Konstantinos Karampatsas (United Kingdom)
St George's, University of London Paediatric Infectious Diseases Research GroupPresenter of 1 Presentation
STREPTOCOCCAL SEPSIS WITH RECURRENCE AND IN MULTIPLES: LEARNING FROM ERRORS IN NEONATAL HOST-COMMENSAL ADAPTATION (ID 116)
Abstract
Background
Group B Streptococcus (GBS) is a common intestinal coloniser during the neonatal period but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonised infants after day 3 of life. Transmission routes and risk factors of this late-onset form of GBS disease are not fully understood.
Methods
Cases of invasive GBS disease (iGBS) with recurrence (n = 25) and those occurring in parallel in twins/triplets (n = 32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analysed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease.
Results
The risk of iGBS among infants from multiple births was high (17%) if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was significantly shorter compared to recurrent cases (4.5 vs 12.5 days, P = 0.01) indicating differences in mode of infection and pathogenesis. Disturbances of the individual microbiome, including the persistence of infectious foci, are suggested, e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics (OR 4.2 (1.3-14.2), P = 0.02). Identical GBS strains in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants.
Conclusions
The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
Clinical Trial Registration
Not applicable
Moderator of 1 Session
