Analysis of 11 Cases of Neonatal Invasive Streptococcus pyogenes InfectionFunding None.
23 November 2019
21 February 2020
24 March 2020 (online)
Objective This study aimed to improve the understanding of clinical characteristics of neonatal invasive Streptococcus pyogenes infection (iSPI).
Methods A retrospective study was performed to analyze the clinical and laboratory aspects of culture-confirmed neonatal iSPI cases during 2010 to 2017.
Results Eleven cases of neonatal iSPI were confirmed. The ages ranged from 2 hours to 26 days. Ten cases had positive blood culture results and one had positive cerebrospinal fluid culture for S. pyogenes. Seven patients had fever and seven had identified focal infection, including six skin and soft tissue infections and one case of pneumonia. All of the S. pyogenes strains were sensitive to penicillin, cefotaxime, and vancomycin, and nine were resistant to clindamycin and erythromycin. Six patients received penicillin or cephalosporin monotherapy. Three patients received meropenem plus vancomycin initially, and then two of them were switched to penicillin and one to vancomycin after pathogen identification. Two cases were treated with vancomycin monotherapy. All cases were discharged after being cured or showing improvement.
Conclusion Skin and soft tissue infection is a common manifestation of neonatal iSPI. Streptococcus pyogenes strains are highly sensitive to β-lactams, which should be used as the first-choice treatment.
Further study is needed to determine if there were any common emm types associated with invasive neonatal disease.
This study was approved by the ethics committee and the Institutional Board of Privacy and Security at the hospitals (2018-IEC-047).
The data used to support the findings of this study are available from the corresponding author upon request.
- 1 Ralph AP, Carapetis JR. Group a streptococcal diseases and their global burden. Curr Top Microbiol Immunol 2013; 368: 1-27
- 2 Li JP, Hua CZ, Sun LY, Wang HJ, Chen ZM, Shang SQ. Epidemiological features and antibiotic resistance patterns of Haemophilus influenzae originating from respiratory tract and vaginal specimens in pediatric patients. J Pediatr Adolesc Gynecol 2017; 30 (06) 626-631
- 3 Watanabe S, Takemoto N, Ogura K, Miyoshi-Akiyama T. Severe invasive streptococcal infection by Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis. Microbiol Immunol 2016; 60 (01) 1-9
- 4 Tapiainen T, Launonen S, Renko M. , et al. Invasive group A streptococcal infections in children: a nationwide survey in Finland. Pediatr Infect Dis J 2016; 35 (02) 123-128
- 5 O'Loughlin RE, Roberson A, Cieslak PR. , et al; Active Bacterial Core Surveillance Team. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis 2007; 45 (07) 853-862
- 6 Safar A, Lennon D, Stewart J. , et al. Invasive group A streptococcal infection and vaccine implications, Auckland, New Zealand. Emerg Infect Dis 2011; 17 (06) 983-989
- 7 Seale AC, Davies MR, Anampiu K. , et al. Invasive group A Streptococcus infection among children, rural Kenya. Emerg Infect Dis 2016; 22 (02) 224-232
- 8 Boyd R, Patel M, Currie BJ, Holt DC, Harris T, Krause V. High burden of invasive group A streptococcal disease in the Northern Territory of Australia. Epidemiol Infect 2016; 144 (05) 1018-1027
- 9 Williamson DA, Morgan J, Hope V. , et al. Increasing incidence of invasive group A Streptococcus disease in New Zealand, 2002-2012: a national population-based study. J Infect 2015; 70 (02) 127-134
- 10 Zachariadou L, Stathi A, Tassios PT, Pangalis A, Legakis NJ, Papaparaskevas J. ; Hellenic Strep-Euro Study Group. Differences in the epidemiology between paediatric and adult invasive Streptococcus pyogenes infections. Epidemiol Infect 2014; 142 (03) 512-519
- 11 Cancellara AD, Melonari P, Firpo MV. , et al. Multicenter study on invasive Streptococcus pyogenes infections in children in Argentina. Arch Argent Pediatr 2016; 114 (03) 199-208
- 12 Sivagnanam S, Zhou F, Lee AS, O'Sullivan MV. Epidemiology of invasive group A Streptococcus infections in Sydney, Australia. Pathology 2015; 47 (04) 365-371
- 13 Luca-Harari B, Darenberg J, Neal S. , et al; Strep-EURO Study Group. Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2009; 47 (04) 1155-1165
- 14 Nijman RG, Moll HA, Smit FJ. , et al. C-reactive protein, procalcitonin and the lab-score for detecting serious bacterial infections in febrile children at the emergency department: a prospective observational study. Pediatr Infect Dis J 2014; 33 (11) e273-e279
- 15 Bressan S, Andreola B, Cattelan F, Zangardi T, Perilongo G, Da Dalt L. Predicting severe bacterial infections in well-appearing febrile neonates: laboratory markers accuracy and duration of fever. Pediatr Infect Dis J 2010; 29 (03) 227-232
- 16 Naseer U, Steinbakk M, Blystad H, Caugant DA. Epidemiology of invasive group A streptococcal infections in Norway 2010-2014: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2016; 35 (10) 1639-1648
- 17 Wajima T, Morozumi M, Chiba N. , et al. Associations of macrolide and fluoroquinolone resistance with molecular typing in Streptococcus pyogenes from invasive infections, 2010-2012. Int J Antimicrob Agents 2013; 42 (05) 447-449
- 18 Chochua S, Metcalf BJ, Li Z. , et al. Population and whole genome sequence based characterization of invasive group A streptococci recovered in the United States during 2015. MBio 2017; 8 (05) e01422-e1417
- 19 Lu B, Fang Y, Fan Y. , et al. High prevalence of macrolide-resistance and molecular characterization of Streptococcus pyogenes isolates circulating in China from 2009 to 2016. Front Microbiol 2017; 8: 1052
- 20 de Almeida Torres RS, Fedalto LE, de Almeida Torres RF, Steer AC, Smeesters PR. Group A Streptococcus meningitis in children. Pediatr Infect Dis J 2013; 32 (02) 110-114
- 21 Reta MA, Zeleke TA. Neonatal bacterial meningitis in Tikur Anbessa Specialized Hospital, Ethiopia: a 10-year retrospective review. Springerplus 2016; 5 (01) 1971
- 22 Yamada T, Yamada T, Yamamura MK. , et al. Invasive group A streptococcal infection in pregnancy. J Infect 2010; 60 (06) 417-424
- 23 Sosa ME. Group A streptococcal infection in pregnancy and the puerperium. J Perinat Neonatal Nurs 2016; 30 (02) 124-130
- 24 Bingen E, Denamur E, Lambert-Zechovsky N. , et al. Mother-to-infant vertical transmission and cross-colonization of Streptococcus pyogenes confirmed by DNA restriction fragment length polymorphism analysis. J Infect Dis 1992; 165 (01) 147-150
- 25 Gazzano V, Berger A, Benito Y. , et al. Reassessment of the role of rapid antigen detection tests in diagnosis of invasive group A streptococcal infections. J Clin Microbiol 2016; 54 (04) 994-999