The incidence of invasive infant group B streptococcal disease in the UK has substantially increased during the past decade, despite the presence of national intrapartum antibiotic prophylaxis guidelines for prevention of early-onset disease, according to a new study published in the Lancet Infectious Diseases.
Prospective, active national surveillance of invasive group B streptococcal disease in infants younger than 90 days was carried out from April 1, 2014 to April 30, 2015 through the British Paediatric Surveillance Unit, microbiology reference laboratories, and national public health agencies in the UK and Ireland.
During the 13-month surveillance period, 856 cases of group B streptococcus were identified, giving an incidence of 0.94 per 1000 live births (95% CI 0.88-1.00), with the highest incidence in England (0.97).
The incidence for early-onset disease (age 0-6 days, n=517) was 0.57 per 1000 live births (95% CI 0.52–0.62), while for late-onset disease (age 7-89 days, n=339) it was 0.37 per 1000 live births (95% CI 0.33–0.41).
Approximately 18% of cases (30% of late-onset disease cases) presented with meningitis.
A total 53 infants died (case fatality rate 6.2%). Of the 27 infants with early-onset disease who died, only one had received intrapartum antibiotic prophylaxis.
Isolates were received from 402 (47%) cases; with none resistant to penicillin, but resistance to clindamycin was identified in 72 (17%) isolates, and to erythromycin in 101 (25%) isolates, while 70 (17%) isolates were resistant to both clindamycin and erythromycin. Only 28 (6%) isolates were susceptible to tetracycline; 389 (91%) were fully resistant and 12 (3%) had intermediate resistance.
Given the study findings, new strategies for prevention of group B streptococcal disease are required, the authors concluded.