Recurrent Invasive Group B Streptococcus Infections in Neonates: French Study 2007–2021
Overview
A retrospective study of 1527 neonatal invasive GBS infections in France identified a 2.36% recurrence rate, predominantly affecting preterm and low-birth-weight infants. Recurrence was strongly associated with the hypervirulent clonal complex 17 strain, but no β-lactam tolerance or specific genomic markers explained recurrence.
Background
Group B Streptococcus (GBS) is a leading cause of invasive bacterial infections in neonates, presenting as early-onset disease (EOD) or late-onset disease (LOD). While EOD is typically due to maternal-fetal transmission, LOD may involve vertical or horizontal transmission. Recurrent neonatal GBS infections are rare and poorly understood, with prematurity and breastmilk contamination suggested as risk factors. β-lactam tolerance has been hypothesized as a mechanism for bacterial persistence and relapse.
Data Highlights
Parameter
Recurrent Cases (n=36)
Nonrecurrent Cases (n=1491)
Recurrence Rate
2.36%
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Median Interval Between Episodes
22 days (range 9–66)
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Preterm Infants
68%
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Low Birth Weight Infants
72%
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Hypervirulent CC17 Strain
83%
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Odds Ratio for CC17 Association
2.86 (95% CI, 1.18–6.92)
—
Key Findings
Recurrent GBS infections occurred in 2.36% of neonatal invasive cases over 15 years in France.
Recurrence predominantly affected preterm (68%) and low-birth-weight (72%) infants.
Hypervirulent clonal complex 17 (CC17) strains were significantly associated with recurrence (83% of recurrent cases; OR 2.86).
No β-lactam–tolerant GBS strains were identified among recurrent isolates.
Whole-genome sequencing did not reveal specific genetic features linked to recurrence.
The median time between initial and recurrent infection was 22 days, with no third episodes observed.
Clinical Implications
Clinicians should be aware that recurrent GBS infections, although rare, mainly affect preterm and low-birth-weight neonates and are associated with hypervirulent CC17 strains. Standard β-lactam antibiotics remain effective as no tolerance was detected. Close monitoring and possibly extended follow-up may be warranted in high-risk infants to detect and manage recurrence promptly.
Conclusion
Recurrent neonatal GBS infections are uncommon but disproportionately affect vulnerable infants and are linked to hypervirulent strains without evidence of antibiotic tolerance. Further large-scale studies are needed to optimize management strategies for these cases.
References
French Reference Center for Streptococci, 2007–2021 -- Recurrent Invasive Infections of Group B Streptococcus in Neonates
