Unusual occurrence of an epidemic of type Ib/c group B streptococcal sepsis in a neonatal intensive care unit

Abstract

An epidemic of late-onset sepsis due to type Ib/c group B Streptococcus (Ib/c-GBS) occurred in a neonatal intensive care unit (NICU). During a seven-week period, five very low birth weight infants (index cases [ICs]) more than four weeks of age became bacteremic. Bacteriologic surveillance of neonates revealed persistent colonization in three ICs and identified three asymptomatic carriers (ACs). All ICs and one AC acquired Ib/c-GBS nosocomially, whereas the other two ACs were colonized at birth. Among nursery personnel, 39% carried GBS, but only two harbored Ib/c-GBS. Although phage typing of Ib/c-GBS isolates identified two patterns of susceptibility, we believe a single strain was involved in the epidemic, because the patterns overlapped and most isolates carried the same lysogenic phage. Analysis of events suggested infant-to-infant spread via the hands of personnel, but acquisition from the colonized staff was also possible. The control measures instituted prevented further spread of Ib/c-GBS in the NICU.