Du L, Jyotsnav J, Wan-Li F and Ya-Ping X
Aim: To explore the clinical characteristics and challenges involved in treating group B streptococcal (GBS) infection in neonates and infants.
Methods: Clinical data of group B streptococcal infections in new-borns and infants (≤ 3 months old) admitted to The Children’s Hospital, Zhejiang University School of Medicine, Department of Neonatology from May 2015 to January 2018 were retrospectively analysed. The clinical characteristics of group B streptococcal infection, difficulties involved in its treatment and its prognosis were analysed.
Results: A total of 52 patients were studied, among which, 29 were males and 23 were females. There were 39 neonates ageing from zero to 28 days and 13 infants ageing from 29 to 90 days. The age of onset was <7 days in 15 cases and >7 days in 37 cases. Premature infants were 12 in number and full-term infants, 40. The average duration from onset to hospitalization ranged from half a day to one day. The average hospitalization time was 12.45 ± 5.28 and 36.27 ± 17.68 days in the septicemia and meningitis groups respectively. The main clinical manifestations in the septicemia group were fever (77.27%), poor feeding, reduced crying and movement (59.09%) and finally respiratory distress (27.27%), while fever (96.15%), poor feeding, reduced crying and movement (92.31%), bulging of anterior fontanel or seizure (50%), were noted in the meningitis group. A decrease in white blood cells (WBC) was observed in 45.83% of cases, an increase in 22.92% of cases, and the remaining 31.25% were in the normal range, occurrence of thrombocytopenia was lower than 10.42% and C-reactive protein increased significantly in both groups. However, the recovery time of C-reactive protein in the septicemia group was significantly shorter compared to the meningitis group (7.33+3.31 days, 14.96+9.55 days, P<0.01). Cerebrospinal fluid manifestations: When cranial MRI of cerebrally injured and normal patients were compared, a significant difference was noted in their respective CSF cell count (3964+4279/ul, 1745+2396/uL, P<0.05), sugar level (0.94+0.9 mmol/L, 1.80+0.999 mmol/L, P<0.01), protein content (5366.0+1486.8 mg/L, 1591.6+860.2 mg/L, P<0.01) and positive bacterial smear (60%, 7%, P<0.01). Drug sensitivity: 52 cases of GBs were 100% sensitive to ampicillin, penicillin, vancomycin, linezolid and tigecycline. All patients were resistant to clindamycin, 84.61% to tetracycline and 23.08% to levofloxacin or ciprofloxacin.
Discussion: In the septicemia group, 68.2% (15/22) a combination of penicillin or ampicillin + cephalosporin was chosen, while in the meningitis group, 73.1% (19/26) of children were given a combination of either (a) penicillin or ampicillin + ceftriaxone or cefotaxime palate, or (b) vancomycin, meropenem. Patients who had a slow CSF recovery or recurrent fever two weeks post initial antibiotic treatment were given vancomycin or linezolid or rifampicin in addition to their baseline treatment. Two patients in the local infection group did not use systemic antibiotics, and two patients chose a mono-antibiotic therapy. 8. Complications and prognosis: All patients in the septicemia group recovered and met discharge criteria, 4/22 had shock, 4/22 had respiratory distress syndrome, 1/22 had toxic enteroparalysis as complication (s). In the meningitis group, 92.3% (24/26) of the patients were discharged from hospital with normal or improved cerebrospinal fluid results (31.38 (+19.82 days), 1 child was discharged without recovery and 1 child unfortunately died; 10/26 of them had extensive brain injury, 6/26 had subdural effusion, 4/26 had shock, 3/26 had liver injury, and 2/26 had cerebral hernia.
Conclusion: Neonatal and infant GBS infections can cause sepsis, meningitis, respiratory distress syndrome, urinary tract infections, skin and umbilical infections, which progress rapidly and hence, need urgent medical intervention. Among all, the treatment of group B streptococcal suppurative meningitis is particularly challenging, thereby leading to a longer period of hospitalization and the risk of serious neurological complications is high. The authors believe that attention should be paid to the screening of group B Streptococcus (GBs) during pregnancy and also during nursing of the skin, umbilical cord and oral cavity of new-borns for early prevention of the infection.
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