Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis

Objectives: The epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae)outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages. Methods: A systematic review (PROSPERO CRD42017068914)and meta-analysis of GBS as a proportion (%)of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI)was conducted. Results: Seventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI)0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%)of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%)of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%)were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%)and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%)of community and 0.27% (95% CI 0.15–0.48%)of hospital RTI isolates. Conclusions: GBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.