Risk Factors for Group B Streptococcal Disease in Adults

doi:10.1059/0003-4819-123-6-199509150-00003

Risk Factors for Group B Streptococcal Disease in Adults

From the Centers for Disease Control and Prevention and Emory University School of Medicine, Atlanta, Georgia; Johns Hopkins University, Baltimore, Maryland; and University of California at Berkeley, Berkeley, California. Acknowledgments: The authors thank Ruth Bessinger, MPH, Lillian Bill-mann, RN, MPH, Matthew Brennan, MD, Pam Daily, MPH, Katherine A. Deaver-Robinson, Diane M. Dwyer, MD, R. Chris Harvey, MPH, Timm Missbach, MD, Bharat Pattni, MD, MPH, and Gretchen Rothrock, MPH, for their assistance in collecting the data for this study. Requests for Reprints: Anne Schuchat, MD, Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Mailstop C-09, Atlanta, GA 30333. Current Author Addresses: Dr. Jackson: Department of Epidemiology, Box 357236 Seattle, WA 98195-7236.

Abstract

Objective: To determine risk factors for community-acquired and nosocomial group B streptococcal disease in adults.

Design: Case-control study.

Setting: 3 metropolitan areas in the United States with an aggregate population of 6.6 million persons.

Patients: 219 nonpregnant adults with invasive group B streptococcal infection identified by a population-based surveillance in 1991 and 1992 and 645 hospital-matched controls.

Results: The following conditions were associated with a significantly increased risk for community-acquired group B streptococcal infection after controlling for age in multivariate analysis: cirrhosis (odds ratio, 9.7 [95% CI, 3.5 to 26.9]; P < 0.001), diabetes (odds ratio, 3.0 [CI, 1.9 to 4.7]; P < 0.001), stroke (odds ratio, 3.5 [CI, 1.9 to 6.4]; P < 0.001), breast cancer (odds ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), decubitus ulcer (odds ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), and neurogenic bladder (odds ratio, 4.6 [CI, 1.4 to 15.1]; P = 0.01). Sixty-three percent of community case-patients had at least one of these conditions. Nosocomial infection (48 cases [22%]) was independently associated with the placement of a central venous line (odds ratio, 30.9 [CI, 5.2 to 184.1]; P < 0.001), diabetes, congestive heart failure, and seizure disorder.

Conclusions: Several chronic conditions were independently associated with group B streptococcal disease, and most case-patients had at least one of these conditions. If group B streptococcal vaccines being developed for prevention of neonatal disease are protective in adults, a vaccination strategy targeting those at highest risk has the potential to substantially reduce the burden of invasive group B streptococcal infection in adults.