Collin, SM; Lamb, P; Jauneikaite, E; Doare, KL; Creti, R; Berardi, A; Heath, PT; Sriskandan, S; Lamagni, T
(2019)
Hospital clusters of invasive Group B Streptococcal disease: a systematic review.
J Infect.
ISSN 1532-2742
https://doi.org/10.1016/j.jinf.2019.11.008
SGUL Authors: Heath, Paul Trafford
Abstract
OBJECTIVES: To characterise 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 1966-2019. 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.
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