{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T02:01:53Z","timestamp":1783735313991,"version":"3.55.0"},"reference-count":122,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union funding"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Group B Streptococcus (GBS, Streptococcus agalactiae) is a pathogen of increasing importance in adults. Severe and invasive cases in non-pregnant adults were collected during the period 2015\u20132019 by voluntary-based surveillance. In total, 108 GBS strains were phenotypically and genotypically characterized for the serotype, antimicrobial resistance, pili, surface protein genes, and the hyper-virulent adhesin hvgA. Patients were divided into two age groups: adults (18\u201364 years; n = 32) and older adults (\u226565 years; n = 72). The average age was 70.8 years, with a male\/female ratio of 1.7. Most isolates were recovered from cases of bacteremia (blood, n = 93), and a higher frequency of invasive GBS infections (iGBS) was found among older adults (66.7%). Serotype III was the most frequent (n = 41, 38%), followed by type Ia and type V (n = 20 each, 18.5%). Serotypes Ia, Ib, II, III, IV, and V accounted for all but one isolates (99.1%). The iGBS isolates were universally susceptible to penicillin, while the prevalence of resistance to clindamycin, erythromycin, tetracycline, and high-level gentamicin resistance was 26.8%, 24.1%, 85.2%, and 5.5%, respectively, with the predominance of the erm(B) gene for macrolide resistance and the tet(M) gene for tetracycline resistance. The associations between the serotypes\/antimicrobial resistance\/virulence traits underlined the increasing importance of serotype III and its contribution to antimicrobial resistance as well as the steady increase over time of serotype IV. This nationwide study confirmed the need for monitoring the GBS epidemiology in non-pregnant adults through continuous surveillance of GBS infections.<\/jats:p>","DOI":"10.3390\/pathogens13090807","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T04:59:54Z","timestamp":1726721994000},"page":"807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Group B Streptococcus Infections in Non-Pregnant Adults, Italy, 2015\u20132019"],"prefix":"10.3390","volume":"13","author":[{"given":"Monica","family":"Imperi","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Gherardi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3567-9266","authenticated-orcid":false,"given":"Giovanna","family":"Alfarone","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4290-9039","authenticated-orcid":false,"given":"Roberta","family":"Creti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/S1473-3099(16)30055-X","article-title":"Prevalence of maternal colonisation with group B streptococcus: A systematic review and meta-analysis","volume":"16","author":"Kwatra","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1093\/ajcp\/51.2.207","article-title":"Identification and significance of Streptococcus agalactiae (Lancefield group B)","volume":"51","author":"Braunstein","year":"1969","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJM196412102712401","article-title":"Neonatal Sepsis and Other Infections Due to Group B Beta-Hemolytic Streptococci","volume":"271","author":"Eickhoff","year":"1964","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1056\/NEJM196501212720308","article-title":"Meningitis Due to the Group B Beta-Hemolytic Streptococcus","volume":"272","author":"Lazarus","year":"1965","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1056\/NEJM196205032661803","article-title":"Infections due to group B beta-hemolytic streptococci. Report of three cases and review of the literature","volume":"266","author":"Mannik","year":"1962","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S0029-7844(97)00587-5","article-title":"Timing of intrapartum ampicillin and prevention of vertical transmission of group B streptococcus","volume":"91","author":"Sanchez","year":"1998","journal-title":"Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.1093\/cid\/cix655","article-title":"Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide: Systematic review and meta-analyses","volume":"65","author":"Russell","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S160","DOI":"10.1093\/cid\/cix656","article-title":"Infant group B streptococcal disease incidence and serotypes worldwide: Systematic review and meta-analyses","volume":"65","author":"Madrid","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e00049-18","DOI":"10.1128\/CMR.00049-18","article-title":"Perinatal Streptococcus agalactiae epidemiology and surveillance targets","volume":"31","author":"Furfaro","year":"2018","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1093\/cid\/cix653","article-title":"Group B streptococcal disease worldwide for pregnant women, stillbirths, and children: Why, what, and how to undertake estimates?","volume":"65","author":"Lawn","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1111\/j.1469-0691.2011.03628.x","article-title":"Invasive group B streptococcal infections in adults, France (2007\u20132010)","volume":"17","author":"Tazi","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1086\/599369","article-title":"Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990\u20132007","volume":"49","author":"Skoff","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Chaiwarith, R., Jullaket, W., Bunchoo, M., Nuntachit, N., Sirisanthana, T., and Supparatpinyo, K. (2011). Streptococcus agalactiae in adults at Chiang Mai University Hospital: A retrospective study. BMC Infect. Dis., 11.","DOI":"10.1186\/1471-2334-11-149"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1056\/NEJM199306243282503","article-title":"A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults","volume":"328","author":"Farley","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1001\/archinte.1997.00440230087011","article-title":"Group B streptococcus bacteremia in nonpregnant adults","volume":"157","author":"Llancaqueo","year":"1997","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1001\/jama.1991.03470080082034","article-title":"Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta","volume":"266","author":"Schwartz","year":"1991","journal-title":"JAMA"},{"key":"ref_17","unstructured":"Bennett, J.E.D.R., and Blaser, M.J. (2015). Streptococcus agalactiae (Group B Streptococcus). Mandell, Douglas, and Bennett\u2019s Principles and Practice of Infectious Diseases, Saunders. [8th ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e777","DOI":"10.1016\/j.ijid.2013.01.011","article-title":"Group B streptococcal bacteremia in a major teaching hospital in Malaysia: A case series of eighteen patients","volume":"17","author":"Eskandarian","year":"2013","journal-title":"Int. J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"415","DOI":"10.7326\/0003-4819-123-6-199509150-00003","article-title":"Risk factors for group B streptococcal disease in adults","volume":"123","author":"Jackson","year":"1995","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1056\/NEJM200001063420103","article-title":"Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis","volume":"342","author":"Schrag","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s10096-003-1098-9","article-title":"Group B streptococcal disease in nonpregnant adults: Incidence, clinical characteristics, and outcome","volume":"23","author":"Blancas","year":"2004","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1086\/315699","article-title":"Invasive disease due to group B streptococcal infection in adults: Results from a Canadian, population-based, active laboratory surveillance study--1996. Sentinel Health Unit Surveillance System Site Coordinators","volume":"182","author":"Tyrrell","year":"2000","journal-title":"J. Infect. Dis."},{"key":"ref_23","first-page":"237","article-title":"Group B streptococcal bacteremia in non-pregnant adults","volume":"39","author":"Huang","year":"2006","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1086\/322696","article-title":"Group B streptococcal disease in nonpregnant adults","volume":"33","author":"Farley","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1097\/00007611-200194120-00016","article-title":"Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital","volume":"94","author":"Larppanichpoonphol","year":"2001","journal-title":"South. Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"D7","DOI":"10.1016\/j.vaccine.2013.01.009","article-title":"An overview of global GBS epidemiology","volume":"31","author":"Heath","year":"2013","journal-title":"Vaccine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1086\/432804","article-title":"Group B streptococcal infections in elderly adults","volume":"41","author":"Edwards","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"386","DOI":"10.3109\/23744235.2015.1131330","article-title":"The changing epidemiology of group B streptococcus bloodstream infection: A multi-national population-based assessment","volume":"48","author":"Ballard","year":"2016","journal-title":"Infect. Dis. (Lond.)"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"ofy030","DOI":"10.1093\/ofid\/ofy030","article-title":"Obesity, diabetes, and the risk of invasive group B streptococcal disease in nonpregnant adults in the United States","volume":"5","author":"Pitts","year":"2018","journal-title":"Open Forum Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1128\/JCM.05488-11","article-title":"Dominance of serotype Ia among group B streptococci causing invasive infections in nonpregnant adults in Portugal","volume":"50","author":"Martins","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1128\/AAC.00185-08","article-title":"First molecular characterization of group B streptococci with reduced penicillin susceptibility","volume":"52","author":"Kimura","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1128\/AAC.00461-08","article-title":"Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to beta-lactam antibiotics","volume":"52","author":"Dahesh","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1093\/jac\/dkv022","article-title":"Classification of group B streptococci with reduced \u03b2-lactam susceptibility (GBS-RBS) based on the amino acid substitutions in PBPs","volume":"70","author":"Kimura","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"574.e7","DOI":"10.1016\/j.cmi.2017.02.021","article-title":"Short-read whole genome sequencing for determination of antimicrobial resistance mechanisms and capsular serotypes of current invasive Streptococcus agalactiae recovered in the USA","volume":"23","author":"Metcalf","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3406","DOI":"10.1128\/JCM.01291-14","article-title":"Penicillin-susceptible group B streptococcal clinical isolates with reduced cephalosporin susceptibility","volume":"52","author":"Nagano","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1093\/cid\/cit337","article-title":"Emerging trends in the epidemiology of invasive group B streptococcal disease in England and Wales, 1991\u20132010","volume":"57","author":"Lamagni","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"727505","DOI":"10.1155\/2008\/727505","article-title":"Antibiotic resistance patterns in invasive group B streptococcal isolates","volume":"2008","author":"Castor","year":"2008","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1001\/jamainternmed.2018.7269","article-title":"Epidemiology of invasive group B streptococcal infections among nonpregnant adults in the United States, 2008\u20132016","volume":"179","author":"McGee","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1001\/jamapediatrics.2018.4826","article-title":"Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: Multistate laboratory and population-based surveillance","volume":"173","author":"Nanduri","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Wang, P., Tong, J.J., Ma, X.H., Song, F.L., Fan, L., Guo, C.M., Shi, W., Yu, S.J., Yao, K.H., and Yang, Y.H. (2015). Serotypes, antibiotic susceptibilities, and multi-locus sequence type profiles of Streptococcus agalactiae isolates circulating in Beijing, China. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0120035"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2590","DOI":"10.1128\/JCM.00582-17","article-title":"Reliable detection of group B Streptococcus in the clinical laboratory","volume":"55","author":"Spellerberg","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2929","DOI":"10.1128\/JCM.00117-07","article-title":"Serotype IX, a proposed new Streptococcus agalactiae serotype","volume":"45","author":"Slotved","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1093\/infdis\/jiz062","article-title":"A novel hexavalent capsular polysaccharide conjugate vaccine (GBS6) for the prevention of neonatal group B streptococcal infections by maternal immunization","volume":"220","author":"Buurman","year":"2019","journal-title":"J. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2695","DOI":"10.1128\/JCM.01183-16","article-title":"Molecular characteristics of group B streptococci isolated from adults with invasive infections in Japan","volume":"54","author":"Morozumi","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1099\/jmm.0.05067-0","article-title":"Towards a genotyping system for Streptococcus agalactiae (group B Streptococcus): Use of mobile genetic elements in Australasian invasive isolates","volume":"52","author":"Kong","year":"2003","journal-title":"J. Med. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"379.e9","DOI":"10.1016\/j.cmi.2015.11.020","article-title":"Changing epidemiology of group B streptococcal infections among adults in Iceland: 1975\u20132014","volume":"22","author":"Martins","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.cmi.2015.05.039","article-title":"Group B streptococcus neonatal invasive infections, France 2007\u20132012","volume":"21","author":"Joubrel","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1128\/JCM.03554-13","article-title":"Characterization of invasive group B streptococcus strains from the greater Toronto area, Canada","volume":"52","author":"Teatero","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Campisi, E., Rosini, R., Ji, W., Guidotti, S., Rojas-L\u00f3pez, M., Geng, G., Deng, Q., Zhong, H., Wang, W., and Liu, H. (2016). Genomic analysis reveals multi-drug resistance clusters in group B streptococcus CC17 hypervirulent isolates causing neonatal invasive disease in Southern Mainland China. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.01265"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Creti, R., Imperi, M., Berardi, A., Lindh, E., Alfarone, G., Pataracchia, M., Recchia, S., and The Italian Network on Neonatal and Infant GBS Infections (2021). Invasive group B streptococcal disease in neonates and infants, Italy, years 2015\u20132019. Microorganisms, 9.","DOI":"10.3390\/microorganisms9122579"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Schindler, Y., Rahav, G., Nissan, I., Treygerman, O., Prajgrod, G., Attia, B.Z., Raz, R., Valenci, G.Z., Tekes-Manova, D., and Maor, Y. (2023). Group B streptococcus virulence factors associated with different clinical syndromes: Asymptomatic carriage in pregnant women and early-onset disease in the newborn. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1093288"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1002\/bdr2.2173","article-title":"Preclinical development of a novel Group B Streptococcus (GBS) vaccine candidate for maternal immunization based upon the alpha-like protein family of GBS surface proteins (Alp)","volume":"115","author":"Banks","year":"2023","journal-title":"Birth Defects Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/infdis\/jiac148","article-title":"A recombinant alpha-like protein subunit vaccine (GBS-NN) provides protection in murine models of group B streptococcus infection","volume":"226","author":"Brokaw","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"106261","DOI":"10.1016\/j.isci.2023.106261","article-title":"Safety and immunogenicity of the group B streptococcus vaccine AlpN in a placebo-controlled double-blind phase 1 trial","volume":"26","author":"Pawlowski","year":"2023","journal-title":"iScience"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1126\/science.1111563","article-title":"Genome analysis reveals pili in group B Streptococcus","volume":"309","author":"Lauer","year":"2005","journal-title":"Science"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1111\/j.1365-2958.2006.05190.x","article-title":"Assembly and role of pili in group B streptococci","volume":"60","author":"Dramsi","year":"2006","journal-title":"Mol. Microbiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1365-2958.2006.05225.x","article-title":"Identification of novel genomic islands coding for antigenic pilus-like structures in Streptococcus agalactiae","volume":"61","author":"Rosini","year":"2006","journal-title":"Mol. Microbiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1084\/jem.20092594","article-title":"The surface protein HvgA mediates group B Streptococcus hypervirulence and meningeal tropism in neonates","volume":"207","author":"Tazi","year":"2010","journal-title":"J. Exp. Med."},{"key":"ref_59","unstructured":"Centers for Disease Control and Prevention (2024, August 01). Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group B Streptococcus, Available online: www.cdc.gov\/abcs\/downloads\/GBS_Surveillance_Report_2019.pdf."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1700473","DOI":"10.2807\/1560-7917.ES.2018.23.21.1700473","article-title":"Increasing macrolide resistance among Streptococcus agalactiae causing invasive disease in non-pregnant adults was driven by a single capsular-transformed lineage, Portugal, 2009 to 2015","volume":"23","author":"Lopes","year":"2018","journal-title":"Euro Surveill."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1128\/JCM.02365-10","article-title":"International external quality assurance for laboratory identification and typing of Streptococcus agalactiae (Group B streptococci)","volume":"49","author":"Afshar","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e3105","DOI":"10.7717\/peerj.3105","article-title":"Evaluation of procedures for typing of group B Streptococcus: A retrospective study","volume":"5","author":"Slotved","year":"2017","journal-title":"PeerJ"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.mimet.2009.11.010","article-title":"A multiplex PCR assay for the direct identification of the capsular type (Ia to IX) of Streptococcus agalactiae","volume":"80","author":"Imperi","year":"2010","journal-title":"J. Microbiol. Methods"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.cmi.2022.04.011","article-title":"Laboratory breakpoints for assessing high level gentamicin resistance in Streptococcus agalactiae: It is the time for a consensus","volume":"28","author":"Creti","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/INF.0000000000001414","article-title":"Neonatal group B streptococcus infections: Prevention strategies, clinical and microbiologic characteristics in 7 years of surveillance","volume":"36","author":"Creti","year":"2017","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1128\/AAC.43.8.1935","article-title":"Phenotypes and genotypes of erythromycin-resistant Streptococcus pyogenes strains in Italy and heterogeneity of inducibly resistant strains","volume":"43","author":"Giovanetti","year":"1999","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1128\/JCM.00999-07","article-title":"Molecular epidemiology and distribution of serotypes, surface proteins, and antibiotic resistance among group B streptococci in Italy","volume":"45","author":"Gherardi","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Martins, E.R., Pedroso-Roussado, C., Melo-Cristino, J., Ramirez, M., and Portuguese Group for the Study of Streptococcal Infections (2017). Streptococcus agalactiae causing neonatal infections in Portugal (2005\u20132015): Diversification and emergence of a CC17\/PI-2b multidrug resistant sublineage. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.00499"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Creti, R., Imperi, M., Khan, U.B., Berardi, A., Recchia, S., Alfarone, G., and Gherardi, G. (2024). Emergence of high-level gentamicin resistance in Streptococcus agalactiae hypervirulent serotype IV ST1010 (CC452) strains by acquisition of a novel Integrative and Conjugative Element. Antibiotics, 13.","DOI":"10.3390\/antibiotics13060491"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1128\/JCM.42.3.1326-1329.2004","article-title":"Multiplex PCR assay for direct identification of group B streptococcal alphaprotein-like protein genes","volume":"42","author":"Creti","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1128\/JB.01130-09","article-title":"Evidence for rare capsular switching in Streptococcus agalactiae","volume":"192","author":"Martins","year":"2010","journal-title":"J. Bacteriol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1016\/j.micinf.2006.02.008","article-title":"Rapid detection of the \u201chighly virulent\u201d group B Streptococcus ST-17 clone","volume":"8","author":"Lamy","year":"2006","journal-title":"Microbes Infect."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Springman, A.C., Lacher, D.W., Waymire, E.A., Wengert, S.L., Singh, P., Zadoks, R.N., Davies, H.D., and Manning, S.D. (2014). Pilus distribution among lineages of group b streptococcus: An evolutionary and clinical perspective. BMC Microbiol., 14.","DOI":"10.1186\/1471-2180-14-159"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Raabe, V., and Shane, A. (2019). Streptococcus group B (Streptococcus agalactiae). Microbiol. Spectr., 7.","DOI":"10.1128\/microbiolspec.GPP3-0007-2018"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.3201\/eid2606.191141","article-title":"Invasive group B Streptococcus infections in adults, England, 2015\u20132016","volume":"26","author":"Collin","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2200807","DOI":"10.2807\/1560-7917.ES.2023.28.31.2200807","article-title":"Invasive beta-haemolytic streptococcal infections, Finland, 2006 to 2020: Increase in Lancefield group C\/G infections","volume":"28","author":"Paspaliari","year":"2023","journal-title":"Euro Surveill."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.3201\/eid1508.081381","article-title":"Invasive group B streptococcal disease in the elderly, Minnesota, USA, 2003\u20132007","volume":"15","author":"Kothari","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1001\/jama.299.17.2056","article-title":"Epidemiology of invasive group B streptococcal disease in the United States, 1999\u20132005","volume":"299","author":"Phares","year":"2008","journal-title":"JAMA"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Uggen, E., Olaisen, C., Lyng, R.V., Simonsen, G.S., B\u00e6vre-Jensen, R.M., Gran, F.W., \u00c5svold, B.O., Nilsen, T.I.L., Dam\u00e5s, J.K., and Afset, J.E. (2024). Incidence of invasive infections with Group B streptococcus in adults in Norway 1996\u20132019: A nationwide registry-based case-control study. Infection, 14, Epub ahead of print.","DOI":"10.1007\/s15010-024-02210-3"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Gudj\u00f3nsd\u00f3ttir, M.J., Hentz, E., Berg, S., Backhaus, E., Elfvin, A., Kawash, S., and Trollfors, B. (2015). Serotypes of group B streptococci in western Sweden and comparison with serotypes in two previous studies starting from 1988. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1266-4"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e0071421","DOI":"10.1128\/AAC.00714-21","article-title":"Population Genomics Reveals Distinct Temporal Association with the Emergence of ST1 Serotype V Group B Streptococcus and Macrolide Resistance in North America","volume":"66","author":"Cubria","year":"2022","journal-title":"Antimicrob Agents Chemother"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"6431","DOI":"10.1073\/pnas.1504725112","article-title":"Sequence type 1 group B Streptococcus, an emerging cause of invasive disease in adults, evolves by small genetic changes","volume":"112","author":"Flores","year":"2015","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Navarro-Torn\u00e9, A., Curcio, D., Mo\u00efsi, J.C., and Jodar, L. (2021). Burden of invasive group B Streptococcus disease in non-pregnant adults: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258030"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s10096-008-0565-8","article-title":"Invasive group B streptococcus (GBS) disease in Norway 1996\u20132006","volume":"27","author":"Bergseng","year":"2008","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Feuerschuette, O.H.M., Alves, E.V., Scheffer, M.C., Vilela, A.P.P., Barazzetti, F.H., Feuerschuette, H.M., Cancelier, A.C.L., and Bazzo, M.L. (2022). Genetic diversity and antimicrobial resistance of invasive, noninvasive and colonizing group B Streptococcus isolates in southern Brazil. Access Microbiol., 4.","DOI":"10.1099\/acmi.0.000370"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1007\/s10096-010-0941-z","article-title":"Characterisation of invasive group B streptococci from adults in Denmark 1999 to 2004","volume":"29","author":"Lambertsen","year":"2010","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s10096-020-04041-0","article-title":"Invasive group B Streptococcus among non-pregnant adults in Brussels-Capital Region, 2005\u20132019","volume":"40","author":"Graux","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_89","unstructured":"Sacheli, R., Meex, C., Melin, P., Descy, J., Huynen, P., and Hayette, M.-P. (2018). Surveillance of group B streptococcus (GBS) strains isolated from invasive diseases among adults in Belgium: Bacteriological and clinical characteristics. Abstract Book of 1st International Symposium on Streptococcus agalactiae Disease (ISSAD), Cape Town, South Africa, 20\u201323 February 2018, University of Li\u00e8ge. Available online: https:\/\/hdl.handle.net\/2268\/223202."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1007\/s10096-014-2055-5","article-title":"Molecular epidemiology of group B streptococci in Ireland reveals a diverse population with evidence of capsular switching","volume":"33","author":"Meehan","year":"2014","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1093\/cid\/ciaa151","article-title":"Multistate, population-based distributions of candidate vaccine targets, clonal complexes, and resistance features of invasive group B streptococci within the United States, 2015\u20132017","volume":"72","author":"McGee","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Hirai, N., Kasahara, K., Nakano, R., Ogawa, Y., Suzuki, Y., Ogawa, M., Hishiya, N., Nakano, A., Ichimura, S., and Yano, H. (2020). Clinical characteristics and molecular epidemiology of invasive Streptococcus agalactiae infections between 2007 and 2016 in Nara, Japan. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240590"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1007\/s10096-022-04505-5","article-title":"Clinical and molecular epidemiology of invasive group B Streptococcus infections in adults in a referral center in Korea","volume":"41","author":"Lee","year":"2022","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Aiewsakun, P., Ruangchai, W., Thawornwattana, Y., Jaemsai, B., Mahasirimongkol, S., Homkaew, A., Suksomchit, P., Dubbs, P., and Palittapongarnpim, P. (2022). Genomic epidemiology of Streptococcus agalactiae ST283 in Southeast Asia. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-08097-0"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"S145","DOI":"10.1093\/cid\/cix021","article-title":"2015 epidemic of severe Streptococcus agalactiae sequence type 283 infections in Singapore associated with the consumption of raw freshwater fish: A detailed analysis of clinical, epidemiological, and bacterial sequencing data","volume":"64","author":"Kalimuddin","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s15010-022-01965-x","article-title":"Neonatal invasive disease caused by Streptococcus agalactiae in Europe: The DEVANI multi-center study","volume":"51","author":"Lohrmann","year":"2023","journal-title":"Infection"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"20825","DOI":"10.2807\/1560-7917.ES2014.19.23.20825","article-title":"Epidemiological surveillance of colonising group B Streptococcus epidemiology in the Lisbon and Tagus Valley regions, Portugal (2005 to 2012): Emergence of a new epidemic type IV\/clonal complex 17 clone","volume":"19","author":"Florindo","year":"2014","journal-title":"Euro Surveill."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"585","DOI":"10.3201\/eid2014.140759","article-title":"Population structure and antimicrobial resistance of invasive serotype IV group B Streptococcus, Toronto, Ontario, Canada","volume":"21","author":"Teatero","year":"2015","journal-title":"Emerg. Infect. Dis."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"551","DOI":"10.3201\/eid1904.121572","article-title":"Serotype IV and invasive group B Streptococcus disease in neonates, Minnesota, USA, 2000\u20132010","volume":"19","author":"Ferrieri","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Crespo-Ortiz Mdel, P., Casta\u00f1eda-Ramirez, C.R., Recalde-Bola\u00f1os, M., and V\u00e9lez-Londo\u00f1o, J.D. (2014). Emerging trends in invasive and noninvasive isolates of Streptococcus agalactiae in a Latin American hospital: A 17-year study. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-428"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"222","DOI":"10.7883\/yoken.66.222","article-title":"Screening for group B streptococci with reduced penicillin susceptibility in clinical isolates obtained between 1977 and 2005","volume":"66","author":"Kimura","year":"2013","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1093\/jac\/dkv203","article-title":"High isolation rate of MDR group B streptococci with reduced penicillin susceptibility in Japan","volume":"70","author":"Seki","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_103","unstructured":"WHO (2024). WHO Bacterial Priority Pathogens List, 2024: Bacterial Pathogens of Public Health Importance to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance, World Health Organization. Licence: CC BY-NC-SA 3.0 IGO."},{"key":"ref_104","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial consumption in the EU\/EEA (ESAC-Net)-Annual Epidemiological Report 2021, ECDC."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e01283-21","DOI":"10.1128\/Spectrum.01283-21","article-title":"Epidemiological characterization of group B Streptococcus infections in Alberta, Canada: An update from 2014 to 2020","volume":"9","author":"Ma","year":"2021","journal-title":"Microbiol. Spectr."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Gizachew, M., Tiruneh, M., Moges, F., Adefris, M., Tigabu, Z., and Tessema, B. (2020). Molecular characterization of Streptococcus agalactiae isolated from pregnant women and newborns at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-4776-7"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ijid.2015.06.019","article-title":"Serotype distribution, antimicrobial resistance, and molecular characterization of invasive group B Streptococcus isolates recovered from Chinese neonates","volume":"37","author":"Wang","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.ajic.2021.12.006","article-title":"Molecular determination, serotyping, antibiotic profile and virulence factors of group B Streptococcus isolated from invasive patients at Arabcare Hospital Laboratory, Palestine","volume":"50","author":"Awwad","year":"2022","journal-title":"Am. J. Infect. Control"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Slotved, H.C., and Hoffmann, S. (2020). The Epidemiology of Invasive Group B Streptococcus in Denmark from 2005 to 2018. Front. Public Health, 8.","DOI":"10.3389\/fpubh.2020.00040"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Chen, S.L. (2019). Genomic Insights Into the Distribution and Evolution of Group B Streptococcus. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.01447"},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Rinaudo, C.D., Rosini, R., Galeotti, C.L., Berti, F., Necchi, F., Reguzzi, V., Ghezzo, C., Telford, J.L., Grandi, G., and Maione, D. (2010). Specific involvement of pilus type 2a in biofilm formation in group B Streptococcus. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0009216"},{"key":"ref_112","doi-asserted-by":"crossref","unstructured":"Tsai, I.-A., Su, Y., Wang, Y.-H., and Chu, C. (2022). Alterations in genes rib, scpB and pilus island decrease the prevalence of predominant serotype V, not III and VI, of Streptococcus agalactiae from 2008 to 2012. Pathogens, 11.","DOI":"10.3390\/pathogens11101145"},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Parker, R.E., Laut, C., Gaddy, J.A., Zadoks, R.N., Davies, H.D., and Manning, S.D. (2016). Association between genotypic diversity and biofilm production in group B Streptococcus. BMC Microbiol., 16.","DOI":"10.1186\/s12866-016-0704-9"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Lacasse, M., Valentin, A.S., Corvec, S., B\u00e9mer, P., Jolivet-Gougeon, A., Plouzeau, C., Tand\u00e9, D., Mereghetti, L., Bernard, L., and Lartigue, M.F. (2022). Genotypic characterization and biofilm production of group B streptococcus strains isolated from bone and joint infections. Microbiol. Spectr., 10.","DOI":"10.1128\/spectrum.02329-21"},{"key":"ref_115","doi-asserted-by":"crossref","unstructured":"Jin, Z., Li, J., Zhou, H., Wang, Z., Yi, L., Liu, N., Du, J., Chang, C.-Y., and Ji, W. (2022). Serotype distribution, virulence determinants and antimicrobial susceptibility of Streptococcus agalactiae isolated from young infants. Pathogens, 11.","DOI":"10.3390\/pathogens11111355"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.jmii.2020.07.018","article-title":"Molecular characterization of pathogenic group B streptococcus from a tertiary hospital in Shanxi, China: High incidence of sequence type 10 strains in infants\/pregnant women","volume":"54","author":"Zhang","year":"2021","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_117","first-page":"411","article-title":"Distribution of Pilus island and antibiotic resistance genes in Streptococcus agalactiae obtained from vagina of pregnant women in Yazd, Iran","volume":"12","author":"Nabavinia","year":"2020","journal-title":"Iran J. Microbiol."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Pena, J.M.S., Lannes-Costa, P.S., and Nagao, P.E. (2024). Vaccines for Streptococcus agalactiae: Current status and future perspectives. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1430901"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1128\/CVI.00643-14","article-title":"Survey of immunological features of the alpha-like proteins of Streptococcus agalactiae","volume":"22","author":"Maeland","year":"2015","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1001\/jamainternmed.2019.1590","article-title":"Vaccination for the prevention of group B Streptococcus infection in nonpregnant adults","volume":"179","author":"Dauby","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1086\/595564","article-title":"Preventing bacterial infections with pilus-based vaccines: The group B streptococcus paradigm","volume":"199","author":"Margarit","year":"2009","journal-title":"J. Infect. Dis."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"10278","DOI":"10.1073\/pnas.1106590108","article-title":"Structure-based approach to rationally design a chimeric protein for an effective vaccine against Group B Streptococcus infections","volume":"108","author":"Nuccitelli","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/9\/807\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:58:55Z","timestamp":1760111935000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/9\/807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,18]]},"references-count":122,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["pathogens13090807"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13090807","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,18]]}}}