Infants with late-onset GBS develop sepsis, meningitis

Sepsis or septic shock and bacterial meningitis, which are associated with non-negligible morbidity and mortality, frequently occur in infants with group B Streptococcus (GBS) late-onset disease (LOD), reports a recent study.

An observational study and subanalysis of a multicentre prospective registry were conducted at a paediatric emergency department (PED). Infants aged between 7 and 89 days with positive blood culture for GBS seen between 2011 and 2016 at any of 22 Spanish PEDs were included in the analysis.

The main outcomes included risk factors (clinical and laboratory variables) for severe infection (sepsis/septic shock or meningitis) and paediatric intensive care unit (PICU) admission. Secondary outcome was the prevalence of poor outcomes, such as acute complications, sequelae, or death.

Seventy-four of 118 patients with LOD (62.7 percent) had a severe infection, of which 66 had sepsis/septic shock (11 with associated meningitis) and eight meningitis. Thirty-five patients (29.7 percent) were also admitted to a PICU.

An altered Pediatric Assessment Triangle (PAT) upon arrival and leukopaenia were independently associated with severe infection (odds ratio [OR], 43.6 percent, 95 percent confidence interval [CI], 8.1‒235.7; p<0.01) and PICU admission (OR, 11.6, 95 percent CI, 1.5‒91.4; p<0.019), respectively.

Poor outcomes occurred in six patients (5.1 percent), including two deaths (1.7 percent). All of them had an altered PAT, elevated procalcitonin (range 4.7‒100 ng/ml), a diagnosis of sepsis/septic shock, and were admitted to a PICU. In addition, four patients developed leukopaenia.

“Clinical appearance was the only risk factor for severe infection, whereas leukopaenia was related to PICU admission,” the investigators said.