Analysis of serotype distribution and characteristics of nonhemolytic and nonpigmented strains among group B Streptococcus isolates in a southern Taiwan local hospital.

Purpose: Group B streptococci (GBS) are Gram-positive bacteria that are a leading cause of neonatal infections. Most invasive isolates are β-hemolytic, and hemolytic activity is critical for GBS virulence. Although nonhemolytic GBS strains are occasionally isolated, they are often thought to be attenuated in virulence. Recent studies have observed that many nonhemolytic and nonpigmented (NH/NP) strains originated from invasive infections, including bacteremia and meningitis, in neonates or adults. The mutations causing the NH/NP phenotype are predominantly localized in the cyl operon and abx1 gene. Previous studies on group B streptococci in Taiwan have focused on the serotype and genotype distribution. In this study, we investigated the serotype distribution of the NH/NP strains and detected the mutations of abx1.

Methods: One hundred clinical GBS strains from non-invasive (vaginal and rectal swabs, 69) and invasive infections (blood, urine and abscess, 31), including 10 NH/NP isolates, were collected during 2019-2021 at Fooyin University Hospital. To confirm GBS isolates, we have developed a multiplex PCR method that detects GBS isolates, virulent strain ST-17 and virulent factor Srr1 simultaneously. Molecular serotyping was performed by multiplex PCR assay using serotype specific primer sets. The genomic region containing abx1 was amplified from DNA extracts by PCR and the amplicons were directly sequenced and analyzed on an ABI prism 3730 DNA analyzer.

Results: The capsular serotypes III and VI were the most abundant in both the non-invasive specimens and invasive specimens. The ST-17 isolates were more frequently associated with invasive infections (16.1%, 5/31) than non-invasive diseases or colonization (7.2%, 5/69). The association of NH/NP strains between noninvasive diseases or colonization (10.1, 7/69) and invasive infection (9.7%, 3/31) is nearly compatible. The NH/NP strains were isolated from various serotypes (Ia, III, V and VI) and five NH/NP isolates were serotype III. The virulence factor Srr1was detected in most of the NH/NP isolates (8/10) and one NH/NP isolate was ST-17. Abx1 mutations, including transitions, transversions and deletions, were observed in some NH/NP isolates, but some mutations also observed in hemolytic isolates. Five NH/NP isolates were erythromycin and clindamycin resistant.

Conclusion: These results indicate NH/NP GBS strains may have the potential for invasive infections and may show higher tendency to get mutated.