Disease burden and antimicrobial resistance of invasive group B streptococcus among infants in China: a protocol for a national prospective observational study

Wenjing Ji, Haiying Liu, Zhengjiang Jin, Aimin Wang, Xiaoping Mu, Xiaosong Qin, Weidong Wang, Chunyan Gao, Yuning Zhu, Xiaodan Feng, Jine Lei, Shangyang She, Lan Jiang, Jing Liu, Shuhua Yang, Zeshi Liu, Gang Li, Qiuhong Li, Dawen Guo, Muhammad Majid Aziz, Ali Hassan Gillani, Yu Fang, Wenjing Ji, Haiying Liu, Zhengjiang Jin, Aimin Wang, Xiaoping Mu, Xiaosong Qin, Weidong Wang, Chunyan Gao, Yuning Zhu, Xiaodan Feng, Jine Lei, Shangyang She, Lan Jiang, Jing Liu, Shuhua Yang, Zeshi Liu, Gang Li, Qiuhong Li, Dawen Guo, Muhammad Majid Aziz, Ali Hassan Gillani, Yu Fang

Abstract

Background: Group B Streptococcus (GBS) is a cause of neonatal sepsis, pneumonia, and meningitis that can lead to neurological sequelae in infants less than 3 months of age. The GBS disease burden is not known in China, therefore it cannot receive major attention. The main objectives of this study are the evaluation of the incidence of neonatal GBS infection, GBS case-fatality ratio, its serotypes and genotypes, bacterial resistance, clinical treatment and outcomes in China.

Methods: We are conducting a nation-wide, population-based, multi-center, prospective, observational cohort study in China from May 2016 to December 2017. Eighteen large urban tertiary care hospitals from 16 provinces were selected that cover the eastern, southern, western, northern and central regions of China. Meanwhile, we retrospectively collected data and GBS strains from January 2015 to April 2016 from selected hospitals. The incidence rate per 1000 live births will be defined as the total number of confirmed GBS cases born in the selected hospitals divided by the number of live births in the hospitals during the study period. All GBS cases detected in selected hospitals will be used to calculate the case-fatality ratio and for the typing analysis. GBS isolates will be serotyped using the Strep-B-Latex® rapid latex agglutination test for serotyping of Group B streptococci. Multi-locus sequence typing (MLST) will be performed by sequencing the internal fragments of seven house-keeping genes. Antimicrobial susceptibility will be tested per interpretive standards established by the Clinical and Laboratory Standards Institute. The presence of the common resistance genes ermA, ermB, mefA, tetI, tetO and tetM will be tested by PCR.

Discussion: We are conducting the first national study to estimate the invasive GBS disease burden and antimicrobial resistance of GBS among infants in China. Study findings will provide important evidence for improving clinical practice to ensure timely diagnosis of GBS disease and decisions for preventive measures. Surveillance of antimicrobial resistance will promote the rational use of antimicrobials.

Trial registration: The study was retrospectively registered at https://ichgcp.net/clinical-trials-registry/NCT02812576" title="See in ClinicalTrials.gov">NCT02812576".

Keywords: Antimicrobial resistance; Case fatality ratio; Genotype; Group B streptococcus; Incidence; Resistance gene; Serotype.

Figures

Fig. 1
Fig. 1
Selected hospital locations throughout China. This figure indicates that the eighteen large urban tertiary hospitals from 16 provinces provide good coverage of the eastern, southern, western, northern and central regions of China. It also demonstrates the study sample has good representativeness
Fig. 2
Fig. 2
Overview of the study procedures and subject enrollment. This figure describes the study procedures and the enrollment process

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