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."

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