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First case of penicillin-resistant Streptococcus agalactiae (group B Streptococcus) isolated from an adult patient in Italy, February 2026
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Roberta Creti1
,
Giovanni Gherardi1
,
Monica Imperi1
,
Andrea Zappavigna2
,
Gabriella Tocci2
,
Nicolò Rossi3
,
Filippo Trapani3
,
Giovanna Alfarone1
,
Ilaria Marani1
,
Anna Teresa Palamara1
,
Giuliana Lo Cascio2,4
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View Affiliations Hide AffiliationsAffiliations: 1 Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy 2 Department of Laboratory Medicine, Microbiology Unit- AUSL, Piacenza, Italy 3 Department of Specialistic Medicine, Infectious Disease Unit- AUSL, Piacenza, Italy 4 Department of Medicine and Surgery- University of Parma, Parma, ItalyCorrespondence:Roberta Cretiroberta.creti iss.it
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Citation style for this article: Creti Roberta, Gherardi Giovanni, Imperi Monica, Zappavigna Andrea, Tocci Gabriella, Rossi Nicolò, Trapani Filippo, Alfarone Giovanna, Marani Ilaria, Palamara Anna Teresa, Lo Cascio Giuliana. First case of penicillin-resistant Streptococcus agalactiae (group B Streptococcus) isolated from an adult patient in Italy, February 2026. Euro Surveill. 2026;31(20):pii=2600374. https://doi.org/10.2807/1560-7917.ES.2026.31.20.2600374 Received: 04 May 2026; Accepted: 21 May 2026
Abstract
A penicillin-resistant group B streptococcal (GBS) strain was identified in Italy, after isolation from the blood culture of a patient in their 80s with comorbidities. The isolate was multidrug-resistant and demonstrated by genome sequencing to be of serotype Ia, sequence type 23, and to possess the alp1 gene. Known and new point mutations were detected in the penicillin-binding-protein genes 2a and 2x. Although sporadic, penicillin-resistance in GBS is a serious concern for prophylaxis and therapy, so continued GBS surveillance remains important.
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References
-
Puopolo KM. Group B Streptococcal Disease. N Engl J Med. 2026;394(9):896-905. https://doi.org/10.1056/NEJMra2313146 PMID: 41740033
-
European Committee on Antimicrobial Susceptibility Testing (EUCAST). MIC and Zone diameter distributions; MIC distributions for Streptococcus agalactiae. Växjö: EUCAST; 2026-05-18. Available from: http://www.eucast.org
-
Nagao Ferreira L, Pimentel Hecht BA, Dos Santos LS, Nagao PE. Penicillin-Binding Proteins in Streptococcus agalactiae and Their Association with Reduced Penicillin Susceptibility: An Overview. Antibiotics (Basel). 2026;15(1):31. https://doi.org/10.3390/antibiotics15010031 PMID: 41594068
-
The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 16. Växjö: EUCAST; 2026. Available from: http://www.eucast.org
-
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. . https://doi.org/10.1111/j.1469-0691.2011.03570.x PMID: 21793988
-
Creti R, Imperi M, Berardi A, Angeletti S, Gherardi G. Laboratory breakpoints for assessing high level gentamicin resistance in Streptococcus agalactiae: it is the time for a consensus. Clin Microbiol Infect. 2022;28(8):1050-2. https://doi.org/10.1016/j.cmi.2022.04.011 PMID: 35526691
-
Oliveira LMA, Simões LC, Crestani C, Costa NS, Pantoja JCF, Rabello RF, et al. Long-Term Co-Circulation of Host-Specialist and Host-Generalist Lineages of Group B Streptococcus in Brazilian Dairy Cattle with Heterogeneous Antimicrobial Resistance Profiles. Antibiotics (Basel). 2024;13(5):389. https://doi.org/10.3390/antibiotics13050389 PMID: 38786118
-
Bacterial Priority Pathogens List WHO. 2024. Bacterial Pathogens of Public Health Importance to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance. Geneva: World Health Organization; 2024.
-
Imperi M, Gherardi G, Alfarone G, Creti R. Group B Streptococcus Infections in Non-Pregnant Adults, Italy, 2015-2019. Pathogens. 2024;13(9):807. https://doi.org/10.3390/pathogens13090807 PMID: 39338998
-
Creti R, Imperi M, Berardi A, Lindh E, Alfarone G, Pataracchia M, et al. Invasive Group B Streptococcal Disease in Neonates and Infants, Italy, Years 2015-2019. Microorganisms. 2021;9(12):2579. https://doi.org/10.3390/microorganisms9122579 PMID: 34946181
-
Koide S, Nagano Y, Takizawa S, Sakaguchi K, Soga E, Hayashi W, et al. Genomic Traits Associated with Virulence and Antimicrobial Resistance of Invasive Group B Streptococcus Isolates with Reduced Penicillin Susceptibility from Elderly Adults. Microbiol Spectr. 2022;10(3):e0056822. https://doi.org/10.1128/spectrum.00568-22 PMID: 35639001
-
McGee L, Chochua S, Li Z, Mathis S, Rivers J, Metcalf B, et al. Multistate, Population-Based Distributions of Candidate Vaccine Targets, Clonal Complexes, and Resistance Features of Invasive Group B Streptococci Within the United States, 2015-2017. Clin Infect Dis. 2021;72(6):1004-13. https://doi.org/10.1093/cid/ciaa151 PMID: 32060499
-
Longtin J, Vermeiren C, Shahinas D, Tamber GS, McGeer A, Low DE, et al. Novel mutations in a patient isolate of Streptococcus agalactiae with reduced penicillin susceptibility emerging after long-term oral suppressive therapy. Antimicrob Agents Chemother. 2011;55(6):2983-5. https://doi.org/10.1128/AAC.01243-10 PMID: 21383092
-
van der Linden M, Mamede R, Levina N, Helwig P, Vila-Cerqueira P, Carriço JA, et al. Heterogeneity of penicillin-non-susceptible group B streptococci isolated from a single patient in Germany. J Antimicrob Chemother. 2020;75(2):296-9. https://doi.org/10.1093/jac/dkz465 PMID: 31740946
-
McGuire E, Ready D, Ellaby N, Potterill I, Pike R, Hopkins KL, et al. A case of penicillin-resistant group B Streptococcus isolated from a patient in the UK. J Antimicrob Chemother. 2025;80(2):399-404. https://doi.org/10.1093/jac/dkae419 PMID: 39545469
-
Nagano N, Nagano Y, Kimura K, Tamai K, Yanagisawa H, Arakawa Y. Genetic heterogeneity in pbp genes among clinically isolated group B Streptococci with reduced penicillin susceptibility. Antimicrob Agents Chemother. 2008;52(12):4258-67. https://doi.org/10.1128/AAC.00596-08 PMID: 18809936
-
Ikebe T, Okuno R, Uchitani Y, Takano M, Yamaguchi T, Otsuka H, et al. , Working Group for Β-Hemolytic Streptococci in Japan. Serotype Distribution and Antimicrobial Resistance of Streptococcus agalactiae Isolates in Nonpregnant Adults with Streptococcal Toxic Shock Syndrome in Japan in 2014 to 2021. Microbiol Spectr. 2023;11(2):e0498722. https://doi.org/10.1128/spectrum.04987-22 PMID: 36786620
-
Morozumi M, Wajima T, Takata M, Iwata S, Ubukata K. Molecular Characteristics of Group B Streptococci Isolated from Adults with Invasive Infections in Japan. J Clin Microbiol. 2016;54(11):2695-700. https://doi.org/10.1128/JCM.01183-16 PMID: 27558182
-
Metcalf BJ, Chochua S, Gertz RE Jr, Hawkins PA, Ricaldi J, Li Z, et al. , Active Bacterial Core surveillance team. Short-read whole genome sequencing for determination of antimicrobial resistance mechanisms and capsular serotypes of current invasive Streptococcus agalactiae recovered in the USA. Clin Microbiol Infect. 2017;23(8):574.e7-14. https://doi.org/10.1016/j.cmi.2017.02.021 PMID: 28257899
-
Kimura K, Suzuki S, Wachino J, Kurokawa H, Yamane K, Shibata N, et al. First molecular characterization of group B streptococci with reduced penicillin susceptibility. Antimicrob Agents Chemother. 2008;52(8):2890-7. https://doi.org/10.1128/AAC.00185-08 PMID: 18490507
-
de Azavedo JC, McGavin M, Duncan C, Low DE, McGeer A. Prevalence and mechanisms of macrolide resistance in invasive and noninvasive group B streptococcus isolates from Ontario, Canada. Antimicrob Agents Chemother. 2001;45(12):3504-8. https://doi.org/10.1128/AAC.45.12.3504-3508.2001 PMID: 11709331
-
Dahesh S, Hensler ME, Van Sorge NM, Gertz RE Jr, Schrag S, Nizet V, et al. Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to β-lactam antibiotics. Antimicrob Agents Chemother. 2008;52(8):2915-8. https://doi.org/10.1128/AAC.00461-08 PMID: 18541727
-
Nagano N, Nagano Y, Toyama M, Kimura K, Tamura T, Shibayama K, et al. Nosocomial spread of multidrug-resistant group B streptococci with reduced penicillin susceptibility belonging to clonal complex 1. J Antimicrob Chemother. 2012;67(4):849-56. https://doi.org/10.1093/jac/dkr546 PMID: 22210756
-
de Azavedo JC, McGavin M, Duncan C, Low DE, McGeer A. Prevalence and mechanisms of macrolide resistance in invasive and noninvasive group B streptococcus isolates from Ontario, Canada. Antimicrob Agents Chemother. 2001;45(12):3504-8. https://doi.org/10.1128/AAC.45.12.3504-3508.2001 PMID: 11709331
-
Gaudreau C, Lecours R, Ismaïl J, Gagnon S, Jetté L, Roger M. Prosthetic hip joint infection with a Streptococcus agalactiae isolate not susceptible to penicillin G and ceftriaxone. J Antimicrob Chemother. 2010;65(3):594-5. https://doi.org/10.1093/jac/dkp458 PMID: 20022939
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