A Case of Late-onset GBS Infection in a Very-low-birth-weight Infant with Recurrent Bacteremia

We report a case of late-onset group B streptococcus (GBS) infection in a very-low-birth-weight male neonate who developed bacteraemia and meningitis in the neonatal intensive care unit (NICU). The mother had a history of abdominal surgery for a rare sarcoma, and because of limited uterine volume the boy was delivered by elective caesarean section after 28 weeks and 5 days' gestation (birth weight: 1,212 g). Although a birth canal culture for GBS during pregnancy had been negative, the infant developed bacteraemia on day 25 after birth. He recovered after a 10-day course of antimicrobial therapy, but bacteraemia recurred on day 47. Further treatment lasting 16 days was needed to achieve complete remission. Because there were no further recurrences or complications, the patient was discharged. A culture of the mother's breast milk was negative for GBS and no other newborns in the NICU were infected, but GBS was still present in the patient's pharynx on discharge. The serotype and genotype matched, confirming a repeat infection by the same pathogen via an unknown route. The prevalence of late-onset invasive GBS infection is increasing, and because of the multiple routes of infection and lack of established preventive measures, premature infants are particularly susceptible. Much more attention should be paid to the risk of recurrence even after discharge from the NICU.