Hospital clusters of invasive Group B Streptococcal disease: A systematic review

Simon Collin*, Peter Lamb, Elita Jauneikaite, Kirsty Le Doare, Roberta Creti, Alberto Berardi, Paul T. Heath, Shiranee Sriskandan, Theresa Lamagni

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Objectives: To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals. Methods: Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where ‘cluster’ was defined as ≥2 linked cases. PROSPERO CRD42018096297. Results: Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset (<7 days of life; n = 3), late-onset (7–90 days; n = 13) index case or colonized infant (n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3–17, range 0–50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified. Conclusions: Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics.

Original languageEnglish
Pages (from-to)521-527
Number of pages7
JournalJournal of Infection
Volume79
Issue number6
DOIs
Publication statusPublished - Dec 2019

Bibliographical note

Funding Information:
We would like to thank Anh Tran at Public Health England Knowledge and Library Services for her assistance with this review, and all study authors who responded to requests for data. SS, EL and TL acknowledge the support of the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance at Imperial College in partnership with Public Health England (PHE), in collaboration with The Sanger Institute, the University of Cambridge Veterinary School and Imperial College Health Partners. SS is based at Imperial College and also acknowledges the NIHR Imperial Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding Information:
We would like to thank Anh Tran at Public Health England Knowledge and Library Services for her assistance with this review, and all study authors who responded to requests for data. SS, EL and TL acknowledge the support of the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance at Imperial College in partnership with Public Health England (PHE), in collaboration with The Sanger Institute, the University of Cambridge Veterinary School and Imperial College Health Partners. SS is based at Imperial College and also acknowledges the NIHR Imperial Biomedical Research Centre . The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Publisher Copyright:
© 2019

Keywords

  • Adult
  • Cluster
  • Group B streptococcal disease
  • Healthcare-associated infection
  • Neonatal
  • Outbreak
  • Streptococcus agalactiae
  • Systematic review

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