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

Introduction: Group-B Streptococcus(GBS) infections may rarely recur after antibiotic treatment. We aimed to fill existing gaps on epidemiology, clinical features, and outcomes of GBS recurrences. Methods: A systematic search of PubMed and Embase was conducted, covering the period until 1 July 2024. The demographics, 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), occurring after the completion of treatment for the initial episode. Results: Among the 213 recurrences, 146 reported individual data and were included in the analysis. GBS recurrences developed shortly after the completion of antibiotic treatment for the initial infection (median = 10 days 95%CI 6.0–18.8). Most infants were preterm (63.5%) and had received an adequately long course of antibiotics for the 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 further GBS recurrence. Case fatalities were 3.7%. Conclusions: Preterm birth is closely associated with GBS recurrences. Adequately long courses of antibiotics or withdrawal of breast milk may not be useful measures to prevent recurrences.