PURPOSE: Group B streptococcus (GBS) remains a leading cause of invasive disease, mainly sepsis and meningitis, in infants < 3 months of age and of mortality among neonates. This study, a major component of the European DEVANI project (Design of a Vaccine Against Neonatal Infections) describes clinical and important microbiological characteristics of neonatal GBS diseases. It quantifies the rate of antenatal screening and intrapartum antibiotic prophylaxis among cases and identifies risk factors associated with an adverse outcome. METHODS: Clinical and microbiological data from 153 invasive neonatal cases (82 early-onset [EOD], 71 late-onset disease [LOD] cases) were collected in eight European countries from mid-2008 to end-2010. RESULTS: Respiratory distress was the most frequent clinical sign at onset of EOD, while meningitis is found in > 30% of LOD. The study revealed that 59% of mothers of EOD cases had not received antenatal screening, whilst GBS was detected in 48.5% of screened cases. Meningitis was associated with an adverse outcome in LOD cases, while prematurity and the presence of cardiocirculatory symptoms were associated with an adverse outcome in EOD cases. Capsular-polysaccharide type III was the most frequent in both EOD and LOD cases with regional differences in the clonal complex distribution. CONCLUSIONS: Standardizing recommendations related to neonatal GBS disease and increasing compliance might improve clinical care and the prevention of GBS EOD. But even full adherence to antenatal screening would miss a relevant number of EOD cases, thus, the most promising prophylactic approach against GBS EOD and LOD would be a vaccine for maternal immunization.

Department for Gynecology and Obstetrics University Medical Center Medical Faculty University of Freiburg Freiburg Germany

Department of Biomedicine Health Aarhus University Aarhus Denmark

Department of Clinical Microbiology National Reference Center Streptococcus agalactiae University Hospital Center of Liege Avenue de L'Hôpital 1 4000 Liège 1 Belgique

Department of Infectious Diseases Istituto Superiore Di Sanità Rome Italy

Department of Pediatrics and Adolescent Medicine University Medical Center Medical Faculty University of Freiburg Freiburg Germany

Department of Pediatrics University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

GSK Siena Italy

National Center of Infectious and Parasitic Diseases Sofia Bulgaria

National Institute of Public Health Prague Czech Republic

Servicio Andaluz de Salud Hospital Universitario Virgen de Las Nieves Granada Spain

Spemann Graduate School of Biology and Medicine Faculty of Biology University of Freiburg and IMM PACT Clinician Scientist Program Faculty of Medicine University of Freiburg Freiburg Germany

UK Health Security Agency GB London UK

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Maternal Streptococcus agalactiae colonization in Europe: data from the multi-center DEVANI study