Bacterial Load and Molecular Markers Associated with Early-onset Group B Streptococcus: A Systematic Review and Meta-analysis

Farah Seedat, Colin Brown, Chris Stinton, Jacoby Patterson, Julia Geppert, Karoline Freeman, Bee Tan, Samantha Ann Johnson, Hannah Fraser, Olalekan A. Uthman, Esther R. Robinson, Noel Denis McCarthy, Aileen Clarke, Sian Taylor-Phillips*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background: The natural history of neonatal group B Streptococcus (GBS) is poorly understood. Little is known about the bacterial factors influencing the transmission of GBS from mother to neonate, or the development of invasive early-onset GBS disease (EOGBS) in colonized neonates. We reviewed whether bacterial load and molecular markers are associated with GBS vertical transmission and progression to EOGBS. Methods: We searched Medline, Embase, Cochrane and Web of Science from inception to October 10, 2016, for observational studies in English. We also hand-searched reference lists of relevant publications and experts cross-checked included studies. Two reviewers independently screened studies, extracted data and appraised the quality of included studies using the Quality in Prognosis Studies tool. We conducted random-effects meta-analyses where possible and narratively synthesized the evidence in text and tables. Results: Seventeen studies were included from 1107 records retrieved from electronic databases and publication references. Meta-analyses of 3 studies showed that neonates colonized by serotype III had a higher risk of developing EOGBS than serotype Ia (pooled risk ratio: 1.51, 95% confidence interval: 1.12-2.03) and serotype II (risk ratio: 1.95, 95% confidence interval: 1.10-3.45). Eleven studies showed that in heavily colonized mothers, 2-3 times more neonates were colonized, and in heavily colonized neonates, up to 15 times more neonates had EOGBS, compared with light colonization. Most evidence was published before 2000 and was at risk of bias. Conclusions: Acknowledging the difficulty of natural history studies, well-controlled studies are needed to assess the predictive value of pathogen subtype and heavy load; they may be useful for better-targeted prevention.

Original languageEnglish
Pages (from-to)E306-E314
JournalPediatric Infectious Disease Journal
Issue number12
Publication statusPublished - 1 Dec 2018

Bibliographical note

Funding Information:
Supported by the UK National Screening Committee (NSC). S.T.-P., A.C., C.S. and H.F. are supported by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands. The views expressed in this publication are those of the authors and are not necessarily those of the NHS, NIHR or UK NSC.

Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.


  • Streptococcus agalactiae
  • bacterial load
  • molecular markers
  • systematic review
  • transmission


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