Department of Bacteriology, University Hospitals Paris Centre-Cochin, French National Reference Centre for Streptococci, Assistance Publique-Hôpitaux de Paris, France.
Department of Bacteriology, University Hospitals Paris Centre-Cochin, French National Reference Centre for Streptococci, Assistance Publique-Hôpitaux de Paris, France; Cochin Institute, INSERM U1016, UMR CNRS 8104, Team Bacteria and Perinatality, France; University of Paris, Paris, France.
Clin Microbiol Infect. 2021 Jan;27(1):129.e1-129.e4. doi: 10.1016/j.cmi.2020.09.037. Epub 2020 Sep 29.
Group B Streptococcus (GBS) (Streptococcus agalactiae) is a pathogen of growing importance in adults. The objective of this study was to describe the features of invasive infections by GBS in non-pregnant adults.
GBS infections were reported to the national reference centre for streptococci. Clinical information was abstracted from questionnaires. Capsular typing, identification of the hypervirulent CC-17 clone, and antibiotic susceptibility testing were performed for all GBS isolates. Multi-locus sequence typing and assignment to clonal complexes (CCs) was performed on a representative sample of 324 isolates.
In total, 1960 GBS invasive infections were analysed from 2007 to 2019. The median age at onset was 71 years old (range 18-103). The main manifestation was bacteraemia without focus (54.5%). Meningitis was more frequent in patients under 40 (26/180, 14.4% versus 78/1780, 4.4%, p < 0.0001). Capsular types Ia, Ib, II, III and V accounted for 91.0% of the cases (1786/1960). CC-1, -10, -17, -19 and -23 accounted for 96.3% (312/324) of the cases. Capsular type III and CC-17 were overrepresented in meningitis (38/104, 36.5%, p < 0.001 and 22/104, 21.2%, p 0.01, respectively). All isolates were susceptible to β-lactam antibiotics. Resistance to erythromycin (32.7%) and clindamycin (26.3%) remained stable, whereas decreased susceptibility to fluoroquinolones increased, reaching 2.7% in 2019 (p for trend 0.002).
This work highlights the susceptibility of the elderly to GBS infections and differences in the clinical manifestations according to the patients' age and GBS type. In agreement with worldwide reports on emerging multidrug-resistant GBS, it reinforces the need for a continued surveillance of GBS epidemiology.
B 群链球菌（GBS）（无乳链球菌）是一种对成人越来越重要的病原体。本研究的目的是描述非孕妇成人侵袭性 GBS 感染的特征。
GBS 感染向国家链球菌参考中心报告。从调查问卷中提取临床信息。对所有 GBS 分离株进行荚膜分型、识别高毒力 CC-17 克隆和抗生素敏感性测试。对 324 株代表性分离株进行多位点序列分型和克隆复合物（CC）的分配。
2007 年至 2019 年共分析了 1960 例 GBS 侵袭性感染。发病中位年龄为 71 岁（18-103 岁）。主要表现为无病灶菌血症（54.5%）。40 岁以下患者更常发生脑膜炎（180 例中有 26 例，14.4%，1780 例中有 78 例，4.4%，p<0.0001）。荚膜型 Ia、Ib、II、III 和 V 占病例的 91.0%（1786/1960）。CC-1、-10、-17、-19 和-23 占病例的 96.3%（312/324）。荚膜型 III 和 CC-17 在脑膜炎中过度表达（38/104，36.5%，p<0.001 和 22/104，21.2%，p<0.01）。所有分离株对β-内酰胺类抗生素均敏感。对红霉素（32.7%）和克林霉素（26.3%）的耐药性保持稳定，而对氟喹诺酮类药物的敏感性降低，2019 年达到 2.7%（趋势 p 值 0.002）。
本研究强调了老年人易患 GBS 感染的情况，以及根据患者年龄和 GBS 类型不同，临床表现的差异。与全球关于新兴多药耐药 GBS 的报告一致，这再次强调了需要继续监测 GBS 流行病学。
