Group B streptococcal bacteremia in nonpregnant adults at a community teaching hospital.Chatrchai Watanakunakorn (+) ABSTRACT Background. Group B streptococcal streptococcal /strep·to·coc·cal/ (-kok´al) pertaining to or caused by a streptococcus. Streptococcal (Streptococcus) Pertaining to any of the Streptococcus bacteria. bacteremia bacteremia: see septicemia. bacteremia Presence of bacteria in the blood. Short-term bacteremia follows dental or surgical procedures, especially if local infection or very high-risk surgery releases bacteria from isolated sites. in nonpregnant adults continues to be a significant infection. Methods. We reviewed medical records of nonpregnant adult patients with group B streptococcal bacteremia from 1995 to 1999 and compared the findings with data from a similar study in our institution between 1980 and 1984. Results. There were 36 episodes of group B streptococcal bacteremia. The mean age was 70 years. Most of the cases (94%) were community-acquired. The most common underlying disease was diabetes mellitus (49%). The most common sources of group B streptococcal bacteremia were pneumonia and soft tissue infections. The overall mortality rate was 16.7%. Conclusions. Group B streptococcal bacteremia is still found mainly in the elderly, with significant underlying disease, particularly diabetes mellitus. The spectrum of infection has included lymphadenitis Lymphadenitis Definition Lymphadenitis is the inflammation of a lymph node. It is often a complication of a bacterial infection of a wound, although it can also be caused by viruses or other disease agents. , ascending cholangitis, mastitis mastitis (măstī`tĭs), inflammation of the breast. Mastitis most commonly occurs in nursing mothers between the first and third weeks after childbirth, usually of the first child. , prostatitis prostatitis (prŏs'tətī`tĭs), inflammation of the prostate gland. Acute prostatitis is usually a result of infection in the urinary tract or infection carried by the blood; in many cases the infection spreads from the urethra and is , and toxic shock syndrome toxic shock syndrome (TSS). acute, sometimes fatal, disease characterized by high fever, nausea, diarrhea, lethargy, blotchy rash, and sudden drop in blood pressure. It is caused by Staphylococcus aureus, an exotoxin-producing bacteria (see toxin). . The mortality has decreased significantly during the past 15 years (16.7% vs 67.9%). GROUP B streptococcal bacteremia in nonpregnant adults was not well appreciated before the 1980s. (1,2) We published a study in 1985, (3) and other articles have been published since that time. (3-17) For the past 25 years, the character of group B streptococcal bacteremia in nonpregnant adults has changed in some aspects. Previous studies (before 1990), both hospital-based and population-based, have reported a high mortality from this infection. (3-6,8,13) Nosocomial nosocomial /noso·co·mi·al/ (nos?o-ko´me-il) pertaining to or originating in a hospital. nos·o·co·mi·al adj. 1. Of or relating to a hospital. 2. acquisition of group B streptococcal bacteremia has been reported. (3-6, 8-11,16) The spectrum of infection has included pneumonia, soft tissue infection, urinary tract infection urinary tract infection (UTI), n infection in one or more of the structures that make up the urinary system. Occurs more often in women and is most commonly caused by bacteria. , septic arthritis, osteomyelitis osteomyelitis (ŏs'tēōmī'əlī`tĭs), infection of the bone and bone marrow. Direct infection of bone usually occurs through open fractures, penetrating wounds, or surgical operations. , endocarditis endocarditis (ĕn'dōkärdī`tĭs), bacterial or fungal infection of the endocardium (inner lining of the heart) that can be either acute or subacute. , and meningitis. In this report, we describe the clinical findings of nonpregnant adult patients with group B streptococcal bacteremia in the late 1990s (1995 to 1999) and compare these with findings in the earlier series (1980 to 1984) from our institution, as well as with findings in other published reports. MATERIALS AND METHODS St. Elizabeth Health Center is a major teaching hospital of the Northeastern Ohio Universities College of Medicine Northeastern Ohio Universities College Of Medicine (NEOUCOM) is a community-based, state medical school that offers a combined B.S./M.D. program that allows students to graduate with their B.S./M.D. in as few as six or seven years. . All patients from whom group B streptococcus group B streptococcus Streptococcus agalactiae A streptococcus classified into 7 capsular serotypes, which is the leading cause of sepsis and meningitis in neonates; GBS affects 1. was isolated from blood culture specimens between January 1995 and December 1999 were identified by using the laboratory logbooks. We reviewed only medical records of nonpregnant adults (more than 18 years of age) who had group B streptococcal bacteremia and were admitted as inpatients. Medical records were reviewed for age, sex, clinical diagnosis, community or nosocomial acquisition of infection, associated medical conditions, concomitant infections, source of group B streptococcal bacteremia, selected clinical laboratory results, treatment, antibiotic susceptibility, and outcome. At this institution, the radiometric blood culture analyzer (BACTEC, Johnson Laboratories, Cockeyville, Md) was used. Group B streptococci-specific antigens were detected by the latex-coagglutination method (Streptocard Acid Latex test, Becton Dickinson Microbiology Syste ms, Becton Dickinson and Co, Sparks, Md). Antibiotic susceptibility tests were done in the clinical microbiologic laboratory by automated methods (Vitek, BioMerieux). Bacteremia was considered community-acquired when the isolate was obtained in outpatients or before 72 hours after admission. A definite source of bacteremia was established by an appropriate clinical description of infection supported by a culture of group B streptococcus from that site. A probable source was determined by a clinical description supported by laboratory data, such as Gram stains of specimens (sputum sputum /spu·tum/ (spu´tum) [L.] expectoration; matter ejected from the trachea, bronchi, and lungs through the mouth. sputum cruen´tum bloody sputum. , joint fluid, cerebrospinal fluid, wound) or imaging studies (chest films, magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. , bone scan). Toxic shock syndrome was diagnosed by using the criteria for toxic shock syndrome due to group A streptococcus group A streptococcus n. A common but virulent streptococcus that kills the tissue it infects and produces toxins that trigger a form of shock that affects the vital organs. , defined by the Working Group on Severe Streptococcal Infections. (18) Endocarditis was diagnosed by the Duke criteria. (19) We analyzed our data and compared findings from our previous study of group B streptoc occal bacteremia. (3) RESULTS From January 1995 to December 1999, 43 patients had blood culture specimens that grew group B streptococcus. There were 44 episodes of group B streptococcal bacteremia, 4 of which occurred in neonates. No group B streptococcal bacteremia was found in parturient parturient /par·tu·ri·ent/ (pahr-tu´re-ent) giving birth or pertaining to birth; by extension, a woman in labor. par·tu·ri·ent adj. 1. Of or relating to giving birth. 2. women. Medical records were not available in 4 episodes of group B streptococcal bacteremia. Thus, a total of 36 episodes of group B streptococcal bacteremia in 35 nonpregnant adults were available for review. The clinical findings of these patients were compared with those from the study published in 1985 (Table 1). (3) In the current series, there were 23 men and 12 women. The median age was 70 years. Thirty-four episodes (94.4%) were community-acquired. Of the 2 episodes of hospital-acquired group B streptococcal bacteremia, 1 was associated with pneumonia, and the other was of undetermined primary source. Five patients had polymicrobial bacteremia: 2 patients with pneumonia, 2 patients with osteomyelitis, and 1 patient with cellulitis Cellulitis Definition Cellulitis is a spreading bacterial infection just below the skin surface. It is most commonly caused by Streptococcus pyogenes or Staphylococcus aureus. . In cases of polymicrobial bacteremia, the concomitant blood culture isolates were methicillin-resistant Staphylococcus aureus methicillin-resistant Staphylococcus aureus Methicillin-aminoglycoside resistant Staphylococcus aureus, MRSA An organism with multiple antibiotic resistances–eg, aminoglycosides, chloramphenicol, clindamycin, erythromycin, rifampin, tetracycline, (2), Haemophilus influenzae (1), Pseudomonas aeruginosa (1), Clostridium clostridium Any of the rod-shaped, usually gram-positive bacteria (see gram stain) that make up the genus Clostridium. They are found in soil, water, and the intestinal tracts of humans and other animals. Some species grow only in the complete absence of oxygen. species (1), and Corynebacterium Corynebacterium /Co·ry·ne·bac·te·ri·um/ (-bak-ter´e-um) a genus of bacteria including C. ac´nes, a species present in acne lesions, C. diphthe´riae, the etiologic agent of diphtheria, C. species (1). The definite source of group B streptococcal bacteremia was identified in 15 episodes by growing group B streptococcus in cultures from the sites of infection (sputum, urine, ulcer/wound, paraspinal abscess abscess, localized inflamation associated with tissue necrosis. Abscesses are characterized by inflamation, which is due to the accumulation of pus in the local tissues, and often painful swelling. , and bile). The probable source of group B streptococcal bacteremia was determined in 15 episodes. The sources of bacteremia are listed in Table 2 and are compared with those from earlier series. The most common sources of group B streptococcal bacteremia were pneumonia and soft tissue infections. The majority of patients with pneumonia were more than 70 years old. The one patient who was younger than 70 was an intravenous drug user. Six of seven episodes of group B streptococcal bacteremic bac·te·re·mi·a n. The presence of bacteria in the blood. bac  te·re pneumonia were community acquired. Five of
seven patients with soft tissue infections had diabetes mellitus. One
episode of soft tissue infection was associated with polymicrobial
bacteremia in a patient who had rheumatoid arthritis treated with
methotrexate methotrexate, drug used in halting the growth of actively proliferating tissues. Introduced in the 1950s, it is used in the treatment of leukemia, psoriasis, and non-Hodgkin's lymphoma. and prednisone prednisone (prĕd`nĭsōn): see corticosteroid drug. .
There were 4 episodes of group B streptococcal bacteremia associated with urinary tract infections. All 4 episodes were community acquired, and 3 were in women. Two of these patients had diabetes mellitus. One episode was associated with a kidney stone. There were 3 episodes of group B streptococcal bacteremia associated with septic arthritis (all in patients with prosthetic pros·thet·ic adj. 1. Serving as or relating to a prosthesis. 2. Of or relating to prosthetics. prosthetic serving as a substitute; pertaining to prostheses or to prosthetics. joints). Although joint fluid culture produced no growth, clinical and laboratory features (fever, joint pain, elevated erythrocyte sedimentation rate Erythrocyte Sedimentation Rate Definition The erythrocyte sedimentation rate (ESR), or sedimentation rate (sed rate), is a measure of the settling of red blood cells in a tube of blood during one hour. , Gram stains of joint fluid, computed tomography of affected joints) were compatible with septic arthritis. Two of these patients had diabetes mellitus. There were 3 cases of osteomyelitis. One of these patients died of infection, 1 had complications (disseminated intravascular coagulopathy disseminated intravascular coagulopathy Hematology An acquired bleeding diathesis with a generally bad outcome in which the balance between coagulation and fibrinolysis tips toward the former; DIC is characterized by accelerated platelet consumption with , gas gangrene), and 1 had diabetes mellitus. One patient had vertebral ver·te·bral adj. 1. Of, relating to, or of the nature of a vertebra. 2. Having or consisting of vertebrae. 3. Having a spinal column. osteomyelitis and paraspinal abscess with positive culture for group B streptococcus. This patient had no significant underlying dis eases and no history of previous spinal surgery. There were three cases of probable endocarditis. The diagnosis was based on clinical features, though two-dimentional echocardiography Echocardiography Definition Echocardiography is a diagnostic test that uses ultrasound waves to create an image of the heart muscle. Ultrasound waves that rebound or echo off the heart can show the size, shape, and movement of the heart's valves and and transesophageal echocardiography showed no lesions compatible with vegetations. Two of these patients were older than 70. One patient, who had diabetes mellitus, had ascending cholangitis (bile grew group B streptococcus). He was found to have extrahepatic ex·tra·he·pat·ic adj. Originating or occurring outside the liver. obstruction of the distal common bile duct common bile duct n. The duct that is formed by the union of the hepatic and cystic ducts and discharges into the duodenum. Also called gall duct. due to a cyst cyst, abnormal sac in the body, filled with a fluid or semisolid and enclosed in a membrane. Cysts can be congenital but are usually acquired, the most common locations being the skin and the ovaries. in the head of the pancreas. One patient had group B streptococcal bacteremia and lymphadenitis on two separate occasions (2 months apart). One patient had group B streptococcal bacteremia with mastitis after lumpectomy Lumpectomy Definition A lumpectomy is a type of surgery used to treat breast cancer. It is considered "breast-conserving" surgery because in a lumpectomy, only the malignant tumor and a surrounding margin of normal breast tissue are and radiation for breast cancer. One patient had prostatitis after biopsy for carcinoma of the prostate. There were two episodes of toxic shock syndrome, both occurring in young women. One was a patient (previously described (12)) with a history of diabetes mellitus and alcoholism, and the source of group B streptococcal bacteremia was not apparent. This patient died. The other had hemochromatosis Hemochromatosis Definition Hemochromatosis is an inherited blood disorder that causes the body to retain excessive amounts of iron. This iron overload can lead to serious health consequences, most notably cirrhosis of the liver. and urinary tract infection, and she survived. The overall mortality was 16.7% (6 of 36 episodes) and the attributable mortality was 11.1% (4 of 36 episodes). Four of these patients were more than 70 years old and had multiple predisposing factors such as diabetes mellitus, lung cancer, corticosteroid corticosteroid /cor·ti·co·ster·oid/ (-ster´oid) any of the steroids elaborated by the adrenal cortex (excluding the sex hormones) or any synthetic equivalents; divided into two major groups, the glucocorticoids and therapy, chronic renal insufficiency, and congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. . Severe complications developed in two other patients who were younger than 70 (one of the young women who had toxic shock syndrome, and one patient who had acute renal failure acute renal failure Acute kidney failure Nephrology An abrupt decline in renal function, triggered by various processes–eg, sepsis, shock, trauma, kidney stones, drug toxicity-aspirin, lithium, substances of abuse, toxins, iodinated radiocontrast. and coagulopathy). All isolates of group B streptococcus were susceptible to penicillin, ampicillin ampicillin (ăm'pĭsĭl`ĭn), a penicillin-type antibiotic that is effective against both gram-negative microorganisms and gram-positive microorganisms such as Escherichia coli. , cefazolin, and vancomycin (Table 3). Only 85% were susceptible to clindamycin and 62% to erythromycin erythromycin (ĭrĭth'rōmī`sĭn), any of several related antibiotic drugs produced by bacteria of the genus Streptomyces (see antibiotic). . Almost all isolates were resistant to tetracycline tetracycline (tĕ'trəsī`klēn), any of a group of antibiotics produced by bacteria of the genus Streptomyces. They are effective against a wide range of Gram positive and Gram negative bacteria, interfering with protein . DISCUSSION Group B streptococcal bacteremia in nonpregnant adults still occurs mainly in the elderly. The median age was 70 in this study and 72 in our previous study, (3) and it ranges from 53 to 68 years in the literature. (3-11, 13-17) Jackson et al (16) reported that nonpregnant adults aged 65 years or older had a 1.8 times greater risk for group B streptococcal infection Infection with Group B Streptococcus (GBS), also known as Streptococcus agalactiae, can cause serious illness and sometimes death, especially in newborn infants and the elderly. than those aged less than 65 years. Tyrrell et al (17) also reported that age greater than 65 was a risk factor for group B streptococcal infection. The overall mortality in the present study was 16.7%, which is significantly lower than in our earlier study (67.9%). (3) Other studies have reported steadily declining mortality (Table 4). In the current series, the mortality among patients aged 70 and older was 23.5% (4 of 17 patients), twice that of patients younger than 70 (11.1%, 2 of 18 patients). Higher mortality among older patients has been reported by Verghese et al, (4) Colford et al, (6) and Trivalle et al. (11) Polymicrobial bacteremia involving group B streptococcus was found in 13.9% of episodes in our series (3) and in less than 20% in other reports. (6-8, 10, 11) Farley et al (15) reported 41% of polymicrobial bacteremia involving group B streptococcus, but their study was population-based. Staphylococcus aureus was associated with group B streptococcus polymicrobial bacteremia in most previous studies. (5,8,9,15,16) Group B streptococcal polymicrobial bacteremia was found mostly in nosocomial infections, as reported in our previous series (3) and by Verghese et al. (4) In contrast, there was no nosocomial polymicrobial bacteremia involving group B streptococcus in the current series. Nosocomial group B streptococcal bacteremia occurred much less often in this series (6%), in contrast to 46% in our previous series, (3) 70% reported by Verghese et al, (4) and between 17% and 35% reported since 1995. (6,8-11,10) Jackson et al (16) reported nosocomial group B streptococcal bacteremia associated with central venous catheters, diabetes mellitus, congestive heart failure, and seizure disorders. Cases of group B streptococcal bacteremia associated with diabetes mellitus, cirrhosis, malignancy, long-term corticosteroid therapy, and central nervous system (CNS See Continuous net settlement. CNS See continuous net settlement (CNS). ) disorders (stroke) have been reported. (3-11,16,17) In our study, the most common underlying disease of patients with group B streptococcal bacteremia was diabetes mellitus alone (48.6%). Pneumonia (19.4%) and soft tissue infections (19.4%) were the most common clinical diagnoses in our study. Pneumonia was also the most common clinical diagnosis in our earlier series and in other hospital-based studies but not the most common clinical diagnosis in population-based studies. (3,4,8,13-10) In the present study, the patients who had pneumonia had CNS disorders, chronic obstructive pulmonary disease chronic obstructive pulmonary disease n. Abbr. COPD A chronic lung disease, such as asthma or emphysema, in which breathing becomes slowed or forced. , and malignancy. Verghese et al (4) reported pneumonia associated with CNS dysfunction, malignancy, and long-term corticosteroid therapy. Of our 7 patients with pneumonia, 6 (86%) were older than 70 years. Pneumonia also has been reported as the most common clinical diagnosis in group B streptococcal bacteremia in the elderly. (11) Reported mortality from pneumonia with group B streptococcal bacteremia has been high. (3,4,6,16) Soft tissue infections (including cellulitis, diabetic foot ulcer, and decubitus ulcer) were common sources of group B streptococcal bacteremia in our current series as well as in the earlier series. (3) Soft tissue infections with group B streptococcal bacteremia have been reported as the most common clinical diagnosis in both population-based studies and hospital-based studies. (6,14-16) Diabetes mellitus has been found to be a common underlying condition in patients with group B streptococcal soft tissue infections, being 71.4% in this series and 34.2% and 56% in two other series. (15,17) Bacteremic group B streptococcal urinary tract infection was found in four patients in the current series and none in our previous study. (3) Urosepsis, a common clinical presentation of group B streptococcal bacteremia, (2,4,11,15,16) was found mostly in female patients with diabetes mellitus in our study. Group B streptococcal urosepsis in men has been found almost always in patients with urinary tract abnormalities such as obstruction, renal calculi, or urinary tract instrumentation." (4,20) Bedridden bed·rid·den or bed·rid adj. Confined to bed because of illness or infirmity. state is commonly associated with group B streptococcal urinary tract infection in the elderly. (11) Three patients in the current study and one patient in the previous study (3) had a septic prosthetic joint. Septic arthritis has also been reported in the literature. (6,13,15,16) Diabetes mellitus, osteoarthritis osteoarthritis or osteoarthrosis or degenerative joint disease Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. , and joint prostheses Prostheses A synthetic object that resembles a missing anatomical part. Mentioned in: Microphthalmia and Anophthalmia are common predisposing factors. In our case of hematogenous hematogenous /he·ma·tog·e·nous/ (he?mah-toj´e-nus) 1. produced by or derived from the blood. 2. disseminated through the blood stream. he·ma·tog·e·nous adj. 1. vertebral osteomyelitis with para-spinal abscess, culture was positive for group B streptococcus, whereas blood cultures were negative in most such cases reported in the literature. (21,26) Group B streptococcus vertebral osteo-myelitis usually has a subacute onset and is found commonly in diabetic patients. (22,25,26) In addition, contiguous infection, recent surgery, or peripheral vascular disease Peripheral Vascular Disease Definition Peripheral vascular disease is a narrowing of blood vessels that restricts blood flow. It mostly occurs in the legs, but is sometimes seen in the arms. may predispose pre·dis·pose v. To make susceptible, as to a disease. to group B streptococcus vertebral osteomyelitis. (26) Urinary tract infection has also been reported as the source of group B streptococcus vertebral osteomyelitis. (26,27) Three patients had probable endocarditis but did not meet the Duke criteria for definite endocarditis. These three patients had diabetes mellitus, presented with subacute onset, and survived. We reported 7 cases of endocarditis in 1986 with high mortality rate. (28) The mortality rate in group B streptococcal endocarditis has decreased from 85% between 1938 and 1945 to 43.5% between 1962 and 1985 and to 12.9% from 1994 to 1996. (28,29) Meningitis was found in one patient without underlying disease in this study, and she survived. Group B streptococcus meningitis can occur in both healthy and immunocompromised hosts? (3,30,31) Endogenous endophthalmitis is an uncommon clinical picture of group B streptococcal infection and was not found in either this series or the earlier study. (3,32-35) Group B streptococcal endogenous endophthalmitis is a metastatic Metastatic The term used to describe a secondary cancer, or one that has spread from one area of the body to another. Mentioned in: Coagulation Disorders metastatic pertaining to or of the nature of a metastasis. infection, usually from endocarditis, meningitis, septic arthritis, and urinary tract infection. (32-33) In this series, there were other clinical presentations of group B streptococcal bacteremia, namely ascending cholangitis, prostatitis, mastitis, and toxic shock syndrome, that were not reported in the 1985 series. (3) Toxic shock syndrome caused by group B streptococcus is rare. Five cases (including one in this series) have been reported. (12,36-38) A pyrogenic pyrogenic /py·ro·gen·ic/ (pi?ro-jen´ik) febrifacient; causing fever. py·ro·gen·ic or py·rog·e·nous adj. 1. Producing or produced by fever. 2. toxin has been isolated by Schlievert et a1 (36) in a case of toxic shock syndrome associated with group B streptococcus in a y oung woman. We found all group B streptococcus strains to be susceptible to penicillin, ampicillin, cefazolin, and vancomycin. Almost all strains were resistant to tetracycline. The antibiotic susceptibility pattern in our study is similar to that reported in the literature, including strains isolated from neonates recently. (6,9,39) CONCLUSIONS Comparison of current cases with those reported 15 years earlier from our institution show that group B streptococcal bacteremia remains an important problem. Diabetes mellitus is still the most important underlying condition. There were fewer nosocomial cases. Pneumonia and soft tissue infections are the most common sources of bacteremia. The spectrum of infection has expanded to include ascending cholangitis, lymphadenitis, mastitis, and prostatitis. The mortality has decreased significantly during the past 15 years. (+.) Deceased. References (1.) Bayer A, Chow A, Anthony B, et al: Serious infections in adults due to group B streptococci Streptococcus (plural, streptococci) A genus of spherical-shaped anaerobic bacteria occurring in pairs or chains. Sydenham's chorea is considered a complication of a streptococcal throat infection. . Am J Med 1976;61:498-503 (2.) Lerner P, Gopalakrishna K, Wolinsky E, et al: Group B streptococcus (S agalactiae) bacteremia in adults: analysis of 32 cases and review of the literature. Medicine 1977; 56:457-473 (3.) Gallagher PG, Watanakunakorn C: Group B streptococcal bacteremia in a community teaching hospital. Am J Med 1985; 78:795-800 (4.) Verghese A, Mireault K, Arbeit PD: Group B streptococcal bacteremia in men. Rev Infect Dis 1986; 8:912-917 (5.) Opal SM, Cross A, Palmer M, et al: Group B streptoccal sepsis in adults and infants. Arch Intern Med 1988; 148:641-645 (6.) Colford JM Jr, Mohle-BoetaniJ, Vosti KL: Group B streptococcal bacteremia in adults, five years' experience and a review of the literature. Medicine 1995; 74:176-190 (7.) Horgan M, Edwards M, Dunagan WC: Group B streptococcal bacteremia in adults. Infect Dis Clin Pract 1997; 5:210-212 (8.) Munoz P, Llancaqueo A, Rodriguez-Creixems M, et al: Group B streptococcus bacteremia in nonpregnant adults. Arch Intern Med 1997; 157:213-216 (9.) Schugk J, Harjola V-P, Sivonen A, et al: A clinical study of beta-haemolytic groups A, B, C and G streptococcal bacteremia in adults over an 8-year period. Scand J Infect Dis 1997; 29:233-238 (10.) Cooper BW, Morganelli E: Group B streptococcal bacteremia in adults at Hartford Hospital 1991-1996. Conn Med 1998; 62:515-517 (11.) Trivalle C, Martin E, Martel P, et al: Group B streptococcal bacteremia in the elderly. J Med Microbiol 1998; 47:649-652 (12.) Cheng MM, Watanakunakorn C: Toxic shock syndrome caused by group B streptococcus. Infect Dis Clin Pract 1999; 8:46-48 (13.) Schwartz B, Schuchat A, Oxtoby MJ, et al: Invasive group B streptococcal disease in adults, a population-based study in metropolitan Atlanta. JAMA JAMA abbr. Journal of the American Medical Association 1991; 266:1112-1114 (14.) Zangwill KM, Schuchat A, Wenger JD: Group B streptococcal disease in the United States, 1990: report from a multi-state active surveillance system. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation Surveill Summ 1992; 41(SS-6):25-32 (15.) Farley MM, Harvey C, Stull T, et al: A population-based assessment of invasive disease due to group B streptococcus in nonpregnant adults. N Engl J Med 1993; 328:1807-1811 (16.) Jackson LA, Hilsdon P, Farley MM, et al: Risk factors for group B streptococcal disease in adults. Ann Intern Med 1995; 123:415420 (17.) Tyrrell GJ, Senzilet LD, Spika JS, et al: Invasive disease due to group B streptococcal infection in adults: results from a Canadian, population-based, active laboratory surveillance study--1996. J Infect Dis 2000; 182:168-173 (18.) The Working Group on Severe Streptococcal Infections: Defining the group A streptococcal toxic shock syndrome: rationale and consensus definition. JAMA 1993; 269:390391 (19.) Durack DT, Lukes AS, Bright DK, et al: New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Ant J Med 1994; 96:200-209 (20.) Johnson FM, Garcia A: Sepsis with group B streptococci (Streptococcus agalactiae) secondary to urinary tract infection in an adult male. J Am Geriatr Soc 1999; 47:629-630 (21.) Gordon DM, Oster CN: Hematogenous group B streptococcal osteomyelitis in an adult. South MedJ 1984; 77:643-645 (22.) McMeeking AA, Holzman R, Desiderio D, et al: Group B streptococcal osteomyelitis in an adult. NY State J Med 1987; 87:466-467 (23.) Fasano FJ Jr, Graham DR, Stauffer ES: Vertebral osteomyelitis secondary to Streptococcus agalactiae. Clin Orthop 1990; 256:101-104 (24.) Bath PMW PMW Pacific Media Watch PMW Palestine Media Watch PMW Patmont Motor Werks PMW Pari-Mutuel Wagering PMW Passive Microwave PMW Project Management Workshop PMW Perfect Magnetic Wall PMW Program Manager, Warfare (SPAWAR) , Pettingale KW: Group B streptococcal osteomyclitis of the spine. J R Soc Med 1990; 83:188 (25.) Elhanan G, Raz R: Group B streptococcal vertebral osteorayelitis in an adult. Infection 1993; 21:397-399 (26.) Ganapathy ME, Rissing JP: Group B streptococcal vertebral osteomyelitis with bacteremia. South Med J 1995; 88:350-351 (27.) Bauer TM, Pippert H, Zimmerli w: Vertebral osteomyelitis caused by group B streptococci (Streptococcus agalactiae) secondary to urinary tract infection. Eur J Clin Microbiol Infect Dis 1997; 16:244-246 (28.) Gallagher PG, Watanakunakorn C: Group B streptococcal endocarditis: report of seven cases and review of the literature, 1962-1985. Rev Infect Dis 1986; 8:175-188 (29.) Baddour LM and the Infectious Diseases Society of America's Emerging Infections Network: Infective endocarditis caused by beta-hemolytic streptococci. Clin Infect Dis 1998; 26:66-71 (30.) Dunne DW, Quagliarello V: Group B streptococcal meningitis in adults. Medicine 1993; 72:1-10 (31.) Barile AJ, Kallen AJ, Wallace MR: Fatal group B streptococcal meningitis in a previously healthy young adult. Clin Infect Dis 1999; 28:151 (32.) O'Brart DPS Minicomputer series from Bull HN. 1. (language, text) DPS - Display PostScript. 2. (language) DPS - A real-time language with direct expression of timing requests. ["Language Constructs for Distributed Real-Time PRogramming", I. , Eykyn SJ: Septicaemic septicaemic see septicemic. infection with group B streptococci presenting with endophthalmitis in adults. Eye 1992; 6:396-399 (33.) Nagelberg HP, Petashnick DE, To KW, et al: Group B streptococcal metastatic endophthalmitis. Am J Ophthalmol 1994; 117:498-500 (34.) Buglass TD, Romanchuk KG: Fatal case of group B streptococcal endogenous endophthalmitis. Can J Ophthalmol 1995; 30:149-150 (35.) MacGonnell TJ, Ferro A: A sore eye and meningitis. Lancet 1995; 346:1269 (36.) 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TABLE 1
Nonpregnant Adult Patients With Group B Streptococcal Bacteremia
Present Series Previous Series (3)
(1995-1999) (1980-1984)
No. of episodes 36 28
No. of patients 35 27
Median age in years (range) 70 (26-91) 72 (31-90)
Male/female 23/12 16/11
Diabetes mellitus 17 (48.6%) 9 (33.3%)
Malignancies 3 (8.6%) 4 (14.8%)
Hospital-acquired bacteremia 2 (5.6%) 13 (46.4%)
Polymicrobial bacteremia 5 (13.9%) 7 (25.0%)
Overall mortality 6 (16.7%) 19 (67.9%)
TABLE 2
Sources of Group B Streptococcal Bacteremia
Present Series Previous Series (3)
Sources of Bacteremia (1995-1999) (1980-1984)
Pneumonia 7 (19.4%) 5 (17.8%)
Soft tissue infections, cellulitis 7 (19.4%) 5 (17.8%)
(including diabetic foot ulcer)
Urinary tract infection 4 (11.1%) -
Arthritis 3 (8.3%) 1 (3.6%)
Osteomyelitis 3 (8.3%) 1 (3.6%)
Lymphadenitis 2 (5.6%) -
Meningitis 1 (2.8%) 1 (3.6%)
Mastitis 1 (2.8%) -
Ascending cholangitis 1 (2.8%) -
Prostatitis 1 (2.8%) -
Intravascular device infection - 1 (3.6%)
Unknown 6 (16.6%) 9 (32.1%)
TABLE 3
In Vitro Susceptibility of Group B Streptococcus
Antibiotics No. Susceptible/No. Tested
Vancomycin 13/13 (100%)
Ampicillin 27/27 (100%)
Penicillin 27/27 (100%)
Cefazolin 27/27 (100%)
Clindamycin 23/27 (85%)
Erythromycin 17/27 (62%)
Tetracycline 2/23 (9%)
TABLE 4
Comparison of Mortality From Group B Streptococcal Bacteremia During the
Past 25 Years
Period of No. of
References Study Sites Study Episodes
Gallagher and Youngstown, Ohio 1980-1984 28
Watanakunakorn (3)
Verghese et al (4) Boston, Mass 1978-1985 23
Opal et al (5) Washington, DC 1975-1984 24
Colford et al (6) San Francisco, Calif 1985-1990 29
Horgan et al (7) St.Louis, Mo 1990-1992 58
Munoz et al (8) Madrid, Spain 1985-1994 51
Cooper and Farmington, Conn 1991-1996 55
Morganelli (10)
Schwartz et al (13) Atlanta, Ga 1982-1983 56
Farley et al (15) Atlanta, Ga 1989-1990 140
Present study Youngstown, Ohio 1995-1999 36
Overall Attributable
References Mortality Mortality
Gallagher and 67.9% 53.5%
Watanakunakorn (3)
Verghese et al (4) 43% --
Opal et al (5) 41.7% --
Colford et al (6) 37.9% 27.6%
Horgan et al (7) 19% 10.3%
Munoz et al (8) 33.3% 25.5%
Cooper and 16.4% --
Morganelli (10)
Schwartz et al (13) 32% --
Farley et al (15) 21% --
Present study 16.7% 11.1%
RELATED ARTICLE: KEY POINTS * Group B streptococcal bacteremia in nonpregnant adults is a disease of elderly patients with significant underlying diseases, particularly diabetes mellitus. * Pneumonia, soft tissue infections, urosepsis, septic arthritis, and osteomyelitis are common presentations. * All group B streptococcal strains are susceptible to penicillin, ampicillin, cefazolin, and vancomycin. * The mortality has decreased significantly during the past 15 years (16.7% vs 67.9%). |
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