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Group B streptococcal disease in nonpregnant adults
1Emory University School of Medicine and the Atlanta Veterans Affairs Medical Center, 1670 Clairmont Road, Atlanta, GA 30333, USA. mfarley@emory.edu
Abstract:
Group B streptococcal (GBS) disease in nonpregnant adults is increasing, particularly in elderly persons and those with significant underlying diseases. Diabetes, neurological impairment, and cirrhosis increase risk for invasive GBS disease. Skin, soft-tissue, and osteoarticular infections, pneumonia, and urosepsis are common presentations. Meningitis and endocarditis are less common but associated with serious morbidity and mortality. Disease is frequently nosocomial and may be related to the placement of an iv catheter. Recurrent infection occurs in 4.3% of survivors. Capsular serotypes Ia, III, and V account for the majority of disease in nonpregnant adults. Although group B streptococci are susceptible to penicillin, minimum inhibitory concentrations are 4-fold to 8-fold higher than for group A streptococci. Resistance to erythromycin and clindamycin is increasing. The role of antibodies in protection against GBS disease in nonpregnant adults is unresolved. However, the immunogenicity of GBS vaccines being developed for prevention of neonatal disease should be assessed for adults who are at risk.
Insights
Group B streptococcal (GBS) disease is rising in nonpregnant adults, especially the elderly and those with chronic conditions. Risk factors and common GBS infections are identified, with a call to assess vaccine efficacy in at-risk adults.
Area of Science:
- Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- Group B streptococcal (GBS) disease is increasingly prevalent in nonpregnant adults.
- Elderly individuals and those with underlying conditions like diabetes, neurological impairment, and cirrhosis face higher risks.
- Common GBS infections include skin/soft-tissue, osteoarticular, pneumonia, and urosepsis, while meningitis and endocarditis are less common but severe.
Purpose of the Study:
- To describe the epidemiology and clinical features of GBS disease in nonpregnant adults.
- To identify risk factors and common presentations of invasive GBS infections.
- To inform potential prevention strategies, including vaccine development.
Main Methods:
- Review of clinical data and epidemiological trends of GBS infections in nonpregnant adults.
- Analysis of common GBS serotypes and antimicrobial susceptibility patterns.
- Assessment of risk factors associated with invasive GBS disease.
Main Results:
- GBS disease incidence is increasing in nonpregnant adults, particularly the elderly and immunocompromised.
- Diabetes, neurological impairment, and cirrhosis are significant risk factors.
- Serotypes Ia, III, and V are most common; penicillin susceptibility is noted, but resistance to erythromycin and clindamycin is rising.
- Nosocomial infections, often linked to IV catheters, are frequent, with a 4.3% recurrence rate in survivors.
Conclusions:
- GBS disease poses a growing threat to nonpregnant adults, necessitating targeted prevention strategies.
- Understanding risk factors and common presentations is crucial for early diagnosis and treatment.
- The immunogenicity of GBS vaccines developed for neonates should be evaluated for at-risk adult populations.