Clonal Complex 12 Serotype lb Streptococcus agalactiae Strain Causing Complicated Sepsis in Neonates: Clinical Features and Genetic Characteristics

Streptococcus agalactiae (group B Streptococcus [GBS]) is well known to cause serious diseases in infants. A serotype lb GBS strain has recently emerged and become prevalent in Southeast Asia. We aimed to investigate the clinical and genetic characteristics of this strain. All neonates with invasive GBS diseases from a tertiary-level medical center in Taiwan between 2003 and 2020 were analyzed. The capsule serotyping, multilocus sequence typing, and antimicrobial resistance analyses were performed on all the invasive GBS isolates, and whole-genome sequencing (WGS) was performed specifically on the type lb GBS strain. A total of 188 neonates with invasive GBS disease during the study period were identified. The type lb GBS strain accounted for 7.4% (n = 14) of neonatal GBS invasive diseases. Almost all type lb GBS isolates belonged to sequence type 12 (13/14, 92.9%) and clonal complex 12. Neonates with type lb GBS disease had a significantly higher rate of complicated sepsis (10/14, 71.4%; P < 0.05) and sepsis-attributable mortality (6/14, 42.9%; P < 0.05). Additionally, type lb GBS isolates had significantly higher rates of resistance to erythromycin and clindamycin (both 100%; P < 0.05) than other GBS serotypes. WGS revealed the presence of an similar to 75-kb integrative and conjugative element, ICESag37, comprising multiple antibiotic resistance and virulence genes, and PI-1 plus PI-2a were noted in all type lb serotype 12 (ST12) GBS isolates:, these isolates may be responsible for its high invasiveness and antimicrobial resistance rates. The genomic characteristics of the type lb clonal complex 12 (CC12) GBS strain may account for the high illness severity associated with this strain and its antibiotic resistance. Continuous monitoring and advanced strategies to control the spread of type lb CC12 GBS should be considered. IMPORTANCE A type lb ST12 GBS strain is not a common isolate in neonatal invasive diseases and has been ignored for a long time. However, the recent literature and our data showed that such a GBS strain is associated with a significantly higher risk of severe sepsis, higher illness severity, and a significantly higher rate of sepsis-attributable mortality. This study found a novel gene cluster, including the presence of ICESag37 and specific pilus genes, carrying multiple antimicrobial resistance and virulence genes, which may be responsible for the clinical characteristics. Because of the higher mortality and severity of illness, we concluded that continuous monitoring of the type lb ST12 GBS strain is warranted in the future.

Automated summary

A type lb ST12 GBS strain is associated with a significantly higher risk of severe sepsis, higher illness severity, and a significantly higher rate of sepsis-attributable mortality. The presence of an ICESag37 gene cluster and specific pilus genes carrying multiple antimicrobial resistance and virulence genes may be responsible for the clinical characteristics. Continuous monitoring of the type lb ST12 GBS strain is warranted in the future.