Epidemiological observations of invasive group BStreptococcusinfections in six major hospitals in Peninsular Malaysia

AbdulRahman Muthanna; Mohd Nasir Mohd Desa; Nurul Asyikin Abdul Rahman; Nurul Diana Dzaraly; Nurul Hana Zainal Baharin; Nur Afiza Aziz; Chua Hui Shan; Zalina Ismail; Lailatul Akmar Mat Nor; Marlindawati Mohd Ali; Nur Hanani Ahmad; Mohammad Noor Amal Azmai; Syafinaz Amin-Nordin

doi:10.4103/apjtm.apjtm_965_23

Asian Pacific Journal of Tropical Medicine ›› 2024, Vol. 17 ›› Issue (9) :384 -391. DOI: 10.4103/apjtm.apjtm_965_23

Original Article

research-article

Epidemiological observations of invasive group BStreptococcusinfections in six major hospitals in Peninsular Malaysia

Author information +

¹ Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

² School of Biology, Faculty of Applied Sciences, Universiti Teknologi MARA, Negeri Sembilan, 72000 Kuala Pilah, Malaysia

³ Department of Oral Biology & Biomedical Sciences, Faculty of Dentistry, MAHSA University, 42610 Jenjarom, Selangor, Malaysia

⁴ School of Bioscience, Faculty of Pharmacy and Biomedical Sciences, MAHSA University, 42610 Jenjarom, Selangor, Malaysia

⁵ Department of Pathology, Sultanah Aminah Hospital, 80100 Johor Bahru, Johor, Malaysia

⁶ Department of Pathology, Melaka General Hospital, 75400 Melaka, Malaysia

⁷ Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia

⁸ Department of Pathology, Sultan Idris Shah Serdang Hospital, 43000 Kajang, Selangor, Malaysia

⁹ Department of Pathology, Tuanku Ja'afar Hospital, 70300 Seremban, Negeri Sembilan, Malaysia

¹⁰ Department of Pathology, Sungai Buloh Hospital, 47000 Sungai Buloh, Selangor, Malaysia

¹¹ Department of Biology, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

¹² Aquatic Animal Health and Therapeutics Laboratory, Institute of Bioscience, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

¹³ Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

¹⁴ Department of Medical Microbiology, Sultan Abdul Aziz Shah Hospital, Universiti Putra Malaysia, Persiaran MARDI-UPM, 43400, Selangor, Malaysia

To whom correspondence may be addressed. E-mail: mnasir@upm.edu.my

Show less

History +

PDF (353KB)

Abstract

Objective: To address the lack of research on invasive group B Streptococcus (GBS) infections in Malaysia and Southeast Asia through a comprehensive analysis of GBS isolates obtained from hospitals.

Methods: Medical records from patients with GBS infection isolated from the sterile site, such as blood and cerebrospinal fluid from 14 July 2019 to 15 December 2020, were reviewed from six major hospitals in Peninsular Malaysia. Inclusion criteria were invasive GBS, sterile sites and non-repeated GBS isolated from the same patients in the same admission. Viable isolates were re-identified for GBS and serotyped.

Results: A total of 118 patients were eligible, with a majority of non-pregnant adults (76.3%). Over half of the patients (62.7%) had underlying medical conditions, with diabetes as the most common disease, followed by respiratory disease, renal disease, cardiovascular disease and skin and soft tissue disease. The most common manifestations were sepsis, followed by soft tissue abscess, diabetic foot ulcer, wet gangrene and cellulitis. The overall mortality was 7.6%. The most common serotype was serotype V.

Conclusions: Invasive GBS infection among non-pregnant adults showed a rising trend, particularly among diabetic individuals. The study underscores the importance of reducing risk factors and highlights the necessity of developing GBS vaccination as a preventive strategy for both infants and adults.

Keywords

Invasive GBS infections / Malaysia

Cite this article

Download citation ▾

AbdulRahman Muthanna, Mohd Nasir Mohd Desa, Nurul Asyikin Abdul Rahman, Nurul Diana Dzaraly, Nurul Hana Zainal Baharin, Nur Afiza Aziz, Chua Hui Shan, Zalina Ismail, Lailatul Akmar Mat Nor, Marlindawati Mohd Ali, Nur Hanani Ahmad, Mohammad Noor Amal Azmai, Syafinaz Amin-Nordin. Epidemiological observations of invasive group BStreptococcusinfections in six major hospitals in Peninsular Malaysia. Asian Pacific Journal of Tropical Medicine, 2024, 17 (9) : 384-391 DOI:10.4103/apjtm.apjtm_965_23

登录浏览全文

4963

注册一个新账户忘记密码

References

Publishing order | Descend order by publishing year | Descend order by cited within

[1]	Shabayek S, Spellerberg B. Group B streptococcal colonization, molecular characteristics, and epidemiology. Front Microbiol 2018; 9: 437. https://doi.org/10.3389/fmicb.2018.00437.

[2]

Hasperhoven GF, Al-Nasiry S, Bekker V, Villamor E, Kramer BWW. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: A systematic review and meta-analysis. Int J Gynecol Obstet 2020; 127(6): 680-691. https://doi.org/10.1111/1471-0528.16085.

[3]	Haghshenas Mojaveri M, Zahedpasha Y, Asnafi N, Farhadi J, Haddad G. A survey on the prevalence of group B Streptococcus in pregnant women referred to the obstetrics and gynecology ward at babol Ayatollah Rouhani hospital. Iran J Neonatol 2014; 5(1): 23-27. https://doi.org/10.22038/IJN.2014.2353.

[4]	Barshak MB. Group B Streptococcus, an A-list pathogen in nonpregnant adults. JAMA Intern Med 2019; 179(4): 488-489. https://doi.org/10.1001/jamainternmed.2018.7296.

[5]	Björnsdóttir ES, Martins ER, Erlendsdóttir H, Haraldsson G, Melo-Cristino J, Kristinsson KG, et al. Changing epidemiology of group B streptococcal infections among adults in Iceland: 1975-2014. Clin Microbiol Infect 2016; 22(4): 379.e9-379.e16. https://doi.org/10.1016/j.cmi.2015.11.020.

[6]	Watkins LKF, McGee L, Schrag SJ, Beall B, Jain JH, Pondo T, et al. Epidemiology of invasive group B streptococcal infections among nonpregnant adults in the United States, 2008-2016. JAMA Intern Med 2019; 179(4): 479-488. https://doi.org/10.1001/jamainternmed.2018.7269.

[7]	Graux E, Hites M, Martiny D, Maillart E, Delforge M, Melin P, et al. Invasive group B Streptococcus among non-pregnant adults in Brussels-Capital Region, 2005-2019. Eur J Clin Microbiol Infect Dis 2021; 40(3): 515-523. https://doi.org/10.1007/s10096-020-04041-0.

[8]	Lim CT, Thong MK, Parasakthi N, Ngeow YF. Group B Streptococcus: Maternal carriage rate and early neonatal septicaemia. Ann Acad Med Singap 1997; 26(4): 421-425.

[9]	Eskandarian N, Neela V, Ismail Z, Puzi SM, Hamat RA, Desa MNM, et al. Group B streptococcal bacteremia in a major teaching hospital in Malaysia: A case series of eighteen patients. Int J Infect Dis 2013; 17(9): e777-e780. https://doi.org/10.1016/j.ijid.2013.01.011.

[10]	Khalid N, Zainun KA, Hisham S, Mazan NI, Nordin SA. Group B Streptococcus infection in a sudden unexpected death of infancy-the importance of microbiological investigation at post-mortem. Trop Biomed 2018; 35(3): 604-609.

[11]	Zakariah SZ, Zainun KA, Najib AM, Nordin SA. Post-partum invasive group B Streptococcus infection with fatal outcome: A case report. Malays J Med Health Sci 2018; 14(3): 57-59.

[12]	Rosa-Fraile M, Spellerberg B. Reliable detection of group B Streptococcus in the clinical laboratory. J Clin Microbiol 2017; 55(9): 2590-2598. https://doi.org/10.1128/JCM.00582-17.

[13]

Muthanna A, Baharin NH, Desa MN, Dzaraly ND, Azmai MN, Amin-Nordin S. Disease burden, antimicrobial resistance and molecular characterization of invasive group B Streptococcus among non-pregnant adults in Malaysia: A protocol study. Asian Pac J Trop Med 2023; 16(11): 498-505. https://doi.org/10.4103/1995-7645.390165.

[14]	Imperi M, Pataracchia M, Alfarone G, Baldassarri L, Orefici G, Creti R. A multiplex PCR assay for the direct identification of the capsular type (I a to IX) of Streptococcus agalactiae. J Microbiol Methods 2010; 80(2): 212-214. https://doi.org/10.1016/j.mimet.2009.11.010.

[15]	Edmond KM. , Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AK, Cousens S, et al. Group B streptococcal disease in infants aged younger than 3 months: Systematic review and meta-analysis. Lancet 2012; 379(9815): 547-556. http://dx.doi.org/10.1016/S0140-6736(11)61651-6.

[16]	Kwatra G, Cunnington MC, Merrall E, Adrian PV, Ip M, Klugman KP, et al. Prevalence of maternal colonisation with group B Streptococcus: A systematic review and meta-analysis. Lancet Infect Dis 2016; 16(9): 1076-1084. https://doi.org/10.1016/S1473-3099(16)30055-X.

[17]	Dhanoa A, Karunakaran R, Puthucheary SD. Serotype distribution and antibiotic susceptibility of group B streptococci in pregnant women. Epidemiol Infect 2010; 138(7): 979-981. https://doi.org/10.1017/S0950268809991105.

[18]	Schoen EJ, Colby CJ, To TT. Cost analysis of neonatal circumcision in a large health maintenance organization. J Urol 2006; 175(3): 1111-1115. https://doi.org/10.1016/S0022-5347(05)00399-X.

[19]	Fluegge K, Siedler A, Heinrich B, Schulte-Moenting J, Moennig MJ, Bartels DB, et al. Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany. Pediatrics 2006; 117(6): e1139-e1145. https://doi.org/10.1542/peds.2005-2481.

[20]	Blancas D, Santin M, Olmo M, Alcaide F, Carratala J, Gudiol F. Group B streptococcal disease in nonpregnant adults: Incidence, clinical characteristics, and outcome. Eur J Clin Microbiol Infect Dis 2004; 23(3): 168-173. https://doi.org/10.1007/s10096-003-1098-9.

[21]	Huang PY, Lee MH, Yang CC, Leu HS. Group B streptococcal bacteremia in non-pregnant adults. J Microbiol Immunol Infect 2006; 39(3): 237-241.

[22]	Ho CM, Chi CY, Ho MW, Chen CM, Liao WC, Liu YM, et al. Clinical characteristics of group B Streptococcus bacteremia in non-pregnant adults. J Microbiol Immunol Infect 2006; 39(5): 396-401.

[23]

Karunakaran R, Raja NS, Hafeez A, Puthucheary SD. Group B Streptococcus infection: Epidemiology, serotypes, and antimicrobial susceptibility of selected isolates in the population beyond infancy (excluding females with genital tract-and pregnancy-related isolates) at the University Malaya Medical Centre, Kuala Lumpur. Jpn J Infect Dis 2009; 62(3): 192-194.

[24]	Lefebvre N, Forestier E, Mohseni-Zadeh M, Remy V, Lesens O, Kuhnert C, et al. Invasive Streptococcus agalactiae infections in non-pregnant adults. Med Mal Infect 2007; 37(12): 796-801.

[25]	Skoff TH, Farley MM, Petit S, Craig AS, Schaffner W, Gershman K, et al. Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007. Clin Infect Dis 2009; 49(1): 85-92. https://doi.org/10.1086/599369.

[26]	Sunkara B, Bheemreddy S, Lorber B, Lephart PR, Hayakawa K, Sobel JD, et al. Group B Streptococcus infections in non-pregnant adults: The role of immunosuppression. Int J Infect Dis 2012; 16(3): e182-e186. https://doi.org/10.1016/j.ijid.2011.11.008.

[27]	Larppanichpoonphol P, Watanakunakorn C. Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital. South Med J 2001; 94(12): 1206-1212. http://dx.doi.org/10.1097/00007611-200194120-00016.

[28]	Barshak MB. Group B Streptococcus, an a-list pathogen in nonpregnant adults. JAMA Intern Med 2019; 179(4): 488-489. https://doi.org/10.1086/432804.

[29]	Buurman ET, Timofeyeva Y, Gu J, Kim JH, Kodali S, Liu Y, et al. A novel hexavalent capsular polysaccharide conjugate vaccine (GBS6) for the prevention of neonatal group B streptococcal infections by maternal immunization. J Infect Dis 2019; 220(1): 105-115. https://doi.org/10.1093/infdis/jiz062.

[30]	Martins ER, Melo-Cristino J, Ramirez M, Portuguese Group for the Study of Streptococcal Infections. Dominance of serotype I a among group B streptococci causing invasive infections in nonpregnant adults in Portugal. J Clin Microbiol 2012; 50(4): 1219-1227. https://doi.org/10.1128/JCM.05488-11.

[31]

Jump RL, Wilson BM, Baechle D, Briggs JM, Banks RE, Song S, et al. Risk factors and mortality rates associated with invasive group B Streptococcus infections among patients in the US Veterans Health Administration. JAMA 2019; 2(12): e1918324-e1918324. https://doi.org/10.1001/jamanetworkopen.2019.18324.

[32]	Sulung F, Hussin A, Hassan SA. Group B Streptococcus bacteremia among non-pregnant adults in Kelantan: Description on clinical presentations, serotypes and virulence genes. Int J Infect Dis 2020; 101: 146. https://doi.org/10.1016/j.ijid.2020.09.394.

[33]	Tazi A, Morand PC, Réglier-Poupet H, Dmytruk N, Billoët A, Antona D, et al. Invasive group B streptococcal infections in adults, France (2007-2010). Clin Microbiol Infect 2011; 17(10): 1587-1589. https://doi.org/10.1111/j.1469-0691.2011.03628.x.

[34]	Pimentel BAS, Martins CAS, Mendonça JC, Miranda PSD, Sanches GF, Mattos-Guaraldi AL, et al. Streptococcus agalactiae infection in cancer patients: A five-year study. Eur J Clin Microbiol Infect Dis 2016; 35(6): 927-933. https://doi.org/10.1007/s10096-016-2617-9.

[35]	Abdelradi A, Murphy A, Ahasic AM. Invasive Streptococcus agalactiae causing meningitis, ventriculitis, and endocarditis in a non-pregnant adult. Cureus 2020; 12(11): e11412. https://doi.org/10.7759/cureus.11412.

[36]	Mallick B, Nath P, Praharaj DL, Panigrahi SC, Anand A. Streptococcus agalactiae-related splenic abscess in uncontrolled diabetes mellitus. Cureus 2020; 12(8): e9513. https://doi.org/10.7759/cureus.9513.

[37]

Suhaimi ME, Desa MN, Eskandarian N, Pillay SG, Ismail Z, Neela VK, et al. Characterization of a group B Streptococcus infection based on the demographics, serotypes, antimicrobial susceptibility and genotypes of selected isolates from sterile and non-sterile isolation sites in three major hospitals in Malaysia. J Infect Public Health 2017; 10(1): 14-21.

[38]	Ezhumalai M, Muthanna A, Suhaili Z, Dzaraly ND, Amin-Nordin S, Amal MN, et al. Multilocus sequence typing analysis of invasive and non-invasive group B Streptococcus of hospital origin in Malaysia. Malays J Med Sci 2020; 27(1): 134-138. https://doi.org/10.21315/mjms2020.27.1.14.

[39]

Eskandarian N, Ismail Z, Neela VK, Van Belkum A, Desa MNM, Nordin SA. Antimicrobial susceptibility profiles, serotype distribution and virulence determinants among invasive, non-invasive and colonizing Streptococcus agalactiae (group B Streptococcus) from Malaysian patients. Eur J Clin Microbiol Infect Dis 2015; 34(3): 579-584. https://doi.org/10.1007/s10096-014-2265-x.

[40]	Tsai MH, Hsu JF, Lai MY, Lin LC, Chu SM, Huang HR, et al. Molecular characteristics and antimicrobial resistance of group B Streptococcus strains causing invasive disease in neonates and adults. Front Microbiol 2019; 10(2): 1-9. https://doi.org/10.3389/fmicb.2019.00264.

[41]	Lo CW, Liu HC, Lee CC, Lin CL, Chen CL, Jeng MJ, et al. Serotype distribution and clinical correlation of Streptococcus agalactiae causing invasive disease in infants and children in Taiwan. J Microbiol Immunol Infect 2019; 52(4): 578-584. https://doi.org/10.1016/j.jmii.2017.09.002.

[42]	Hirai N, Kasahara K, Nakano R, Ogawa Y, Suzuki Y, Ogawa M, et al. Clinical characteristics and molecular epidemiology of invasive Streptococcus agalactiae infections between 2007 and 2016 in Nara, Japan. PLoS One 2020; 15(10): 1-14. https://doi.org/10.1371/journal.pone.0240590.

[43]	Collin SM, Shetty N, Guy R, Nyaga VN, Bull A, Richards MJ, et al. Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis. Int J Infect Dis 2019; 83: 116-129. https://doi.org/10.1016/j.ijid.2019.04.017.