Ann Lab Med.  2021 Jul;41(4):380-385. 10.3343/alm.2021.41.4.380.

Recent Epidemiological Changes in Group B Streptococcus Among Pregnant Korean Women

• Choi SJ
• Kang J
• Uh Y

• KMID: 2512717
• DOI: http://doi.org/10.3343/alm.2021.41.4.380

Abstract

Background
Although group B Streptococcus (GBS) colonization rate among pregnant Korean women is lower than that among women from many Western countries, recent data show an upward trend. We investigated recent epidemiological changes in GBS among pregnant Korean women in terms of colonization rate, antimicrobial susceptibility, serotype, and resistance genotype.
Methods
Vaginal and anorectal swab specimens from 379 pregnant Korean women were cultured on Strep B Carrot Broth with GBS Detect (Hardy Diagnostics, USA), selective Todd-Hewitt broth (Becton Dickinson, USA), and Granada agar plate medium (Becton Dickinson). The antimicrobial susceptibility, serotypes, and macrolide-lincosamide-streptogramin B (MLS B) resistance genes of the GBS isolates were tested.
Results
The GBS colonization rate among pregnant Korean women was 19.8% (75/379). Colonization rates using Strep B Carrot Broth with GBS Detect, selective Todd-Hewitt broth, and Granada agar plate medium cultures were 19.5%, 19.3%, and 15.0%, respectively. Six pregnant women were colonized by non-beta-hemolytic GBS and were detected only in Strep B Carrot Broth with GBS Detect. Resistance rates of GBS to clindamycin, erythromycin, and tetracycline were 16.0%, 28.0%, and 42.7%, respectively. The most common GBS serotypes were V (22.7%), VIII (20.0%), and III (20.0%). The frequency of MLS B resistance genes erm(B) and erm(TR) were 63.6% and 36.4%, respectively.
Conclusions
The GBS colonization rate among pregnant Korean women has risen to levels observed in Western countries. To accurately evaluate GBS epidemiology among pregnant Korean women, periodic studies in multiple centers, including primary clinics, are necessary.

Keyword

Group B Streptococcus; Pregnant Korean women; Clindamycin; Erythromycin; Tetracycline; Serotype; Genotype

Reference

1. Edwards MS, Nizet V, Baker CJ. Wilson CB, editor. 2016. Group B streptococcal infections. Remington and Klein's infectious diseases of the fetus and newborn infant. 8th ed. Elsevier;Philadelphia: p. 411–56.

2. Libster R, Edwards KM, Levent F, Edwards MS, Rench MA, Castagnini LA, et al. 2012; Long-term outcomes of group B streptococcal meningitis. Pediatrics. 130:e8–15. DOI: 10.1542/peds.2011-3453. PMID: 22689869.

3. Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, Lanari M, et al. 2013; Group B streptococcus late-onset disease: 2003-2010. Pediatrics. 131:e361–8. DOI: 10.1542/peds.2012-1231. PMID: 23296441.

4. Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, Harrison LH, et al. 2019; Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr. 173:224–33. DOI: 10.1001/jamapediatrics.2018.4826. PMID: 30640366. PMCID: PMC6439883.

5. Campbell JR, Baker CJ, Edwards MS. 1992; Influence of serotype of group B streptococci on C3 degradation. Infect Immun. 60:4558–62. DOI: 10.1128/IAI.60.11.4558-4562.1992. PMID: 1398967. PMCID: PMC258202.

6. Uh Y, Jang IH, Hwang GY, Yoon KJ. 1999; Antimicrobial resistance and serotypes in the clinical isolates of group B streptococci. Korean J Clin Microbiol. 2:64–70.

7. Uh Y, Jang IH, Hwang GY, Lee MK, Yoon KJ, Kim HY. 2004; Serotypes and genotypes of erythromycin-resistant group B streptococci in Korea. J Clin Microbiol. 42:3306–8. DOI: 10.1128/JCM.42.7.3306-3308.2004. PMID: 15243101. PMCID: PMC446232.

8. Uh Y, Choi SJ, Jang IH, Lee KS, Cho HM, Kwon O, et al. 2009; Colonization rate, serotypes, and distributions of macrolide-lincosamide-streptograminB resistant types of group B streptococci in pregnant women. Korean J Clin Microbiol. 12:174–9. DOI: 10.5145/KJCM.2009.12.4.174.

9. Edwards MS, Baker CJ. Long SS, Prober CG, editors. 2018. Streptococcus agalactiae (group B Streptococcus). Principles and practice of pediatric infectious diseases. 5th ed. Elsevier;Philadelphia: p. 723–29. DOI: 10.1016/B978-0-323-40181-4.00119-5.

10. Kim DH, Min BJ, Jung EJ, Byun JM, Jeong DH, Lee KB, et al. 2018; Prevalence of group B streptococcus colonization in pregnant women in a tertiary care center in Korea. Obstet Gynecol Sci. 61:575–83. DOI: 10.5468/ogs.2018.61.5.575. PMID: 30254993. PMCID: PMC6137023.

11. Uh Y, Kwon JY, Jang IH, Yoon KJ, Kim HG. 1994; Colonization rate of group B Streptococcus in pregnant women and neonates. Korean J Clin Pathol. 14:447–53.

12. Uh Y, Jang IH, Yoon KJ, Lee CH, Kwon JY, Kim MC. 1997; Colonization rates and serotypes of group B streptococci isolated from pregnant women in a Korean tertiary hospital. Eur J Clin Microbiol Infect Dis. 16:753–6. DOI: 10.1007/BF01709259. PMID: 9405948.

13. Park KH, Kim KH, Kang JH, Kim KN, Kim DS, Kim YK, et al. 2011; Current status and clinical presentations of invasive neonatal Group B streptococcal infections in Korea. Pediatr Int. 53:236–9. DOI: 10.1111/j.1442-200X.2010.03165.x. PMID: 20487368.

14. CLSI. 2019. Performance standards for antimicrobial susceptibility testing. CLSI M100. 29th ed. Clinical and Laboratory Standards Institute;Wayne, PA:

15. Kataja J, Huovinen P, Skurnik M, Seppälä H. 1999; Erythromycin resistance genes in group A streptococci in Finland. Antimicrob Agents Chemother. 43:48–52. DOI: 10.1128/AAC.43.1.48. PMID: 9869564. PMCID: PMC89019.

16. Sutcliffe J, Grebe T, Tait-Kamradt A, Wondrack L. 1996; Detection of erythromycin-resistant determinants by PCR. Antimicrob Agents Chemother. 40:2562–6. DOI: 10.1128/AAC.40.11.2562. PMID: 8913465. PMCID: PMC163576.

17. Prevention of perinatal group B streptococcal disease: a public health perspective. 1996; Centers for Disease Control and Prevention. MMWR Recomm Rep. 45:1–24.

18. Le Doare K, O'Driscoll M, Turner K, Seedat F, Russell NJ, Seale AC, et al. 2017; Intrapartum antibiotic chemoprophylaxis policies for the prevention of group B streptococcal disease worldwide: systematic review. Clin Infect Dis. 65(S2):S143–51. DOI: 10.1093/cid/cix654. PMID: 29117324. PMCID: PMC5850619.

19. Dillon HC Jr, Gray E, Pass MA, Gray BM. 1982; Anorectal and vaginal carriage of group B streptococci during pregnancy. J Infect Dis. 145:794–9. DOI: 10.1093/infdis/145.6.794. PMID: 7045248.

20. El Aila NA, Tency I, Claeys G, Saerens B, Cools P, Verstraelen H, et al. 2010; Comparison of different sampling techniques and of different culture methods for detection of group B streptococcus carriage in pregnant women. BMC Infect Dis. 10:285. DOI: 10.1186/1471-2334-10-285. PMID: 20920213. PMCID: PMC2956727.

21. Uh Y, Jang IH, Hwang GY, Yoon KJ. 1998; Serotypes and biochemical reaction patterns of group B streptococci. Korean J Clin Pathol. 18:386–90.

22. Furfaro LL, Chang BJ, Payne MS. 2019; Detection of group B Streptococcus during antenatal screening in Western Australia: a comparison of culture and molecular methods. J Appl Microbiol. 127:598–604. DOI: 10.1111/jam.14331. PMID: 31120589.

23. Verani JR, McGee L, Schrag SJ. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). 2010; Prevention of perinatal group B streptococcal disease-revised guidelines from CDC, 2010. MMWR Recomm Rep. 59:1–36.

24. Yi A, Kim CK, Kimura K, Arakawa Y, Hur M, Yun YM, et al. 2019; First case in Korea of group B Streptococcus with reduced penicillin susceptibility harboring amino acid substitutions in penicillin-binding protein 2X. Ann Lab Med. 39:414–6. DOI: 10.3343/alm.2019.39.4.414. PMID: 30809991. PMCID: PMC6400725.

25. 2020; Prevention of group B streptococcal early-onset disease in newborns: ACOG committee opinion summary, number 797. Obstet Gynecol. 135:489–92. DOI: 10.1097/AOG.0000000000003669. PMID: 31977793.

26. Takahashi T, Maeda T, Lee S, Lee DH, Kim S, Takahashi T, et al. 2020; Clonal distribution of clindamycin-resistant erythromycin-susceptible (CRES) Streptococcus agalactiae in Korea based on whole genome sequences. Ann Lab Med. 40:370–81. DOI: 10.3343/alm.2020.40.5.370. PMID: 32311850. PMCID: PMC7169627.

27. Lachenauer CS, Kasper DL, Shimada J, Ichiman Y, Ohtsuka H, Kaku M, et al. 1999; Serotypes VI and VIII predominate among group B streptococci isolated from pregnant Japanese women. J Infect Dis. 179:1030–3. DOI: 10.1086/314666. PMID: 10068604.

28. Kimura K, Matsubara K, Yamamoto G, Shibayama K, Arakawa Y. 2013; Active screening of group B streptococci with reduced penicillin susceptibility and altered serotype distribution isolated from pregnant women in Kobe, Japan. Jpn J Infect Dis. 66:158–60. DOI: 10.7883/yoken.66.158. PMID: 23514916.

29. Omura Y, Kusama Y, Takeuchi N, Ishiwada N. 2018; Mediastinal, subcutaneous and multiple muscular abscesses caused by group B Streptococcus serotype VIII in a type 2 diabetes mellitus patient. J Infect Chemother. 24:401–3. DOI: 10.1016/j.jiac.2017.12.007. PMID: 29373267.

30. Mikamo H, Johri AK, Paoletti LC, Madoff LC, Onderdonk AB. 2004; Adherence to, invasion by, and cytokine production in response to serotype VIII group B streptococci. Infect Immun. 72:4716–22. DOI: 10.1128/IAI.72.8.4716-4722.2004. PMID: 15271933. PMCID: PMC470694.