/10.1093/pch/4.7.465
  17. Minakami H, Hiramatsu Y, Koresawa M, Fujii T, Hamada H, Iitsuka Y, et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 edition. J Obstet Gynaecol Res 2011;37:1174-97. https://doi.org/10.1111/j.1447-0756.2011.01653.x
  18. Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP, et al. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med 2015;28:766-82. https://doi.org/10.3109/14767058.2014.934804
  19. Money DM, Dobson S; Canadian Paediatric Society, Infectious Diseases Commitee. The prevention of early-onset neonatal group B streptococcal disease. J Obstet Gynaecol Can 2004;26:826-40. https://doi.org/10.1016/S1701-2163(16)30157-8
  20. Darlow B, Campbell N, Austin N, Chin A, Grigg C, Skidmore C, et al. The prevention of early-onset neonatal group B streptococcus infection: New Zealand Consensus Guidelines 2014. N Z Med J 2015;128:69-76.
  21. South Australian Maternal and Neonatal Clinical Network. South Australian Perinatal Practice Guidelines: neonatal sepsis (including maternal group B streptococcal colonisation) [Internet]. Adelaide: South Australian Health; c2012 [cited Jun 29]. Available from: http://www.sahealth.sa.gov.au/wps/wcm/connect/35cac4804ee510ca997f9dd150ce4f37/Neonatal+sepsis_June2014.pdf?MOD=AJPERES&CACHEID=35cac4804ee510ca997f9dd150ce4f37.
  22. Barcaite E, Bartusevicius A, Tameliene R, Kliucinskas M, Maleckiene L, Nadisauskiene R. Prevalence of maternal group B streptococcal colonisation in European countries. Acta Obstet Gynecol Scand 2008;87:260-71. https://doi.org/10.1080/00016340801908759
  23. Lee BK, Song YR, Kim MY, Yang JH, Shin JH, Seo YS, et al. Epidemiology of group B streptococcus in Korean pregnant women. Epidemiol Infect 2010;138:292-8. https://doi.org/10.1017/S0950268809990859
  24. Hickman ME, Rench MA, Ferrieri P, Baker CJ. Changing epidemiology of group B streptococcal colonization. Pediatrics 1999;104(2 Pt 1):203-9. https://doi.org/10.1542/peds.104.2.203
  25. Hong JS, Choi CW, Park KU, Kim SN, Lee HJ, Lee HR, et al. Genital group B streptococcus carrier rate and serotype distribution in Korean pregnant women: implications for group B streptococcal disease in Korean neonates. J Perinat Med 2010;38:373-7.
  26. Uh Y, Jang IH, Yoon KJ, Lee CH, Kwon JY, Kim MC. Colonization rates and serotypes of group B streptococci isolated from pregnant women in a Korean tertiary hospital. Eur J Clin Microbiol Infect Dis 1997;16:753-6. https://doi.org/10.1007/BF01709259
  27. Park JS, Cho DH, Yang JH, Kim MY, Shin SM, Kim EC, et al. Usefulness of a rapid real-time PCR assay in prenatal screening for group B streptococcus colonization. Ann Lab Med 2013;33:39-44. https://doi.org/10.3343/alm.2013.33.1.39
  28. Kim EJ, Oh KY, Kim MY, Seo YS, Shin JH, Song YR, et al. Risk factors for group B streptococcus colonization among pregnant women in Korea. Epidemiol Health 2011;33:e2011010.
  29. Yoon IA, Jo DS, Cho EY, Choi EH, Lee HJ, Lee H. Clinical significance of serotype V among infants with invasive group B streptococcal infections in South Korea. Int J Infect Dis 2015;38:136-40. https://doi.org/10.1016/j.ijid.2015.05.017
  30. Johri AK, Lata H, Yadav P, Dua M, Yang Y, Xu X, et al. Epidemiology of group B streptococcus in developing countries. Vaccine 2013;31 Suppl 4:D43-5. https://doi.org/10.1016/j.vaccine.2013.05.094
  31. Ferrieri P, Lynfield R, Creti R, Flores AE. Serotype IV and invasive group B Streptococcus disease in neonates, Minnesota, USA, 2000-2010. Emerg Infect Dis 2013;19:551-8. https://doi.org/10.3201/eid1904.121572