Group B Streptococcus Early-Onset Disease: New Preventive and Diagnostic Tools to Decrease the Burden of Antibiotic Use

Abstract

The difficulty in recognizing early-onset neonatal sepsis (EONS) in a timely manner due to non-specific symptoms and the limitations of diagnostic tests, combined with the risk of serious consequences if EONS is not treated in a timely manner, has resulted in a low threshold for starting empirical antibiotic treatment. New guideline strategies, such as the neonatal sepsis calculator, have been proven to reduce the antibiotic burden related to EONS, but lack sensitivity for detecting EONS. In this review, the potential of novel, targeted preventive and diagnostic methods for EONS is discussed from three different perspectives: maternal, umbilical cord and newborn perspectives. Promising strategies from the maternal perspective include Group B Streptococcus (GBS) prevention, exploring the virulence factors of GBS, maternal immunization and antepartum biomarkers. The diagnostic methods obtained from the umbilical cord are preliminary but promising. Finally, promising fields from the newborn perspective include biomarkers, new microbiological techniques and clinical prediction and monitoring strategies. Consensus on the definition of EONS and the standardization of research on novel diagnostic biomarkers are crucial for future implementation and to reduce current antibiotic overexposure in newborns.

Keywords: Group B Streptococcus; antibiotics; biomarkers; blood culture; early-onset neonatal sepsis; guidelines; molecular culture techniques.

Figure 1

Overview of diagnostic and preventive strategies for EONS from three different perspectives, complemented with the various assessment methods ofthe guidelines.

Figure 2

Schematic visualization of new PCR techniques. The broad range PCRs refers to the analysis of a common region present in all bacteria, aiming to detect the presence of bacterial DNA in general. Multiplex PCR includes the simultaneous DNA analysis of several specific bacteria in one tube. Real-time PCR is the new technique that enables us to quantify the amount of DNA throughout the entire analysis, instead of the presence of DNA at the end of the analysis in conventional PCR.