Group B Streptococcus agalactiae (GBS) Infections in Children with Immunodeficiency and Hematological Disorders
Lisa Hiskey, Jose Ferrolino, Ronald Dallas, Sandra Arnold, Elisabeth AddersonAbstract
Background
GBS is an important pathogen in neonates, pregnant women and nonpregnant adults with medical morbidities, but information about the characteristics of GBS infection in children outside the neonatal period is limited.
Methods
We reviewed the demographic and clinical characteristics of children with GBS infections treated at St. Jude Children’s Research Hospital between 2008 and 2024.
Results
A total of 24 infections were documented, including 8 bacteremia (1 with co-existing meningitis), 8 skin/soft tissue infections (SSTI), 6 urinary tract infections (UTI), and 2 bone/joint infections (BJI). Patients’ median age was 15.5 years. The majority were male (67%), Black (58%), and not Hispanic (92%). Most (75%) had persistent immunocompromising conditions and 42% had co-existing medical morbidities. None was diabetic. Acute complications included encephalopathy, subdural hematoma and hemiparesis in the patient with meningitis, and evidence of persistent infection (n=1) or local extension of infection (n=1). All isolates were susceptible to penicillin, ampicillin, ceftriaxone, levofloxacin, linezolid, and vancomycin. Most were resistant to clindamycin (18 of 22, 82%), erythromycin (2 of 3, 67%), and tetracycline (20 of 21, 95%). Most patients were empirically treated with antimicrobials to which their organisms were susceptible by in vitro testing. Two patients, who were treated with TMP/SMX or tetracycline for presumed urethritis, improved without specific therapy. The median time to microbiological cure was 1 day among 9 patients who had serial cultures obtained. The median duration of antimicrobial treatment for UTI, bacteremia, SSTI, and BJI was 5.5, 11, 10, and 77 days, respectively. The median duration of hospitalization was 4 days and was longer for patients with bacteremia (7 days) and BJI (6 days) than those with UTI (0 days) or SSTI (1 day). One patient expired of complications of graft-vs-host disease and sepsis after successful treatment of a GBS SSTI. Two patients had recurrence of their SSTI, which resolved upon re-treatment.
Conclusions
GBS infections in this population, with the exception of meningitis, were generally not associated with severe morbidity or mortality, but some patients had slow responses to therapy and 8% of patients had relapses of their infection. Rates of resistance to clindamycin, erythromycin and tetracycline were high.