Recurrence of group B streptococcal infections in infants: a systematic review

Group-B Streptococcus(GBS) infections may rarely recur after antibiotic treatment. We aimed to fillexisting gaps on epidemiology, clinical features, and outcomes of GBS recurrences. A systematic searchof PubMed and Embase was conducted, covering the period until 1 July 2024. Thedemographics, clinical characteristics, treatment, and outcomes of infants withGBS recurrence were analyzed. Recurrence was defined as > 1 episode of invasiveGBS infection (positive blood and/or cerebrospinal fluid culture), occurringafter the completion of treatment for the initial episode. Among the 213recurrences, 146 reported individual data and were included in the analysis. GBSrecurrences developed shortly after the completion of antibiotic treatment forthe initial infection (median = 10 days 95%CI 6.0-18.8). Most infants werepreterm (63.5%) and had received an adequately long course of antibiotics forthe initial infection (median = 13 days, 95%CI 10-14). Serotype III waspredominant. Breast milk yielded GBS in most samples cultured (41/62, 66%);5/15 (33%) infants who discontinued breastfeeding after recurrence had afurther GBS recurrence. Case fatalities were 3.7%. Preterm birth is closelyassociated with GBS recurrences. Adequately long courses of antibiotics orwithdrawal of breast milk may not be useful measures to prevent recurrences.