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Streptococcus pyogenes in Neonates and Postpartum Women: First Report on Prevalence, Resistance, emm Typing, and Risk Factors in Khyber Pakhtunkhwa

ABDUL BASIT

ABDUL BASIT

Department of Microbiology, Kohat University of Science and Technology (KUST)Kohat, Pakistan
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BASIT, ABDUL
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MUBBASHIR HUSSAIN

MUBBASHIR HUSSAIN

Department of Microbiology, Kohat University of Science and Technology (KUST)Kohat, Pakistan
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HUSSAIN, MUBBASHIR
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MUHAMMAD QASIM

MUHAMMAD QASIM

Department of Microbiology, Kohat University of Science and Technology (KUST)Kohat, Pakistan
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QASIM, MUHAMMAD
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TAJ ALI KHAN

TAJ ALI KHAN

Institute of Pathology and Diagnostic Medicine, Khyber Medical UniversityPeshawar, Pakistan
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KHAN, TAJ ALI
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HASSAN NAVEED

HASSAN NAVEED

Department of Microbiology, Kohat University of Science and Technology (KUST)Kohat, Pakistan
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NAVEED, HASSAN
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ABDUL REH-MAN

ABDUL REH-MAN

Department of Microbiology, Kohat University of Science and Technology (KUST)Kohat, Pakistan
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REH-MAN, ABDUL
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MIAN MUFARIH SHAH

MIAN MUFARIH SHAH

Department of Medicine, Medical Teaching Institution (MTI) Hayatabad Medical ComplexPeshawar, Pakistan
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SHAH, MIAN MUFARIH
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MADIHA FATIMA

MADIHA FATIMA

Department of Neurology, the Affiliated Yangchuan Hospital of Chongqing Medical UniversityChongqing, China
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FATIMA, MADIHA
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KHALID J. ALZAHRANI

KHALID J. ALZAHRANI

Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif UniversityTaif, Saudi Arabia
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ALZAHRANI, KHALID J.
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KHALAF F. ALSHARIF

KHALAF F. ALSHARIF

Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif UniversityTaif, Saudi Arabia
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ALSHARIF, KHALAF F.
  
18 giu 2025
Streptococcus pyogenes in Neonates and Postpartum Women: First Report on Prevalence, Resistance, emm Typing, and Risk Factors in Khyber Pakhtunkhwa's Cover Image
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Categoria dell'articolo: Original Paper
Pubblicato online: 18 giu 2025
Pagine: 262 - 274
Ricevuto: 31 mar 2025
Accettato: 14 mag 2025
DOI: https://doi.org/10.33073/pjm-2025-021
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© 2025 ABDUL BASIT et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Map of Khyber Pakhtunkhwa, Pakistan, highlighting the locations of hospitals where Streptococcus pyogenes samples were collected. The hospitals included Hayatabad Medical Complex (HMC), Lady Reading Hospital (LRH), and Khyber Teaching Hospital (KTH) in Peshawar.
Map of Khyber Pakhtunkhwa, Pakistan, highlighting the locations of hospitals where Streptococcus pyogenes samples were collected. The hospitals included Hayatabad Medical Complex (HMC), Lady Reading Hospital (LRH), and Khyber Teaching Hospital (KTH) in Peshawar.

Fig. 2.

Antibiotic resistance and sensitivity patterns in bacterial isolates from postpartum women and neonates. Bars represent the percentage of resistant (red, yellow) and sensitive (gray, orange) isolates across different antibiotics.
Antibiotic resistance and sensitivity patterns in bacterial isolates from postpartum women and neonates. Bars represent the percentage of resistant (red, yellow) and sensitive (gray, orange) isolates across different antibiotics.

Fig. 3.

Distribution of emm types of Streptococcus pyogenes. A) Percentage of different emm types among isolates; B) the most common emm types in postpartum women and neonates identified in the study population. Various colors and patterns indicate distinct emm types.
Distribution of emm types of Streptococcus pyogenes. A) Percentage of different emm types among isolates; B) the most common emm types in postpartum women and neonates identified in the study population. Various colors and patterns indicate distinct emm types.

Fig. 4.

Risk factors associated with neonatal and postpartum maternal infections. Neonatal-associated factors are highlighted in yellow, whereas postpartum maternal-associated factors are shown in gray. * – indicates statistical significance (p< 0.05)
Risk factors associated with neonatal and postpartum maternal infections. Neonatal-associated factors are highlighted in yellow, whereas postpartum maternal-associated factors are shown in gray. * – indicates statistical significance (p< 0.05)

Fig. 5.

Clinical and laboratory findings in neonates and postpartum women with S. pyogenes infections. Neonatal-associated cases are shown in yellow, whereas postpartum maternal cases are depicted in gray. * – indicates statistical significance (p< 0.05)
Clinical and laboratory findings in neonates and postpartum women with S. pyogenes infections. Neonatal-associated cases are shown in yellow, whereas postpartum maternal cases are depicted in gray. * – indicates statistical significance (p< 0.05)

Clinical manifestations of Streptococcus pyogenes infection in postpartum women and neonates in Khyber Pakhtunkhwa_

Clinical Feature Postpartum women (n = 32) Neonates (n = 23) χ2 Value p-Value
Fever (> 38°C) 24 (75.0%) 16 (66.7%) 0.34 0.56
Hypothermia (< 36°C) 4 (12.5%) 6 (27.8%) 1.98 0.16
Sepsis 16 (50.0%) 12 (55.6%) 0.16 0.69
Meningitis 6 (16.7%) 8 (33.3%) 2.18 0.14
Wound infection 10 (33.3%) – – –
Bacteremia 18 (58.3%) 16 (66.7%) 0.37 0.54
Respiratory distress – 12 (55.6%) – –
Jaundice – 8 (33.3%) – –
Hypotension 7 (20.8%) 5 (22.2%) 0.01 0.92
Tachycardia 8 (25.0%) 9 (38.9%) 1.13 0.29
Multi-organ dysfunction 4 (12.5%) 3 (11.1%) 0.02 0.88
Vomiting 8 (25.0%) 10 (44.4%) 2.25 0.13
Hypoglycemia 6 (16.7%) 9 (38.9%) 3.73 0.05
Lethargy 7 (20.8%) 12 (50.0%) 5.46 0.02
Rash 6 (16.7%) 6 (27.8%) 0.96 0.33
Abdominal pain 10 (29.2%) – – –
Feeding difficulties – 8 (33.3%) – –
Cyanosis – 4 (16.7%) – –

Risk factors and laboratory findings associated with Streptococcus pyogenes infection_

Parameter Postpartum women (%) (n = 32) Neonates (%) (n = 23) Crude OR (95% CI) Adjusted OR (95% CI) p-Value
Risk factors
Prolonged labor (> 18h) 13 (40.6%) – 2.9 (1.3–6.4) 2.6 (1.2–6.0) 0.030
Premature rupture of membranes 10 (31.3%) – 2.3 (1.1–4.8) 2.1 (1.0–4.6) 0.039
Low birth weight (< 2.5 kg) – 9 (39.1%) 1.4 (0.6–3.0) 1.2 (0.5–2.8) 0.315
Maternal infection history 8 (25.0%) – 1.8 (0.9–3.5) 1.6 (0.8–3.2) 0.092
Maternal malnutrition 9 (28.1%) – 1.4 (0.7–2.8) 1.3 (0.6–2.7) 0.256
Poor socioeconomic status 15 (46.9%) 12 (52.2%) 2.6 (1.4–5.1) 2.3 (1.2–4.6) 0.027
Home delivery without skilled attendant 11 (34.4%) 10 (43.5%) 3.0 (1.5–6.0) 2.7 (1.3–5.7) 0.020
Limited prenatal care (< 3 visits) 12 (37.5%) – 2.7 (1.3–5.5) 2.4 (1.2–5.0) 0.036
Preterm birth (< 37 weeks) – 10 (43.5%) 3.3 (1.6–7.1) 3.0 (1.4–6.7) 0.013
Neonatal resuscitation at birth – 7 (30.4%) 2.9 (1.4–6.1) 2.6 (1.2–5.7) 0.028
Inadequate hand hygiene in hospital 10 (31.3%) 8 (34.8%) 2.8 (1.3–6.0) 2.4 (1.1–5.2) 0.034
Laboratory features
Elevated CRP (> 10 mg/l) 20 (62.5%) 15 (65.2%) 1.2 (0.6–2.3) 1.1 (0.5–2.2) 0.984
Leukocytosis (WBC > 12,000/μl) 18 (56.3%) 13 (56.5%) 1.4 (0.7–2.7) 1.2 (0.6–2.4) 0.874
Thrombocytopenia (< 150,000/μl) 6 (18.8%) 8 (34.8%) 1.7 (0.8–3.5) 1.5 (0.7–3.1) 0.365
Anemia (Hb < 10 g/dl) 10 (31.3%) 9 (39.1%) 1.5 (0.7–3.1) 1.4 (0.6–2.9) 0.710
Positive Blood Culture for S. pyogenes 18 (56.3%) 15 (65.2%) 2.0 (1.1–3.9) 1.8 (0.9–3.7) 0.054

Prevalence of Streptococcus pyogenes among postpartum women and neonates_

Group Total samples Positive cases Prevalence (%) Male cases Female cases χ2 Value p-Value
Postpartum women 192 32 16.7% - 32 1.52 0.217
Neonates 192 23 11.9% 12 11
Total 384 55 14.3% 12 43
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