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What is the optimal management for the asymptomatic twin after diagnosis of late-onset group B streptococcal disease?
  1. Cécile Feildel-Fournial1,
  2. Elise Launay1,2,
  3. Jocelyne Caillon3,
  4. Elise Thomas3,
  5. Cécile Boscher4,
  6. Christele Gras-Le Guen1,2
    1. 1Department of Pediatrics, Pediatric Emergency, Centre Hospitalier Universitaire de Nantes, Nantes, France
    2. 2Clinical Investigation Center 1413 INSERM 1043, Centre Hospitalier Universitaire de Nantes, Nantes, France
    3. 3Microbiology Laboratory, UMR INSERM 1235, Centre Hospitalier Universitaire de Nantes, Nantes, France
    4. 4Division of Neonatalogy, Pediatric Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
    1. Correspondence to Professor Christele Gras-Le Guen, Department of Pediatrics, Pediatric Emergency, Centre Hospitalier Universitaire de Nantes, Nantes 44092, France; christele.grasleguen{at}chu-nantes.fr

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    Scenario

    A 22-day-old baby presents at your emergency department with a 3-hour history of poor feeding and fever. Blood and cerebrospinal fluid cultures reveal late-onset group B streptococcal (LOGBS) meningitis and bacteraemia. This child has a dizygotic twin who is asymptomatic. You wonder if it is necessary to test, hospitalise and give antibiotics to the asymptomatic twin?

    Structured clinical question

    In an asymptomatic child whose twin has an LOGBS infection (patient), is it necessary to do immediate evaluation, discontinue breast feeding and prescribe antibiotics (intervention) to avoid serious complications of group B streptococcal (GBS) disease (outcome)?

    Search strategy

    Secondary sources

    A search of the Cochrane Library using the terms ‘group B streptococcal infection’ and ‘twins’ was used.

    Primary sources

    MEDLINE was searched via PubMed from 1976 to August 2018. The advanced search mode was used with the terms ‘late-onset neonatal infection’, ‘twins’, ‘group B streptococcus’. Additional studies were found following the review of the references of articles. A total of 13 articles (case series or case reports) reporting LOGBS infections in twins were found (see table 1).

    View this table:
    Table 1

    Summary of evidence

    Commentary

    GBS remains a serious pathogen in young infants. Among bacteria responsible for invasive infections before 3 months of age, GBS represents the leading cause of meningitis1 2 and the second cause of bacteraemia.1–3 Intrapartum antibiotic prophylaxis produced a spectacular decrease in incidence of early-onset GBS disease,4–6 but has no effect in incidence of LOGBS disease.6–11 Despite advances in intensive care, case-fatality …

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