Prognostic Factors in Late-Onset Streptococcus agalactiae Sepsis and Bacteremia

Serafin Castellano Damaso ¹ Raquel Gómez García ² José David Andrade Guerrero ¹ Inés De Augusto Claudino ⁷ Virginia Santana Rojo ¹ Mariano Silva Hernández ¹ Marta Dorado Criado ¹ Celia Fabra Garrido ¹ María Fátima Ara Montojo ¹ Rosario López López ³ María de Ceano-Vivas la Calle ³ Julia Martín Sánchez ³ María Pilar Romero Gómez ⁴ Iker Falces Romero ⁴ Juan José Menéndez Suso ⁵ Cristina Verdú Sánchez ⁵ Miguel Sáenz de Pipaón Marcos ⁶ Laura Sánchez García ⁶ Luis Escosa García ¹ Cristina Ots Ruiz ¹ Fernando Baquero Artigao ¹ Ana Méndez Echevarría ¹ Teresa del Rosal Rabes ¹ Luis Alfonso Alonso García ¹ Francisco Javier Aracil Santos ¹

¹General Paediatrics and Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Spain
²Centro de Salud Alpedrete, Atención Primaria Madrid, Spain
³Emergency Department, Hospital Universitario La Paz, Spain
⁴Microbiology Department, Hospital Universitario La Paz, Spain
⁵Pediatric Intensive Care Unit, Hospital Universitario La Paz, Spain
⁶Neonatalogy Department, Hospital Universitario La Paz, Spain
⁷Pediatrics Department, Centro Hospitalar Oeste, Portugal

Background: Streptococcus agalactiae or Group B Streptococcus (GBS) is one of the main causes of sepsis in newborns and young infants. GBS is also a major cause of meningitis in newborns, and it might lead to neurological impairment in those children affected. Disease manifestations are often non-specific, and symptoms are of short duration before diagnosis is made.

Objective: To determine possible prognostic factors of late-onset Group B streptococcal sepsis, diagnosed at a single tertiary care hospital in Madrid, Spain.

Methods: Retrospective review of culture-proven GBS sepsis, after 7th day of life, between 2000 and 2013.

Results: Sixty-eight episodes of late-onset GBS sepsis or bacteremia were diagnosed. Clinical onset started during after-birth hospitalization in 10 % of patients. GBS was identified in blood culture (67 cases) and/or CSF (14 cases). Sixteen (24%) presented meningitis. Mean age at diagnosis was 34 days (8-125 days). Mother’s rectal-vaginal culture was positive for GBS in only 14.5%, negative in 58% and was not performed in 27.5%. The most common clinical symptoms were: fever (73%), irritability (58%) and food rejection (52%). Three patients died (4.4%). Seven patients developed severe neurological impairment.

Adverse outcome (death or neurological impairment) in the univariate analysis was related to lower temperature, lower WBC count, lower platelets, lower neutrophils, higher immature/total neutrophil ratio (I/T) and male gender (p<0.05). With logistic regression analysis, variables related to adverse outcome with p 0,1.

Conclusion: Despite preventive measures, GBS remains a leading cause of sepsis and meningitis in newborns. GBS continues to cause mortality and frequent neurological sequelae. GBS sepsis seems to be more severe in male patients, in those with lower fever, lower WBC, lower neutrophil and lower platelet count and in those with higher immature neutrophil count.