DETECTION OF ANTIBIOTIC RESISTANCE AND CAPSULAR TYPES OF GROUP B STREPTOCOCCI ISOLATED FROM COLONIZED PREGNANT WOMEN

  • Bojana Paunović Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade
  • Dušan Kekić Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade
  • Jovana Kabić Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade
  • Ina Gajić Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade
  • Miloš Jovićević Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade
DOI: https://doi.org/10.5937/mp74-39252
Keywords: Group B streptococcus, Resistance, Capsular distribution, Clone ST17

Abstract


Introduction: Group B streptococcus (GBS) is an opportunistic pathogen that colonizes the gastrointestinal and genital tract of 10-30% healthy people. GBS can cause early or late-onset disease manifested as pneumonia, sepsis, and meningitis. Penicillins are the first-choice therapy and prophylaxis of mother-to-child transmission. In the case of penicillin allergy, macrolides or vancomycin are used. The objective of this study was to determine antimicrobial susceptibility and macrolides resistance phenotypes of GBS isolated from vaginal swabs of pregnant women, as well as to determine capsular types (CPS) and identification of hypervirulent ST17 clone.

Material and methods: From 1st January to 31st December 2021, 134 GBS isolates were collected. Identification was performed using conventional microbiological methods and molecular detection of species-specific dltR gene. The disk diffusion method was used to test antibiotic resistance according to EUCAST standard. Capsular typing was conducted by multiplex PCR method. A hypervirulent ST17 clone was identified by detection of the hvgA gene using PCR.

Results: All isolates were sensitive to penicillin, vancomycin, and fluoroquinolones. Tetracycline resistance was the most common, detected in 81.3% (109/134) strains. Macrolide resistance was detected in 37.3% (50/134) of isolates, while 14.9% (20/134) showed resistance to high doses of gentamicin. Resistance to chloramphenicol was noticed in 1.5% (2/134) isolates. The most common macrolide resistance phenotype was cMLS (31/50, 62.0%). The most identified CPS were V found in 33 isolates (25.0%) and III identified in 30 strains (22.0%). A hypervirulent ST17 clone was detected in 12.7% (17/134) of isolates; 15 belonged to CPS III and 2 to CPS IV.

Conclusion: The high frequency of macrolide resistance in group B streptococci isolated from colonized pregnant women is a severe public health concern. Also, the detection of many CPS III isolates and ST17 clones indicates the need for continuous screening and monitoring of the prevalence of GBS infections in pregnant women and neonates.

Author Biographies

Dušan Kekić, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade

assistant

Jovana Kabić, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade

Research Associate

Ina Gajić, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade

Assistant professor

Miloš Jovićević, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade

Teaching Associate

References


  1. Russell NJ, Seale AC, O’Driscoll M, O’Sullivan C, Bianchi-Jassir F, Gonzalez-Guarin J, et al. Maternal Colonization with Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis. 2017;65(Suppl 2):S100–11.

  2. Van Du V, Dung PT, Toan NL, Van Mao C, Bac NT, Van Tong H, et al. Antimicrobial resistance in colonizing group B Streptococcus among pregnant women from a hospital in Vietnam. Sci Rep. 2021;11(1):1–7.

  3. Valkenburg-Van Den Berg AW, Sprij AJ, Dekker FW, Dorr PJ, Kanhai HHH. Association between colonization with Group B Streptococcus and preterm delivery: A systematic review. Acta Obstet Gynecol Scand. 2009;88(9):958–67.

  4. Tita ATN, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010;37(2):339–54.

  5. Zimmermann P, Gwee A, Curtis N. The controversial role of breast milk in GBS late-onset disease. J Infect. 2017;74:S34–40.

  6. George I, Mathews J, Mathews K. Postpartum Group B streptococcal meningitis. J Postgrad Med. 2008;54(1):65–6.

  7. Cape A, Tuomala RE, Taylor C, Puopolo KM. Peripartum bacteremia in the era of group B streptococcus prophylaxis. Obstet Gynecol. 2013;121(4):812–8.

  8. Shabayek S, Spellerberg B. Group B streptococcal colonization, molecular characteristics, and epidemiology. Front Microbiol. 2018;9(MAR):1–14.

  9. Puopolo KM, Lynfield R, Cummings JJ. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019;144(2).

  10. Hayes K, O’Halloran F, Cotter L. A review of antibiotic resistance in Group B Streptococcus: the story so far. Crit Rev Microbiol. 2020;46(3):253–69.

  11. Brimil N, Barthell E, Heindrichs U, Kuhn M, Lütticken R, Spellerberg B. Epidemiology of Streptococcus agalactiae colonization in Germany. Int J Med Microbiol. 2006;296(1):39–44.

  12. Furfaro LL, Chang BJ, Payne MS. Perinatal streptococcus agalactiae epidemiology and surveillance targets. Clin Microbiol Rev. 2018;31(4):1–18.

  13. Martins ER, Pedroso-Roussado C, Melo-Cristino J, Ramirez M, Oliveira H, Vaz T, et al. Streptococcus agalactiae causing neonatal infections in Portugal (2005-2015): Diversification and emergence of a CC17/PI-2b multidrug resistant sublineage. Front Microbiol. 2017;8(MAR):1–9.

  14. Poyart C, Tazi A, Ne Réglier-Poupet H, Billoët A, Tavares N, Raymond J, et al. Multiplex PCR Assay for Rapid and Accurate Capsular Typing of Group B Streptococci. J Clin Microbiol. 2007;45(6):1985.

  15. Lamy MC, Dramsi S, Billoët A, Réglier-Poupet H, Tazi A, Raymond J, et al. Rapid detection of the “highly virulent” group B streptococcus ST-17 clone. Microbes Infect. 2006;8(7):1714–22.

  16. Perme T, Golparian D, Bombek Ihan M, Rojnik A, Lučovnik M, Kornhauser Cerar L, et al. Genomic and phenotypic characterisation of invasive neonatal and colonising group B Streptococcus isolates from Slovenia, 2001–2018. BMC Infect Dis. 2020;20(1):1–9.

  17. Da Cunha V, Davies MR, Douarre PE, Rosinski-Chupin I, Margarit I, Spinali S, et al. Streptococcus agalactiae clones infecting humans were selected and fixed through the extensive use of tetracycline. Nat Commun. 2014;5:1–12.

  18. Matani C, Trezzi M, Matteini A, Catalani C, Messeri D, Catalani C. Streptococcus agalactiae:Prevalence of antimicrobial resistance in vaginal and rectal swabs in Italian pregnant women. Infez Med. 2016;24(3):217–21.

  19. Hayes K, Cotter L, Barry L, O’Halloran F. Emergence of the L phenotype in Group B Streptococci in the South of Ireland. Epidemiol Infect. 2017;145(16):3535–42.

  20. Lopes E, Fernandes T, Machado MP, Carriço JA, Melo-Cristino J, Ramirez M, et al. Increasing macrolide resistance among Streptococcus agalactiae causing invasive disease in non-pregnant adults was driven by a single capsular-transformed lineage, Portugal, 2009 to 2015. Eurosurveillance. 2018;23(21).

  21. Fröhlicher S, Reichen G, Müller M, Surbek D, Droz S, Spellerberg B, et al. Serotype distribution and antimicrobial susceptibility of group B streptococci in pregnant women: Results from a Swiss tertiary centre. Swiss Med Wkly. 2014;144(March):1–6.

  22. Von Both U, Buerckstuemmer A, Fluegge K, Berner R. Heterogeneity of genotype-phenotype correlation among macrolide-resistant Streptococcus agalactiae isolates. Antimicrob Agents Chemother. 2005;49(7):3080–2.

  23. Vuillemin X, Hays C, Plainvert C, Dmytruk N, Louis M, Touak G, et al. Invasive group B Streptococcus infections in non-pregnant adults: a retrospective study, France, 2007–2019. Clin Microbiol Infect. 2021;27(1):129.e1-129.e4.

  24. Villar HE, Jugo MB. Emergencia de streptococcus agalactiae con resistencia de alto nivel a gentamicina y estreptomicina en Buenos Aires, Argentina. Rev Esp Quimioter. 2013;26(2):112–5.

  25. Gomi Y, Wang L, Matsushima H, Kawabe A, Kikugawa A, Takagi A, et al. Variations in antibiotic susceptibility of group B Streptococcus in Japanese women: A long-term population-based cohort study. Taiwan J Obstet Gynecol. 2019;58(6):805–7.

  26. Bob-Manuel M, McGee L, Igunma JA, Alex-Wele MA, Obunge OK, Wariso KT. Whole genome sequence based capsular typing and antimicrobial resistance prediction of Group B streptococcal isolates from colonized pregnant women in Nigeria. BMC Genomics. 2021;22(1):1–6.

  27. Patras KA, Nizet V. Group B sStreptococcal maternal colonization and neonatal disease: Molecular mechanisms and preventative approaches. Front Pediatr. 2018;6(February):1–17.

  28. Barcaite E, Bartusevicius A, Tameliene R, Kliucinskas M, Maleckiene L, Nadisauskiene R. Prevalence of maternal group B streptococcal colonisation in European countries. Acta Obstet Gynecol Scand. 2008;87(3):260–71.

  29. Genovese C, D’Angeli F, Di Salvatore V, Tempera G, Nicolosi D. Streptococcus agalactiae in pregnant women: serotype and antimicrobial susceptibility patterns over five years in Eastern Sicily (Italy). Eur J Clin Microbiol Infect Dis. 2020;39(12):2387–96.

  30. Von Both U, Ruess M, Mueller U, Fluegge K, Sander A, Berner R. A serotype V clone is predominant among erythromycin-resistant Streptococcus agalactiae isolates in a southwestern region of Germany. J Clin Microbiol. 2003;41(5):2166–9.

  31. Kardos S, Tóthpál A, Laub K, Kristóf K, Ostorházi E, Rozgonyi F, et al. High prevalence of group B streptococcus ST17 hypervirulent clone among non-pregnant patients from a Hungarian venereology clinic. BMC Infect Dis. 2019;19(1):1–10.

  32. Usein CR, Grigore L, Georgescu R, Bältoiu M, Sträu M, Cristea V. Molecular characterization of adult-colonizing Streptococcus agalactiae from an area-based surveillance study in Romania. Eur J Clin Microbiol Infect Dis. 2012;31(9):2301–10.

  33. Gajic I, Plainvert C, Kekic D, Dmytruk N, Mijac V, Tazi A, et al. Molecular epidemiology of invasive and non-invasive group B Streptococcus circulating in Serbia. Int J Med Microbiol. 2019;309(1):19–25.

Published
2024/02/22
Issue
Vol. 74 No. 5 (2023): Medicinski podmladak
Section
Original Scientific Paper