Group B Streptococcal Infections

Tara M. Randis; Jacqueline A. Baker; Adam J. Ratner

doi:10.1542/pir.2016-0127

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Tara M. Randis, MD, MS*
Jacqueline A. Baker, MD^†
Adam J. Ratner, MD, MPH*,^‡

Departments of ^*Pediatrics and
^‡Microbiology, New York University School of Medicine, New York, NY
^†Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY

AUTHOR DISCLOSURE
Dr Randis has disclosed that she has received a no-cost extension of a NICHD-K23 grant award to determine the relationship between vitamin D status and the development of bacterial vaginosis. Drs Baker and Ratner have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

CDC:: Centers for Disease Control and Prevention
CFR:: case fatality rate
CSF:: cerebrospinal fluid
EO:: early-onset
GBS:: group B Streptococcus
HIV:: human immunodeficiency virus
IAP:: intrapartum antibiotic prophylaxis
LO:: late-onset
PCR:: polymerase chain reaction

Education Gap

Despite recommendations for universal screening and intrapartum antibiotic prophylaxis strategies for pregnant women, group B Streptococcus remains a major cause of neonatal disease.

Objectives

After completing this article, readers should be able to:

Understand the epidemiology of group B Streptococcus (GBS) infections.
Recognize the major clinical features associated with GBS infection, including early-onset and late-onset disease.
Understand the evidence-based guidelines for screening, intrapartum antibiotic prophylaxis, and management of infants born to mothers colonized with GBS.
Describe current testing strategies for diagnosis of GBS colonization or disease.
Understand the role of antibiotic resistance in the evolution of treatment strategies for GBS.
Describe future directions in GBS prevention, including investigational vaccines currently in clinical trials.

Introduction

Organism

Streptococcus agalactiae, or group B Streptococcus (GBS), was first recognized as a distinct entity in the 1930s by Rebecca Lancefield, who used immunologic typing of carbohydrate antigens as a means to classify streptococci. (1) Early studies by her group and others indicated that GBS was an uncommon cause of human disease and was more frequently isolated as an etiologic agent of bovine mastitis. Sporadic case reports from that time demonstrated the potential for GBS to cause invasive infections, especially in peripartum women, although such infections were believed to be infrequent. However, over the period of the 1950s to the early 1970s, GBS became the major cause of neonatal sepsis in the United States and worldwide.