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Group B Streptococcal Bacteremia in Adults in the 21st Century: Review of 132 Episodes Over a 10-Year Period in a Large Community Teaching Hospital

Kaseman, Julia A. DO*; Myers, Natalie M.; Miracle, Jill E. MD; Myers, Joseph P. MD§

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e318279ee4f
Original Articles
Abstract

Background: Group B Streptococcus (GBS) remains a major pathogen in adult patients, and bacteremia from GBS is common.

Methods: We reviewed the medical records of all adults (≥16 years of age) with group B streptococcal bacteremia (GBSB) at our institution from July 1, 2002, to December 31, 2011, and report the incidence, epidemiology, source of infection, comorbid conditions, and results of therapy. These data are compared with prior studies of adults with GBSB.

Results: There were 132 episodes of GBSB in 126 patients. Six patients had recurrent GBSB. There was a mean of 13.2 episodes per year: 73 episodes (55.3%) in women and 59 episodes (44.7%) in men. The patients’ ages ranged from 16 to 97 years (mean, 64.4 years). Common sources of infection were skin and soft tissue (38 episodes [28.8%]), septic arthritis (13 episodes [9.8%]), infective endocarditis (13 episodes [9.8%]), pneumonia (11 episodes [8.3%]), osteomyelitis (10 episodes [7.6%]), pyelonephritis (9 episodes [6.8%]). Seventeen patients (12.9%) had primary bacteremia. The most common underlying illnesses were diabetes mellitus, hypertension, coronary artery disease, and congestive heart failure. The mean Charlson comorbidity index was 2.41, with an age-adjusted index of 4.11. Seventeen of 126 known patients died (13.4% mortality rate). Detailed antimicrobial treatment data were available for 105 of our patients, and length of treatment for our patients is reviewed.

Conclusions: Group B streptococcal bacteremia is common in adult patients in the 21st century with considerable morbidity and a 13.4% mortality rate despite uniformly appropriate antimicrobial therapy. Diabetes mellitus is the most commonly identifiable comorbid condition and remains a harbinger of group B streptococcal infection/bacteremia. All of our GBS strains remained exquisitely sensitive to penicillin G, ampicillin, cefotaxime, and ceftriaxone throughout the 10-year study period and remain effective first-line therapeutic agents.

In Brief

Kaseman et al. report the epidemiologic, clinical,microbiological and treatment results in 126 patients with 132 episodes of group B streptococcal bacteremia. Diabetes mellitus was the most common predisposing illness. Clinical manifestations ranged from primary bacteremia to severe bone and joint infections. There was a 13% mortality with this generally antimicrobially susceptible organism even in the first decade of the 21st century.

Author Information

From the *Internal Medicine Residency, Summa Health System/Northeast Ohio Medical University Program, Akron, OH; †University of Texas, Austin, TX; ‡Infectious Disease Fellowship Program, Wake Forest School of Medicine, Winston-Salem, NC and §Department of Medicine, Summa Health System and Northeast Ohio Medical University, Rootstown, OH.

Correspondence to: Joseph P. Myers, MD, Chair, Department of Medicine, Summa Akron City/St. Thomas Hospitals, 55 Arch St, Ste. 1-A, Akron, OH 44304. E-mail: myersj@summahealth.org.

The authors have no funding or conflicts of interest to disclose.

© 2013 by Lippincott Williams & Wilkins.