Group B Streptococcal sepsis: An old or ongoing threat? Pamela Barbadoro, MD, a,b Anna Marigliano, MD, a Sandra Savini, PhD, b Marcello Mario D’Errico, MD, a,b and Emilia Prospero, MD, MPH a,b Ancona, Italy Background: Group B Streptococcus (GBS) is a major cause of severe infections in newborns. Early-onset disease (EOD) occurs within the first week of life, and it is usually vertically transmitted. In late-onset disease (LOD), pathogens may also come from nosocomial sources. We report 3 cases of GBS infection in very low birth weight infants hospitalized by a neonatal intensive care unit (NICU) in Italy. Methods: The cluster was identified thanks to an active surveillance program; an epidemiologic investigation took place. Pulsed- field gel electrophoresis (PFGE) was used to assess the clonal relatedness of strains. An audit to stress the adherence to isolation precautions and hand hygiene was organized. Results: During a 16-day period, 2 preterm newborns developed GBS LOD; an earlier case of GBS EOD occurred in a baby hospi- talized by the same ward. The 3 GBS strains had the same antibiotic susceptibility pattern. The PFGE profiles of the 2 cases of LOD are indistinguishable from each other and closely related with the case of EOD. Strict infection control measures were adopted. Conclusion: The implementation of additional infection control measures was able to stop the diffusion of infection; however, clusters like this should remind us the ongoing threat of GBS for the small NICU patients. Key Words: Sepsis; streptococcus agalactiae; intensive care unit; neonatal. Copyright ª 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. (Am J Infect Control 2011;39:e45-e48.) Group B Streptococcus (GBS) is a major cause of se- vere infections in newborns, and it can result in death or long-term disabilities. GBS early-onset disease (EOD) occurs within the first week of life, with most cases ap- pearing within 24 hours; EOD is usually related to vag- inal colonization of the mother and consequent vertical transmission during delivery. 1,2 On the other hand, only a fraction of late-onset disease (LOD) in infants has a similar association. 1 Very low birth weight infants with prolonged hospital stay and more invasive inter- vention in the neonatal intensive care units are at in- creased risk for nosocomial sepsis. 2-4 GBS may come from the mother’s genital tract (vertically transmitted) but also may be originated by human or nosocomial sources after birth (horizontally transmitted). In fact, it has been repeatedly demonstrated that a significant proportion of infants who are colonized with group B Streptococci acquires this microorganism by nosoco- mial transmission and not from their mothers. 5 Cross contamination from maternally infected to uninfected neonates can occur from the hands of nursery person- nel. 2 There are several studies showing that neonates with LOD acquired GBS through nosocomial routes, 6,7 especially because of transient hand contamination of health care workers. 7 Recently, there has been a pau- city of GBS nosocomial outbreaks reported in the liter- ature, 2,3 probably because of the dramatic reduction of GBS infections following the introduction of intrapar- tum antibiotic prophylaxis. 8 However, a recent review has underlined a lack of evidence from well-designed and conducted trials to recommend intrapartum antibi- otic prophylaxis to reduce GBS neonatal infection, both early and late. 9 Moreover, although GBS neonatal infec- tion is relatively common, recognizable outbreaks are not often described. In part, this must be because of the difficulties in distinguishing maternally acquired from nosocomial disease. 10 In this paper, we report 3 cases of GBS infection in very low birth weight infants hospitalized by the neo- natal intensive care unit (NICU) of the Riuniti Hospital Ancona, Italy. Moreover, the evaluation of possible cross transmission within the NICU has been assessed. From the Department of Biomedical Science, Section of Hygiene, Poly- technic University of the Marches a ; and Hospital Hygiene Service, AOU Ospedali Riuniti Ancona, Ancona, Italy. b Address correspondence to Pamela Barbadoro, MD, Dipartimento di Scienze Biomediche-Sezione di Igiene, Medicina Preventiva e Sanit a, Pubblica, Universit a Politecnica delle Marche, Via Tronto 10/a-60100, Ancona, Italy. E-mail: p.barbadoro@univpm.it. Conflicts of interest: None to report. 0196-6553/$36.00 Copyright ª 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ajic.2010.12.017 e45