Data reveal high global variability of antibiotic resistance in group B strep

News brief

A review and meta-analysis of studies from 57 countries highlights varying patterns of antibiotic resistance in group B Streptococcus (GBS) strains, an international team of researchers reported this week in Frontiers in Microbiology.

GBS is a leading cause of severe infections in vulnerable groups such as newborns, the elderly, and pregnant women. Although the pathogen has remained susceptible to penicillin and ampicillin, resistance has increasingly been reported against macrolides, lincosamides, and fluoroquinolones. Of particular concern is rising resistance to erythromycin and clindamycin, which are options for patients with penicillin allergies. Since prior studies on resistance to GBS have been limited to specific regions or antibiotics, the researchers set out to evaluate the prevalence of resistance globally.

The meta-analysis of 266 studies revealed significant variability in GBS resistance rates. The resistance rates for penicillin (1.7%) and ampicillin (3.1%) were low, with no significant heterogeneity observed. Vancomycin (1.4%) and linezolid (0.8%) also showed low resistance rates, which suggests they remain reliable for treating GBS.

But clindamycin (29.3%), erythromycin (35%), azithromycin (40.1%), and clarithromycin (43.4%) had notably higher resistance rates, with significant heterogeneity. And tetracycline (80.1%) and doxycycline (64.9%) exhibited extremely high resistance rates.

Disparities by country and continent

Subgroup analyses revealed disparities in resistance rates based on country, continent, and methodologic categories, which the study authors say suggests that local factors, including antibiotic prescribing patterns and access to healthcare resources, play crucial roles in shaping resistance patterns.

The study authors say the analysis emphasizes the "complex and multifaceted nature" of antibiotic resistance in GBS.

"Effective management of GBS infections requires ongoing surveillance, tailored antibiotic stewardship programs, and continuous adaptation of treatment guidelines based on the latest evidence," they wrote. "By addressing these challenges, healthcare providers can better manage GBS infections and mitigate the impact of antibiotic resistance on public health."

Studies across 14 nations show 25% to 30% rate of long COVID

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Stephanie Soucheray, MA

A new study in BMJ Global Health across 13 middle- and high-income countries reveals that 25% of patients reported symptoms of long COVID after symptomatic COVID-19, and long COVID is significantly more prevalent in participants from less wealthy nations and in patients of Arab or North African ethnicity.

A second study published in BMC Public Health showed that, among 3,693 COVID-19 patients in China, 30.2% reported at least one persistent long-COVID symptom, and 10.7% noted symptoms affecting daily life.

Higher rate in those of Arab/North African ethnicity

The first study involved 6,528 adult patients with symptomatic COVID-19 in Argentina, Brazil, Canada, Colombia, Ecuador, Egypt, India, Nepal, Pakistan, Philippines, Russia, Saudi Arabia, South Africa, and the United Arab Emirates.

Long COVID was defined as the presence of patient-reported symptoms 180 days after COVID-19, the authors said.

Among the 25.1% of participants who said they experienced long-COVID symptoms, 12.8% reported sleeping disorders, 9.8% reported joint pain, 8.7% had fatigue, and 8.1% noted headaches. Almost a third of participants (29.8%) from lower middle-income countries said they had long COVID, compared with 14.4% in high-income countries (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI], 1.10 to 2.14).

The highest long-COVID prevalence was seen in patients with Arab/North African ethnicity (36.1%), and hospitalized patient were also at increased risk of long COVID (aOR, 2.04; 95% CI, 1.63 to 2.54).

Our results thus suggest that the burden to health and healthcare-related costs may fall disproportionately on countries with the least capacity to carry them.

"Our results thus suggest that the burden to health and healthcare-related costs may fall disproportionately on countries with the least capacity to carry them, and most frequently affect individuals that may be under-represented in clinical trials of interventions aimed to combat long COVID," the authors wrote.

Older age, re-infection tied to higher risk

In the second study, people with COVID-19 were asked to complete a survey on symptoms 180 days after infection in March 2023 through June 2023.

Older age, female sex, and COVID re-infection were all associated with increased risk for self-reported long COVID. Reported use of Chinese medicine and more than three vaccine doses were protective factors.

Quick takes: Heavy US public health ax, lawyer vetting ACIP recs, malaria in Belize

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Jim Wappes

An internal document drawn up by the Trump administration indicates officials are planning to cut about a third of the federal health budget and eliminate dozens of programs, CNN and other news outlets are reporting. The document, dated a week ago, comes after massive layoffs of public health officials and could still be modified. But it calls for the budget for the Centers for Disease Control and Prevention (CDC) to be slashed more than 40% and eliminates the CDC's global health center and efforts focused on US HIV/AIDS prevention and chronic disease prevention. It would also cut the budget for the National Institutes of Health by more than 40% and reduce its 27 research institutes to just 8.
Yesterday, the CDC's Advisory Committee for Immunization Practices (ACIP) updated recommendations on respiratory syncytial virus (RSV), meningococcal, and chikungunya vaccines. The Associated Press reports that those recommendations are now being assessed by CDC Chief of Staff Matthew Buzzelli, an attorney. This breaks from decades of having ACIP guidance approved by a professional with a medical background, typically the CDC director. But, without a director at this point, the decision falls to Buzzelli. Last month, President Donald Trump chose acting CDC Director Susan Monarez, PhD, to lead the agency, but her appointment requires Senate approval. Stay tuned.
Belize has its first locally acquired malaria cases in 6 years, the country's Ministry of Health & Wellness reported this week. Four recently confirmed malaria patients are from two towns in Cayo district in western Belize, home to its capital, Belmopan. The initial case was confirmed on January 17, with the others detected on March 11 and April 5. Three of the cases are locally acquired, while one is imported from Guatemala. All the patients have received treatment.