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1.
Emerg Infect Dis ; 26(6): 1174-1181, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32441619

RESUMEN

During 2015-2016, a total of 3,156 episodes of invasive group B Streptococcus (iGBS) infection in adults (>15 years of age) were recorded in England, corresponding to an annual incidence of 3.48/100,000 population. iGBS incidence was highest in older patients and women of childbearing age. The 493 pregnancy-related iGBS episodes correspond to a rate of 1.34/10,000 live births. In adults up to 60-69 years of age and in pregnant women, iGBS incidence increased with higher levels of socioeconomic deprivation. Hospital admissions associated with iGBS were predominantly emergency admissions (73% [2,260/3,099]); only 7% of nonpregnancy iGBS diagnoses were made >48 hours after admission. Underlying conditions were highly prevalent in nonpregnant adult case-patients, including cardiovascular (57%), lung (43%), and kidney (45%) disease and diabetes (40%). Post-iGBS episode 30-day and 12-month all-cause mortality rates in nonpregnant adults were 12% and 24%, respectively. No pregnancy-related iGBS deaths were identified.

3.
Genes Immun ; 21(1): 63-70, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31462703

RESUMEN

Invasive group A streptococcal (GAS) disease is uncommon but carries a high case-fatality rate relative to other infectious diseases. Given the ubiquity of mild GAS infections, it remains unclear why healthy individuals will occasionally develop life-threatening infections, raising the possibility of host genetic predisposition. Here, we present the results of a case-control study including 43 invasive GAS cases and 1540 controls. Using HLA imputation and linear mixed models, we find each copy of the HLA-DQA1*01:03 allele associates with a twofold increased risk of disease (odds ratio 2.3, 95% confidence interval 1.3-4.4, P = 0.009), an association which persists with classical HLA typing of a subset of cases and analysis with an alternative large control dataset with validated HLA data. Moreover, we propose the association is driven by the allele itself rather than the background haplotype. Overall this finding provides impetus for further investigation of the immunogenetic basis of this devastating bacterial disease.

4.
J Infect ; 79(6): 521-527, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31733233

RESUMEN

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.

5.
Lancet Infect Dis ; 19(11): 1209-1218, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31519541

RESUMEN

BACKGROUND: Since 2014, England has seen increased scarlet fever activity unprecedented in modern times. In 2016, England's scarlet fever seasonal rise coincided with an unexpected elevation in invasive Streptococcus pyogenes infections. We describe the molecular epidemiological investigation of these events. METHODS: We analysed changes in S pyogenes emm genotypes, and notifications of scarlet fever and invasive disease in 2014-16 using regional (northwest London) and national (England and Wales) data. Genomes of 135 non-invasive and 552 invasive emm1 isolates from 2009-16 were analysed and compared with 2800 global emm1 sequences. Transcript and protein expression of streptococcal pyrogenic exotoxin A (SpeA; also known as scarlet fever or erythrogenic toxin A) in sequenced, non-invasive emm1 isolates was quantified by real-time PCR and western blot analyses. FINDINGS: Coincident with national increases in scarlet fever and invasive disease notifications, emm1 S pyogenes upper respiratory tract isolates increased significantly in northwest London in the March to May period, from five (5%) of 96 isolates in 2014, to 28 (19%) of 147 isolates in 2015 (p=0·0021 vs 2014 values), to 47 (33%) of 144 in 2016 (p=0·0080 vs 2015 values). Similarly, invasive emm1 isolates collected nationally in the same period increased from 183 (31%) of 587 in 2015 to 267 (42%) of 637 in 2016 (p<0·0001). Sequences of emm1 isolates from 2009-16 showed emergence of a new emm1 lineage (designated M1UK)-with overlap of pharyngitis, scarlet fever, and invasive M1UK strains-which could be genotypically distinguished from pandemic emm1 isolates (M1global) by 27 single-nucleotide polymorphisms. Median SpeA protein concentration in supernatant was nine-times higher among M1UK isolates (190·2 ng/mL [IQR 168·9-200·4]; n=10) than M1global isolates (20·9 ng/mL [0·0-27·3]; n=10; p<0·0001). M1UK expanded nationally to represent 252 (84%) of all 299 emm1 genomes in 2016. Phylogenetic analysis of published datasets identified single M1UK isolates in Denmark and the USA. INTERPRETATION: A dominant new emm1 S pyogenes lineage characterised by increased SpeA production has emerged during increased S pyogenes activity in England. The expanded reservoir of M1UK and recognised invasive potential of emm1 S pyogenes provide plausible explanation for the increased incidence of invasive disease, and rationale for global surveillance. FUNDING: UK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust.

6.
J Infect ; 79(5): 435-443, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31419474

RESUMEN

An outbreak of an uncommon emm type (emm66.0) of group A streptococcus (GAS) occurred in England and Wales between January 2016 and May 2017, involving 52 individuals who were homeless or injecting drugs users. In order to investigate the outbreak, epidemiological and network analysis were performed; moreover 55 isolates (32 outbreak, 5 non-outbreak and 13 historical - 2005-2015) were tested with whole genome sequencing (WGS), antimicrobial resistance determination, Bayesian evolutionary analysis (BEAST). Forty one isolates (including 32 outbreak strains) belonged to a single emm66.0 clade (average SNP difference 6.6; range 0-16 SNPs) separate from the other isolates and two strains previously considered part of the outbreak (SNP average: 5876; range 93-8417 SNPs). Antibiotic resistance was not detected in the outbreak clone. No common source of infection was identified. WGS confirmed expansion of an emm66.0 clone in a hard-to-reach population and enabled refinement of the initial case definition.

7.
Infect Control Hosp Epidemiol ; 40(9): 983-990, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31218977

RESUMEN

OBJECTIVE: To assess the validity of multivariable models for predicting risk of surgical site infection (SSI) after colorectal surgery based on routinely collected data in national surveillance networks. DESIGN: Retrospective analysis performed on 3 validation cohorts. PATIENTS: Colorectal surgery patients in Switzerland, France, and England, 2007-2017. METHODS: We determined calibration and discrimination (ie, area under the curve, AUC) of the COLA (contamination class, obesity, laparoscopy, American Society of Anesthesiologists [ASA]) multivariable risk model and the National Healthcare Safety Network (NHSN) multivariable risk model in each cohort. A new score was constructed based on multivariable analysis of the Swiss cohort following colorectal surgery, then based on colon and rectal surgery separately. RESULTS: We included 40,813 patients who had undergone elective or emergency colorectal surgery to validate the COLA score, 45,216 patients to validate the NHSN colon and rectal surgery risk models, and 46,320 patients in the construction of a new predictive model. The COLA score's predictive ability was poor, with AUC values of 0.64 (95% confidence interval [CI], 0.63-0.65), 0.62 (95% CI, 0.58-0.67), 0.60 (95% CI, 0.58-0.61) in the Swiss, French, and English cohorts, respectively. The NHSN colon-specific model (AUC, 0.61; 95% CI, 0.61-0.62) and the rectal surgery-specific model (AUC, 0.57; 95% CI, 0.53-0.61) showed limited predictive ability. The new predictive score showed poor predictive accuracy for colorectal surgery overall (AUC, 0.65; 95% CI, 0.64-0.66), for colon surgery (AUC, 0.65; 95% CI, 0.65-0.66), and for rectal surgery (AUC, 0.63; 95% CI, 0.60-0.66). CONCLUSION: Models based on routinely collected data in SSI surveillance networks poorly predict individual risk of SSI following colorectal surgery. Further models that include other more predictive variables could be developed and validated.

8.
Int J Infect Dis ; 83: 116-129, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31028879

RESUMEN

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.


Asunto(s)
Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae , Infección de la Herida Quirúrgica/epidemiología , Cesárea , Femenino , Humanos , Masculino , Embarazo , Prevalencia , Infecciones del Sistema Respiratorio , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/clasificación , Infección de la Herida Quirúrgica/microbiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología
9.
Emerg Infect Dis ; 25(3): 529-537, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30602121

RESUMEN

The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011-2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.


Asunto(s)
Escarlatina/epidemiología , Escarlatina/transmisión , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/transmisión , Streptococcus pyogenes , Niño , Preescolar , Inglaterra/epidemiología , Composición Familiar , Femenino , Historia del Siglo XXI , Humanos , Incidencia , Lactante , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Escarlatina/historia , Escarlatina/microbiología , Infecciones Estreptocócicas/historia , Infecciones Estreptocócicas/microbiología
10.
Lancet Infect Dis ; 19(1): 83-90, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30497953

RESUMEN

BACKGROUND: Group B streptococcus is a leading cause of serious infection in young infants in many countries worldwide. We aimed to define the burden and clinical features of invasive group B streptococcal disease in infants younger than 90 days in the UK and Ireland, together with the characteristics of disease-causing isolates. METHODS: Prospective, active national surveillance of invasive group B streptococcal disease in infants younger than 90 days was done from April 1, 2014, to April 30, 2015, through the British Paediatric Surveillance Unit, microbiology reference laboratories, and national public health agencies in the UK and Ireland. Early onset was defined as disease in the first 6 days of life and late onset was defined as 7-89 days of life. Incidence was calculated using livebirths in 2014 (after adjustment for the 13-month surveillance period). Isolates were characterised by serotyping, multilocus sequence typing, and antimicrobial susceptibility testing. FINDINGS: 856 cases of group B streptococcus were identified in 2014-15, an incidence of 0·94 per 1000 livebirths (95% CI 0·88-1·00). Incidence for early-onset disease (n=517) was 0·57 per 1000 livebirths (95% CI 0·52-0·62), and for late-onset disease (n=339) was 0·37 per 1000 livebirths (0·33-0·41). 53 infants died (case fatality rate 6·2%), of whom 27 had early-onset disease (case fatality rate 5·2%) and 26 had late-onset disease (case fatality rate 7·7%). The predominant serotypes were III (241 [60%] of 402 serotyped isolates) and Ia (69 [17%]); five serotypes (Ia, Ib, II, III, V) accounted for 377 (94%) of all serotyped isolates. INTERPRETATION: The incidence of invasive infant group B streptococcal disease in the UK and Ireland has increased since a comparable study done in 2000-01. The burden of early-onset disease has not declined despite the introduction of national prevention guidelines. New strategies for prevention are required. FUNDING: Meningitis Now.

11.
Vaccine ; 36(46): 7033-7042, 2018 11 12.
Artículo en Inglés | MEDLINE | ID: mdl-30293765

RESUMEN

BACKGROUND: There is a considerable global burden of invasive group B streptococcal (GBS) disease. Vaccines are being developed for use in pregnant women to offer protection to neonates. OBJECTIVE: To estimate the potential impact and cost-effectiveness of maternal immunisation against neonatal and maternal invasive GBS disease in the UK. METHODS: We developed a decision-tree model encompassing GBS-related events in infants and mothers, following a birth cohort with a time horizon equivalent to average life expectancy (81 years). We parameterised the model using contemporary data from disease surveillance and outcomes in GBS survivors. Costs were taken from NHS sources and research studies. Maternal immunisation in combination with risk-based intrapartum antibiotic prophylaxis (IAP) was compared to the current standard practice of risk-based IAP alone from an NHS and Personal Social Services (health-provider) perspective. We estimated the cases averted and cost per QALY gained through vaccination. One-way sensitivity analysis, scenario analysis and probabilistic sensitivity analysis were performed. RESULTS: An effective maternal immunisation programme could substantially reduce the burden of GBS disease. The deterministic analysis estimated the threshold cost-effective price for a GBS vaccine to be £54 per dose at £20,000/QALY (£71 per dose at £30,000/QALY). Results were most sensitive to assumptions on disease incidence, sequelae rate and vaccine efficacy. Probabilistic analysis showed 90.66% of iterations fell under the £30,000 threshold at a vaccine price of £55. Inclusion of modest prevention of stillbirths and/or, preterm births, carer health impacts, maternal GBS deaths and 1.5% discounting improved cost-effectiveness compared to the base case. Lowering vaccine strain coverage made the vaccine less cost-effective. A key limitation is that the properties of the final GBS vaccine are unknown. CONCLUSIONS: Maternal GBS immunisation is expected to be cost-effective, even at a relatively high vaccine price.


Asunto(s)
Sepsis Neonatal/economía , Sepsis Neonatal/prevención & control , Infecciones Estreptocócicas/economía , Infecciones Estreptocócicas/prevención & control , Vacunas Estreptocócicas/economía , Vacunas Estreptocócicas/inmunología , Streptococcus agalactiae/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Análisis Costo-Beneficio , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Persona de Mediana Edad , Modelos Estadísticos , Sepsis Neonatal/epidemiología , Embarazo , Infecciones Estreptocócicas/epidemiología , Vacunas Estreptocócicas/administración & dosificación , Reino Unido/epidemiología , Adulto Joven
13.
Clin Infect Dis ; 67(6): 854-860, 2018 08 31.
Artículo en Inglés | MEDLINE | ID: mdl-29509833

RESUMEN

Background: Invasive Group B streptococcus (GBS) is a major cause of serious neonatal infection. Current strategies to reduce early-onset GBS disease have no impact on late-onset disease (LOD). Although GBS LOD is viewed as a sporadic event in the community, LOD arising within the neonatal intensive care unit (ICU) raises questions about mode of acquisition. Methods: Following a cluster of 4 GBS LOD cases, enhanced surveillance for all GBS LOD was undertaken over 2 years in the neonatal ICU supported by neonatal rectal screening. GBS isolates were serotyped and genome-sequenced. Results: Twelve late -onset invasive GBS episodes were identified (incidence 0.6/1000 live births). Genomic analysis revealed that 11/12 GBS isolates (92%) were linked to at least one other LOD isolate. Isolates from the first cluster were serotype V, resistant to macrolides and lincosamides, and sequencing confirmed isolates were indistinguishable, or distinguishable by only one SNP difference, from each other. Rectal carriage was rare. Prospective surveillance identified three further clusters of LOD due to serotypes Ia (3 cases), Ib (2 cases), and III (2 cases), that would not have been identified without surveillance and genome sequencing, leading to a re-evaluation of interventions required to prevent GBS LOD. Conclusion: Acquisition routes for LOD GBS in the neonatal ICU are poorly understood; cases may not necessarily be sporadic. Within this neonatal ICU, our data suggest that a single case of LOD GBS sepsis should be considered a potential nosocomial transmission event warranting prompt investigation, heightened infection prevention vigilance and action where required.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae/genética , Bacteriemia/epidemiología , Análisis por Conglomerados , Genómica , Humanos , Incidencia , Recién Nacido , Tamizaje Neonatal , Filogenia , Estudios Prospectivos , Factores de Riesgo , Serogrupo , Streptococcus agalactiae/aislamiento & purificación , Reino Unido/epidemiología , Secuenciación Completa del Genoma
14.
Lancet Infect Dis ; 18(2): 180-187, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29191628

RESUMEN

BACKGROUND: After decades of decreasing scarlet fever incidence, a dramatic increase was seen in England beginning in 2014. Investigations were launched to assess clinical and epidemiological patterns and identify potential causes. METHODS: In this population-based surveillance study, we analysed statutory scarlet fever notifications held by Public Health England from 1911 to 2016 in England and Wales to identify periods of sudden escalation of scarlet fever. Characteristics of cases and outbreaks in England including frequency of complications and hospital admissions were assessed and compared with the pre-upsurge period. Isolates from throat swabs were obtained and were emm typed. FINDINGS: Data were retrieved for our analysis between Jan 1, 1911, and Dec 31, 2016. Population rates of scarlet fever increased by a factor of three between 2013 and 2014 from 8·2 to 27·2 per 100 000 (rate ratio [RR] 3·34, 95% CI 3·23-3·45; p<0·0001); further increases were observed in 2015 (30·6 per 100 000) and in 2016 (33·2 per 100 000), which reached the highest number of cases (19 206) and rate of scarlet fever notifcation since 1967. The median age of cases in 2014 was 4 years (IQR 3-7) with an incidence of 186 per 100 000 children under age 10 years. All parts of England saw an increase in incidence, with 620 outbreaks reported in 2016. Hospital admissions for scarlet fever increased by 97% between 2013 and 2016; one in 40 cases were admitted for management of the condition or potential complications. Analysis of strains (n=303) identified a diversity of emm types with emm3 (43%), emm12 (15%), emm1 (11%), and emm4 (9%) being the most common. Longitudinal analysis identified 4-yearly periodicity in population incidence of scarlet fever but of consistently lower magnitude than the current escalation. INTERPRETATION: England is experiencing an unprecedented rise in scarlet fever with the highest incidence for nearly 50 years. Reasons for this escalation are unclear and identifying these remains a public health priority. FUNDING: None.


Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Monitoreo Epidemiológico , Escarlatina/epidemiología , Streptococcus/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos Bacterianos/análisis , Proteínas de la Membrana Bacteriana Externa/análisis , Proteínas Portadoras/análisis , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Hospitalización , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Faringe/microbiología , Escarlatina/microbiología , Streptococcus/clasificación , Gales/epidemiología , Adulto Joven
15.
Am J Infect Control ; 46(2): 238-240, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29031429

RESUMEN

We report an outbreak of invasive and noninvasive group A Streptococcus during April 2017 among people who inject drugs in southwest England. To date we have identified 14 cases linked to a specific town, all confirmed as group A Streptococcus emm94.0, a strain type not previously reported in the area. We have yet to identify a source for this ongoing outbreak. Actions described here may help reduce the burden of infection in vulnerable populations.


Asunto(s)
Brotes de Enfermedades , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/genética , Streptococcus pyogenes/aislamiento & purificación , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Recolección de Datos , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven
16.
BMJ Open ; 7(11): e018795, 2017 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-29158327

RESUMEN

OBJECTIVES: To describe the impact on early-onset group B Streptococcus (EOGBS) infection rates following reversion from screening-based to risk-based intrapartum antimicrobial prophylaxis (IAP) for prevention. SETTING: Maternity services provided by secondary healthcare organisation in North West London. PARTICIPANTS: All women who gave birth in the healthcare organisation between April 2016 and March 2017. There were no exclusions. DESIGN: Observational study comparing EOGBS rates in the postscreening period (2016-2017) with prescreening (2009-2013) and screening periods (2014-2015). METHODS: Local guidelines for risk-based IAP were reintroduced in April 2016. Compliance with guidelines was audited. Gestational age, mode of delivery, maternal demographics and EOGBS rates in three time periods were compared using Poisson regression analysis. EOGBS was defined through GBS being cultured from blood, cerebrospinal fluid or other sterile fluids within 6 days of birth. PRIMARY OUTCOME: EOGBS rates/1000 live births in prescreening, screening and postscreening periods RESULTS: Incremental changes in maternity population were observed throughout the study period (2009 onwards), in particular the ethnic profile of mothers. Of the 5033 live births in postscreening period, 9 babies developed EOGBS infection. Only one of the mothers of affected babies had a risk factor indicating use of IAP. Comparison of postscreening period with screening period showed a fivefold increase in EOGBS rates after adjustment for ethnicity (1.79 vs 0.33/1000 live births; risk ratio =5.67, p=0.009). There was no significant difference between prescreening and postscreening periods with rates of infection reverting to their prescreening level. CONCLUSIONS: This study provides further evidence of efficacy of screening-based IAP compared with risk-based IAP in prevention of EOGBS in newborns in an area of high incidence.


Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Tamizaje Masivo , Profilaxis Posexposición , Profilaxis Pre-Exposición , Complicaciones Infecciosas del Embarazo/prevención & control , Infecciones Estreptocócicas/prevención & control , Streptococcus agalactiae , Adulto , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Londres/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/crecimiento & desarrollo , Adulto Joven
17.
Clin Infect Dis ; 65(suppl_2): S112-S124, 2017 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-29117328

RESUMEN

Background: Infections such as group B Streptococcus (GBS) are an important cause of maternal sepsis, yet limited data on epidemiology exist. This article, the third of 11, estimates the incidence of maternal GBS disease worldwide. Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on invasive GBS disease in women pregnant or within 42 days postpartum. We undertook meta-analyses to derive pooled estimates of the incidence of maternal GBS disease. We examined maternal and perinatal outcomes and GBS serotypes. Results: Fifteen studies and 1 unpublished dataset were identified, all from United Nations-defined developed regions. From a single study with pregnancies as the denominator, the incidence of maternal GBS disease was 0.38 (95% confidence interval [CI], .28-.48) per 1000 pregnancies. From 3 studies reporting cases by the number of maternities (pregnancies resulting in live/still birth), the incidence was 0.23 (95% CI, .09-.37). Five studies reported serotypes, with Ia being the most common (31%). Most maternal GBS disease was detected at or after delivery. Conclusions: Incidence data on maternal GBS disease in developing regions are lacking. In developed regions the incidence is low, as are the sequelae for the mother, but the risk to the fetus and newborn is substantial. The timing of GBS disease suggests that a maternal vaccine given in the late second or early third trimester of pregnancy would prevent most maternal cases.


Asunto(s)
Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Femenino , Salud Global/estadística & datos numéricos , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Serogrupo , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/clasificación
18.
Clin Infect Dis ; 65(suppl_2): S190-S199, 2017 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-29117331

RESUMEN

Background: Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. Results: We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. Conclusions: GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities.


Asunto(s)
Discapacidades del Desarrollo/etiología , Infecciones Estreptocócicas/complicaciones , Streptococcus agalactiae , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/microbiología , Salud Global/estadística & datos numéricos , Humanos , Lactante , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/epidemiología , Factores de Riesgo , Infecciones Estreptocócicas/epidemiología
20.
Lancet Infect Dis ; 17(10): 1033-1041, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28711585

RESUMEN

BACKGROUND: Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater-cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. METHODS: We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. FINDINGS: Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. INTERPRETATION: HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. FUNDING: Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones por Mycobacterium/epidemiología , Infecciones por Mycobacterium/microbiología , Mycobacterium/aislamiento & purificación , Infecciones Relacionadas con Prótesis/microbiología , Contaminación de Equipos , Salud Global , Humanos , Enfermedad Iatrogénica , Mycobacterium/genética , Polimorfismo de Nucleótido Simple , Infecciones Relacionadas con Prótesis/epidemiología
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