Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP). Recent evidence suggests higher incidence in Africa, where IAP is rare. We investigated the global incidence of infant invasive GBS disease and the associated serotypes, updating previous estimates. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0–89 days. We conducted random-effects meta-analyses of incidence, case fatality risk (CFR), and serotype prevalence. We identified 135 studies with data on incidence (n = 90), CFR (n = 64), or serotype (n = 45). The pooled incidence of invasive GBS disease in infants was 0.49 per 1000 live births (95% confidence interval [CI], .43–.56), and was highest in Africa (1.12) and lowest in Asia (0.30). Early-onset disease incidence was 0.41 (95% CI, .36–.47); late-onset disease incidence was 0.26 (95% CI, .21–.30). CFR was 8.4% (95% CI, 6.6%–10.2%). Serotype III (61.5%) dominated, with 97% of cases caused by serotypes Ia, Ib, II, III, and V. The incidence of infant GBS disease remains high in some regions, particularly Africa. We likely underestimated incidence in some contexts, due to limitations in case ascertainment and specimen collection and processing. Burden in Asia requires further investigation.

Using Probiotics to Flatten the Curve of Coronavirus Disease COVID-2019 Pandemic

Empirical therapy of newborns at risk for or with suspected early-onset sepsis (EOS) represents the main contributor to the use of antibiotics in early life.¹ The reported number of newborns receiving antibiotic therapy for 1 episode of culture-proven EOS ranges from 18 to 118 in high-risk infants, and up to 1400 in well-appearing newborns born to mothers with chorioamnionitis.^2-4 Thus, for each case of culture-proven EOS many newborns are exposed to potential harms related to empirical antibiotic therapy. Use of antibiotics in newborns is associated with early adverse consequences such as increased risk of necrotizing enterocolitis, fungal infections, and death in preterm infants.^5,6 Moreover, antibiotics increase antibiotic resistance, mother-child separation, and health care costs.^7,8 Antibiotic-induced microbiome alterations early in life, with downstream effects on the developing immune system,^9,10 are also associated with increased risks of allergic diseases, obesity, and autoimmune diseases later in life.^6,11,12

Administration of probiotics to premature newborns has been shown to prevent necrotizing enterocolitis and reduce all-cause mortality. In our hospital, we documented 2 cases of Bifidobacterium longum subspecies infantis bacteremia in newborns receiving probiotics. By comparative genomics, we confirmed that the strains isolated from each patient originated from the probiotics.