Simon M Collin1, Peter Lamb2, Elita Jauneikaite3, Kirsty Le Doare4, Roberta Creti5, Alberto Berardi6, Paul T Heath7, Shiranee Sriskandan8, Theresa Lamagni9. 1. Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. Electronic address: simon.collin@phe.gov.uk. 2. Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. 3. Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK; NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK. 4. Paediatric Infectious Diseases Research Group, St George's University of London, London, UK; MRC/Uganda Virus Research Institute (UVRI) and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Pathogen Immunity Group, Public Health England, Porton Down, UK. 5. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy. 6. Neonatal Intensive Care Unit, Maternal and Child Department, University Hospital, Modena, Italy. 7. Paediatric Infectious Diseases Research Group, St George's University of London, London, UK. 8. NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK; MRC Centre for Molecular Bacteriology & Infection, Imperial College, London, UK. 9. Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College, London, UK.
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.
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.