Recurrent Group B Streptococcus Neonatal Invasive Infections, France, 2007–2021

Category	Detail
Condition	Recurrent invasive neonatal infections caused by Group B Streptococcus (GBS)
Key Mechanisms	Infections caused by hypervirulent GBS clonal complex 17; no β-lactam tolerance identified; recurrence possibly linked to bacterial persistence and host factors
Target Population	Neonates, especially preterm and low-birth-weight infants
Care Setting	Neonatal care units and pediatric infectious disease management settings

Recurrent GBS infections are rare, occurring in approximately 2.36% of neonatal invasive GBS cases.
Recurrence predominantly affects preterm (68%) and low-birth-weight (72%) infants and is associated with hypervirulent clonal complex 17 strains (83%).
No β-lactam–tolerant GBS strains were identified, and whole-genome sequencing did not reveal specific bacterial features linked to recurrence.

Define invasive infection by isolation of GBS from sterile sites in neonates aged 0–364 days.
Classify infections by onset: early-onset disease (0–6 days), late-onset disease (7–89 days), ultralate-onset disease (90–364 days).
Diagnose meningitis by clinical signs plus positive cerebrospinal fluid culture or pleocytosis with positive blood culture.

Administer antibiotic therapy for 7 days for GBS bacteremia and 14 days for meningitis as per French recommendations.
Initial empiric antibiotic therapy commonly includes amoxicillin or cefotaxime combined with amikacin or gentamicin.

Monitor neonates for recurrence, especially within a median interval of 22 days after initial infection.
Observe clinical recovery before considering infection resolved to identify potential recurrence.

Recognize prematurity and low birth weight as risk factors for recurrence.
Consider hypervirulent clonal complex 17 strains as associated with increased recurrence risk.
Breastfeeding and breastmilk colonization are potential but poorly documented risk factors.

Neonates with invasive GBS infections, including recurrent cases predominantly in preterm and low-birth-weight infants.

Empiric antibiotic regimens typically include β-lactams combined with aminoglycosides; no evidence of β-lactam tolerance influencing recurrence.

Ensure complete antibiotic therapy and clinical recovery before discharge to reduce recurrence risk.
Consider close follow-up for preterm and low-birth-weight infants after initial GBS infection.
Use molecular typing to identify hypervirulent clonal complex 17 strains which may inform prognosis.
Further large-cohort studies are needed to optimize management strategies for recurrent GBS neonatal infections.