Hospital clusters of invasive Group B Streptococcal disease: a systematic review
File(s)
Supporting information
Supporting information
Author(s)
Type
Journal Article
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.
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.
Date Issued
2019-12-01
Date Acceptance
2019-11-08
Citation
Journal of Infection, 2019, 79 (6), pp.521-527
ISSN
0163-4453
Publisher
Elsevier
Start Page
521
End Page
527
Journal / Book Title
Journal of Infection
Volume
79
Issue
6
Copyright Statement
©2019 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC-BY-NC-ND license.(http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
National Institute for Health Research
National Institute for Health Research
Grant Number
HPRU-2012-10047
HPRU-2012-10047
Subjects
Adult
Cluster
Group B streptococcal disease
Healthcare-associated infection
Neonatal
Outbreak
Streptococcus agalactiae
Systematic review
Microbiology
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2019-11-13