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Diseases

Group B streptococcal infection

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Group B streptococcal infection is the most common cause of early, severe infection in newborns.

  • It is also a cause of infection in pregnancy, people with diabetes, immunocompromised people, and older adults.

  • Presentation depends on the age of the patient and the underlying risk factor.

  • Diagnosis is confirmed by isolation of group B streptococci (GBS) from usually sterile body fluid.

  • Targeted antibiotic therapy is the mainstay of therapy in patients with demonstrated GBS infection.

Group B streptococci on blood agar
Group B streptococci on blood agar
From the collection of Dr Brendan Healy

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

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        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Group B streptococci on blood agar

            Group B streptococci on blood agar

          Citations

            Key Articles

            • American Academy of Pediatrics. Group B streptococcal infections. In: Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, et al. Red book: 2021-2024 report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: AAP; 2021:707-13.

            • The American College of Obstetricians and Gynecologists. Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion Summary, Number 797. Obstet Gynecol. 2020 Feb;135(2):489-92.[Abstract][Full Text]

            • National Center for Health Statistics. Active bacterial core surveillance (ABCs) report: emerging infections program network - group B streptococcus, 2018 [internet publication].[Full Text]

            • Royal College of Obstetricians and Gynaecologists. The prevention of early onset neonatal group B streptococcal disease. Green-top guideline no. 36. Sep 2017 [internet publication].[Abstract][Full Text]

            • Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev. 2014 Jun 10;(6):CD007467.[Abstract][Full Text]

            • Puopolo KM, Lynfield R, Cummings JJ, et al. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019 Aug;144(2):e20191881.[Abstract][Full Text]

            • American Society for Microbiology. Guidelines for the detection and identification of group B streptococcus. 29 July 2021 [internet publication].[Full Text]

            Other Online Resources

            • SCCM and ESICM: Surviving Sepsis Campaign - pediatric patients
            • SCCM and ESICM: Surviving Sepsis Campaign - adult patients
            • ACOG: group B streptococcus and pregnancy
            • RCOG: group B Streptococcus (GBS) in pregnancy and newborn babies

            Referenced Articles

            • 1. Edwards MS, Baker CJ. Streptococcus agalactiae (Group B Streptococci). In: Bennett JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th edition. Philadelphia, US: Elsevier; 2020.

            • 2. Phares CR, Lynfield R, Farley M, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008 May 7;299(17):2056-65.[Abstract][Full Text]

            • 3. American Academy of Pediatrics. Group B streptococcal infections. In: Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, et al. Red book: 2021-2024 report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: AAP; 2021:707-13.

            • 4. McDonald HM, Chambers HM. Intrauterine infection and spontaneous midgestation abortion. Is the spectrum of microorganisms similar to that in preterm labour? Infect Dis Obstet Genecol. 2000;8(5-6):220-7.[Abstract][Full Text]

            • 5. Francois Watkins LK, McGee L, Schrag SJ, et al. Epidemiology of invasive group B streptococcal infections among nonpregnant adults in the United States, 2008-2016. JAMA Intern Med. 2019 Apr 1;179(4):479-88.[Abstract][Full Text]

            • 6. The American College of Obstetricians and Gynecologists. Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion Summary, Number 797. Obstet Gynecol. 2020 Feb;135(2):489-92.[Abstract][Full Text]

            • 7. National Center for Health Statistics. Active bacterial core surveillance (ABCs) report: emerging infections program network - group B streptococcus, 2018 [internet publication].[Full Text]

            • 8. Kadambari S, Trotter CL, Heath PT, et al. Group B streptococcal disease in England (1998-2017): a population-based observational study. Clin Infect Dis. 2021 Jun 1;72(11):e791-8.[Abstract]

            • 9. Lamagni TL, Keshishian C, Efstratiou A, et al. Emerging trends in the epidemiology of invasive group B streptococcal disease in England and Wales, 1991-2010. Clin Infect Dis. 2013 Sep;57(5):682-8.[Abstract][Full Text]

            • 10. British Paediatric Surveillance Unit. Annual report 2015-2016. Jan 2017 [internet publication].[Full Text]

            • 11. Schrag SJ, Zell ER, Lynfield R, et al. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med. 2002 Jul 25;347(4):233-9.[Abstract][Full Text]

            • 12. Navarro-Torné A, Curcio D, Moïsi JC, et al. Burden of invasive group B Streptococcus disease in non-pregnant adults: a systematic review and meta-analysis. PLoS One. 2021;16(9):e0258030.[Abstract][Full Text]

            • 13. Farley MM. Group B streptococcal disease in nonpregnant adults. Clin Infect Dis. 2001 Aug 15;33(4):556-61.[Abstract]

            • 14. Herbert MA, Beveridge CJ, Saunders NJ. Bacterial virulence factors in neonatal sepsis: group B streptococci. Curr Opin Infect Dis. 2004 Jun;17(3):225-9.[Abstract]

            • 15. Lin FYC, Weisman LE, Azimi PH, et al. Level of maternal IgG anti-group B streptococcus type III antibody correlated with protection of neonates against early-onset disease caused by this pathogen. J Infect Dis. 2004 Sep 1;190(5):928-34.[Abstract]

            • 16. Lin FYC, Phillips JB, Azimi PH, et al. Level of maternal antibody required to protect neonates against early-onset disease caused by type Ia group B streptococcus; a seroepidemiology study. J Infect Dis. 2001 Oct 15;184(8):1022-8.[Abstract]

            • 17. Schuchat A, Oxtoby M, Sikes S, et al. Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta. J Infect Dis. 1990 Sep;162(3):672-7.[Abstract]

            • 18. Blumberg HM, Stephens DS, Modansky M, et al. Invasive group B streptococcal disease: the emergence of serotype V. J Infect Dis. 1996 Feb;173(2):365-73.[Abstract]

            • 19. Farley MM, Harvey C, Stull T, et al. A population-based assessment of invasive disease due to group B streptococcus in non-pregnant adults. N Engl J Med. 1993 Jun 24;328(25):1807-11.[Abstract][Full Text]

            • 20. Jackson LA, Hilsdon R, Farley MM, et al. Risk factors for group B streptococcal disease in adults. Ann Intern Med. 1995 Sep 15;123(6):415-20.[Abstract]

            • 21. Schuchat A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev. 1998 Jul;11(3):497-513.[Abstract][Full Text]

            • 22. Schuchat A, Deaver-Robinson K, Plikaytis BD, et al. Multistate case-control study of maternal risk factors for neonatal group B streptococcal disease. Pediatr Infect Dis J. 1994 Jul;13(7):623-9.[Abstract]

            • 23. Chen KT, Ringer S, Cohen AP, et al. The role of intrapartum fever in identifying asymptomatic term neonates with early-onset neonatal sepsis, J Perinatol. 2002 Dec;22(8):653-7.[Abstract]

            • 24. Puopolo KM, Draper D, Wi S, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011 Nov;128(5):e1155-63.[Abstract][Full Text]

            • 25. Oddie S, Embleton ND. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ. 2002 Aug 10;325(7359):308.[Abstract][Full Text]

            • 26. Carstensen H, Christensen KK, Grennert L, et al. Early-onset neonatal group b streptococcal septicaemia in siblings. J Infect. 1988 Nov;17(3):201-4.[Abstract]

            • 27. Feikin DR, Thorsen P, Zywiki S, et al. Association between colonization with group B streptococci during pregnancy and preterm delivery amongst Danish Women. Am J Obstet Gynecol. 2001 Feb;184(3):427-33.[Abstract]

            • 28. Zaleznik DF, Rench MA, Hillier S, et al. Invasive disease due to group B streptococcus in pregnant women and neonates from diverse population groups. Clin Infect Dis. 2000 Feb;30(2):276-81.[Abstract]

            • 29. Risso FM, Castagnola E, Bandettini R, et al. Group B streptococcus late onset sepsis in very low birth weight newborns: 10 years experience. J Matern Fetal Neonatal Med. 2018 Jan;31(1):18-20.[Abstract]

            • 30. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002 Aug;110(2 pt 1):285-91.[Abstract]

            • 31. Doran KS, Benoit VM, Gertz RE, et al. Late-onset group B streptococcal infection in identical twins: insight to disease pathogenesis. J Perinatol. 2002 Jun;22(4):326-30.[Abstract]

            • 32. Edwards MS, Jackson CV, Baker CJ. Increased risk of group B streptococcal disease in Twins. JAMA. 1981 May 22-29;245(20):2044-6.[Abstract]

            • 33. Arora HS, Chiwane SS, Abdel-Haq N, et al. Group B streptococcus sepsis in twins. Pediatr Infect Dis J. 2015 May;34(5):548-9.[Abstract][Full Text]

            • 34. Pintye J, Saltzman B, Wolf E, et al. Risk factors for late-onset group B streptococcal disease before and after implementation of universal screening and intrapartum antibiotic prophylaxis. J Pediatric Infect Dis Soc. 2016 Dec;5(4):431-8.[Abstract][Full Text]

            • 35. Parente V, Clark RH, Ku L, et al. Risk factors for group B streptococcal disease in neonates of mothers with negative antenatal testing. J Perinatol. 2017 Feb;37(2):157-61.[Abstract][Full Text]

            • 36. Edwards MA, Baker CJ. Group B streptococcal infections in elderly adults. Clin Infect Dis. 2005 Sep 15;41(6):839-47.[Abstract]

            • 37. Farley MM. Group B streptococcal infection in older patients. Spectrum of disease and management strategies Drugs Aging. 1995 Apr;6(4):293-300.[Abstract]

            • 38. Gopal Rao G, Hiles S, Bassett P, et al. Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross-sectional study. BJOG. 2019 Oct;126(11):1347-53.[Abstract]

            • 39. Rottenstreich M, Rotem R, Srebnik N, et al. The recurrence risk of group B streptococcus in consecutive deliveries. J Matern Fetal Neonatal Med. 2020 Jul;33(13):2263-8.[Abstract]

            • 40. Edwards JM, Watson N, Focht C, et al. Group B streptococcus (GBS) colonization and disease among pregnant women: a historical cohort study. Infect Dis Obstet Gynecol. 2019 Feb 3;2019:5430493.[Abstract][Full Text]

            • 41. Pitts SI, Maruthur NM, Langley GE, et al. Obesity, diabetes, and the risk of invasive group B streptococcal disease in nonpregnant adults in the United States. Open Forum Infect Dis. 2018 Jun;5(6):ofy030.[Abstract][Full Text]

            • 42. Manzanares S, Zamorano M, Naveiro-Fuentes M, et al. Maternal obesity and the risk of group B streptococcal colonisation in pregnant women. J Obstet Gynaecol. 2019 Jul;39(5):628-32.[Abstract]

            • 43. Kleweis SM, Cahill AG, Odibo AO, et al. Maternal obesity and rectovaginal group B streptococcus colonization at term. Infect Dis Obstet Gynecol. 2015;2015:586767.[Abstract][Full Text]

            • 44. Munoz P, Llancaqueo A, Rodriguez-Creixems M, et al. Group B streptococcus bacteremia in nonpregnant adults. Arch Intern Med. 1997 Jan 27;157(2):213-6.[Abstract]

            • 45. Graux E, Hites M, Martiny D, et al. Invasive group B streptococcus among non-pregnant adults in Brussels - capital region, 2005-2019. Eur J Clin Microbiol Infect Dis. 2021 Mar;40(3):515-23.[Abstract][Full Text]

            • 46. Waldman O, Sajda T, Oh I, et al. Group B streptococcus infected tenosynovitis in diabetic foot ulcers. Foot & Ankle Orthopaedics. 2020;5(4):10.1177/2473011420S00483.[Full Text]

            • 47. Sunkara B, Bheemreddy S, Lorber B, et al. Group B streptococcus infections in non-pregnant adults: the role of immunosuppression. Int J Infect Dis. 2012 Mar;16(3):e182-6.[Abstract][Full Text]

            • 48. Henning KJ, Hall EL, Dwyer DM, et al. Invasive group B streptococcal disease in Maryland nursing home residents. J Infect Dis. 2001 Apr 1;183(7):1138-42.[Abstract]

            • 49. Shelburne SA 3rd, Tarrand J, Rolston KV. Review of streptococcal bloodstream infections at a comprehensive cancer care center, 2000-2011. J Infect. 2013 Feb;66(2):136-46.[Abstract]

            • 50. Dauby N, Adler C, Miendje Deyi VY, et al. Prevalence, risk factors, and serotype distribution of group B streptococcus colonization in HIV-infected pregnant women living in Belgium: a prospective cohort study. Open Forum Infect Dis. 2018 Dec;5(12):ofy320.[Abstract][Full Text]

            • 51. Cools P, van de Wijgert JHHM, Jespers V, et al. Role of HIV exposure and infection in relation to neonatal GBS disease and rectovaginal GBS carriage: a systematic review and meta-analysis. Sci Rep. 2017 Oct 23;7(1):13820.[Abstract][Full Text]

            • 52. Dauby N, Chamekh M, Melin P, et al. Increased risk of group B Streptococcuss invasive infection in HIV-exposed but uninfected infants: a review of the evidence and possible mechanisms. Front Immunol. 2016 Nov 16;7:505.[Abstract][Full Text]

            • 53. Perovic O, Crewe-Brown HH, Khoosal M, et al. Invasive group B streptococcal disease in nonpregnant adults. Eur J Clin Microbiol Infect Dis. 1999 May;18(5):362-4.[Abstract]

            • 54. Buser GL, Mató S, Zhang AY, et al. Notes from the field: late-onset infant group B Streptococcus infection associated with maternal consumption of capsules containing dehydrated placenta - Oregon, 2016. MMWR Morb Mortal Wkly Rep. 2017 Jun 30;66(25):677-8.[Abstract][Full Text]

            • 55. Royal College of Obstetricians and Gynaecologists. The prevention of early onset neonatal group B streptococcal disease. Green-top guideline no. 36. Sep 2017 [internet publication].[Abstract][Full Text]

            • 56. Powers RJ, Wirtschafter D; Perinatal Quality Improvement Panel of the California Perinatal Quality Care Collaborative. Prevention of group B streptococcus early-onset disease: a toolkit by the California Perinatal Quality Care Collaborative. J Perinatol. 2010 Feb;30(2):77-87.[Abstract]

            • 57. Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev. 2014 Jun 10;(6):CD007467.[Abstract][Full Text]

            • 58. Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2022 Apr 19;43(5):1-17.[Abstract][Full Text]

            • 59. World Health Organization. Group B streptococcus vaccine: full value vaccine assessment. 2 November 2021 [internet publication].[Full Text]

            • 60. Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database Syst Rev. 2014 Dec 14;(12):CD003520.[Abstract][Full Text]

            • 61. Cutland CL, Madhi SA, Zell ER, et al. Chlorhexidine maternal-vaginal and neonate body wipes in sepsis and vertical transmission of pathogenic bacteria in South Africa: a randomised, controlled trial. Lancet. 2009 Dec 5;374(9705):1909-16.[Abstract]

            • 62. Colbourn TE, Asseburg C, Bojke L, et al. Preventive strategies for group B streptococcal and other bacterial infections in early infancy: cost effectiveness and value of information analyses. BMJ. 2007 Sep 29;335(7621):655.[Abstract][Full Text]

            • 63. National Institute for Health and Care Excellence (UK). Neonatal infection: antibiotics for prevention and treatment. April 2021 [internet publication].[Full Text]

            • 64. Puopolo KM, Lynfield R, Cummings JJ, et al. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019 Aug;144(2):e20191881.[Abstract][Full Text]

            • 65. Paredes A, Wong P, Mason EO, et al. Nocosomial transmission of group B streptococci in a newborn nursery. Pediatrics. 1977 May;59(5):679-82.[Abstract]

            • 66. Ray B, Mangalore J, Harikumar C, et al. Is lumbar puncture necessary for the evaluation of early neonatal sepsis? Arch Dis Child. 2006 Dec;91(12):1033-5.[Abstract][Full Text]

            • 67. Nolla JM, Gomez-Vaquero C, Corbella X, et al. Group B streptococcus (Streptococcus agalactiae) pyogenic arthritis in nonpregnant adults. Medicine. 2003 Mar;82(2):119-28.[Abstract]

            • 68. Honest H, Sharma S, Khan KS. Rapid tests for group B streptococcus colonization in laboring women: a systematic review. Pediatrics. 2006 Apr;117(4):1055-66.[Abstract]

            • 69. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1;39(9):1267-84.[Abstract][Full Text]

            • 70. Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010 Mar;11(2):202-19.[Abstract][Full Text]

            • 71. Yagupsky P, Menegus MA, Powell KR. The changing spectrum of group B streptococcal disease in infants: an eleven-year experience in a tertiary care hospital. Pediatr Infect Dis J. 1991 Nov;10(11):801-8.[Abstract]

            • 72. Taminato M, Fram D, Torloni MR, et al. Screening for group B streptococcus in pregnant women: a systematic review and meta-analysis. Rev Lat Am Enfermagem. 2011;19(6):1470-8.[Abstract][Full Text]

            • 73. Larsen JW, Serve JL. Group B streptococcus and pregnancy: a review. Am J Obstet Gynecol. 2008 Apr;198(4):440-8.[Abstract]

            • 74. Puopolo KM, Madoff LC, Eichenwald EC. Early-onset group B streptococcal disease in the era of maternal screening. Pediatrics. 2005 May;115(5):1240-6.[Abstract]

            • 75. Yancey MK, Schuchat A, Brown LK, et al. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol. 1996 Nov;88(5):811-5.[Abstract]

            • 76. Valkenburg-van den Berg AW, Houtman-Roelofsen RL, Oostvogel PM, et al. Timing of group B streptococcus screening in pregnancy: a systematic review. Gynecol Obstet Invest. 2010;69(3):174-83.[Abstract]

            • 77. Shah V, Ohlsson A; Canadian Task Force on Preventive Health Care. Prevention of early-onset group B streptococcal (GBS) infection in the newborn: systematic review and recommendations CTFPHC technical report 01-6. May 2001 [interent publication].[Full Text]

            • 78. Colbourn T, Asseburg C, Bojke L, et al. Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost-effectiveness and expected value of information analyses. Health Technol Assess. 2007 Aug;11(29):1-226.[Abstract]

            • 79. Daniels J, Gray J, Pattison H, et al. Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technol Assess. 2007 Aug;11(29):1-226.[Abstract]

            • 80. Kotarski J, Heczko PB, Lauterbach R, et al. Polish Gynecological Society's recommendations regarding diagnosis and prevention of Streptococcus agalactiae infection in pregnant women and newborns [in Polish]. Ginekol Pol. 2008 Mar;79(3):221-3.[Abstract]

            • 81. Yudin MH, van Schalkwyk J, Van Eyk N, et al. Antibiotic therapy in preterm premature rupture of the membranes. J Obstet Gynaecol Can. 2009 Sep;13(42):1-154.[Abstract]

            • 82. Queensland Health Statewide Maternity and Neonatal Clinical Guidelines Program. Early onset group B streptococcal disease. April 2020 [internet publication].[Full Text]

            • 83. Money D, Allen VM. No. 298 - The prevention of early-onset neonatal group B streptococcal disease. J Obstet Gynaecol Can. 2018 Aug;40(8):e665-74.[Abstract]

            • 84. Van Dyke MK, Phares CR, Lynfield R, et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med. 2009 Jun 18;360(25):2626-36.[Abstract][Full Text]

            • 85. Society for Maternal-Fetal Medicine. Eighteen things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2022 [internet publication].[Full Text]

            • 86. American Society for Microbiology. Guidelines for the detection and identification of group B streptococcus. 29 July 2021 [internet publication].[Full Text]

            • 87. Price D, Shaw E, Howard M, et al. Self-sampling for group B streptococcus in women 35 to 37 weeks pregnant is accurate and acceptable: a randomized cross-over trial. J Obstet Gynaecol Can. 2006 Dec;28(12):1083-8.[Abstract]

            • 88. Bergeron MG, Danbing KE, Menard C, et al. Rapid detection of group B streptococci in pregnant women at delivery. N Engl J Med. 2000 Jul 20;343(3):175-9.[Abstract][Full Text]

            • 89. Daniels R, Nutbeam T, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011 Jun;28(6):507-12.[Abstract][Full Text]

            • 90. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57.[Abstract]

            • 91. US Food & Drug Administration. FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Mar 2018 [internet publication][Full Text]

            • 92. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. 19 March 2019 [internet publication].[Full Text]

            • 93. US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication].[Full Text]

            • 94. US Food & Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication].[Full Text]

            • 95. Baecher L, Grobman W. Prenatal antibiotic treatment does not decrease group B streptococcus colonization at delivery. Int J Gynaecol Obstet. 2008 May;101(2):125-8.[Abstract]

            • 96. Absalon J, Segall N, Block SL, et al. Safety and immunogenicity of a novel hexavalent group B streptococcus conjugate vaccine in healthy, non-pregnant adults: a phase 1/2, randomised, placebo-controlled, observer-blinded, dose-escalation trial. Lancet Infect Dis. 2021 Feb;21(2):263-74.[Abstract]

            • 97. ClinicalTrials.gov. Trial to evaluate the safety, tolerability, and immunogenicity of a multivalent group B streptococcus vaccine in healthy nonpregnant women and pregnant women and their infants. 15 April 2022 [internet publication].[Full Text]

            • 98. ClinicalTrials.gov. Study of a group B streptococcus vaccine in pregnant women living with HIV and in pregnant women who do not have HIV. 2 March 2022 [internet publication].[Full Text]

            • 99. Allen VM, Yudin MH. No. 276 - Management of group B streptococcal bacteriuria in pregnancy. J Obstet Gynaecol Can. 2018 Feb;40(2):e181-6.[Abstract]

            • 100. Sambola A, Miro JM, Tornos MP, et al. Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature. Clin Infect Dis. 2002 Jun 15;34(12):1576-84.[Abstract]

            • 101. Harrison LH, Ali A, Dwyer DM, et al. Relapsing invasive group B streptococcal Infection in adults. Ann Intern Med. 1995 Sep 15;123(6):421-7.[Abstract]

            • 102. Kohli-Lynch M, Russell NJ, Seale AC, et al. Neurodevelopmental impairment in children after group B streptococcal disease worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017 Nov 6;65(suppl_2):S190-S9.[Abstract][Full Text]

            • 103. Horváth-Puhó E, van Kassel MN, Gonçalves BP, et al. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a national matched cohort study. Lancet Child Adolesc Health. 2021 Jun;5(6):398-407.[Abstract][Full Text]

            • 104. Holmstrom B, Grimsley EW. Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus. South Med J. 2000 Nov;93(11):1096-8.[Abstract]

            • 105. Sarani B, Strong M, Pascual J, et al. Necrotizing fasciitis: current concepts and review of the literature. Am Coll Surg. 2009 Feb;208(2):279-88.[Abstract]

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