Group B streptococcal bacteremia in non-pregnant adults: results from two Korean centers

Abstract

Patients with liver cirrhosis (LC) have impaired immunity and are, thus, predisposed to infection. Few studies have attempted to evaluate group B streptococcal (GBS) bacteremia in LC patients. A retrospective study of patients with GBS bacteremia was performed at the Dongguk University Ilsan Hospital and National Health Insurance Service Ilsan Hospital over a 13-year period (October 2000 to July 2013). During the study period, 97 patients with GBS bacteremia were enrolled. The median age of the patients was 67 years and 54 % were men. Among them, 23 (24 %) patients were classified as LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (26 % vs. 8 %, p = 0.03). The multivariate analysis indicated that LC was associated with an increased risk of 30-day mortality [hazard ratio (HR) 5.0; 95 % confidence interval (CI) 1.53-16.3; p = 0.008], as well as age (HR 1.07; 95 % CI 1.03-1.13; p = 0.02) and high Pitt bacteremia score (HR 1.23; 95 % CI 1.02-1.46; p = 0.03). The probability of survival at day 30 was significantly different for the Child-Pugh class C and the Child-Pugh classes A or B (44 % vs. 93 %, respectively; p = 0.01 by the log-rank test). The mortality rates of LC patients with GBS bacteremia were significantly higher than those of patients with other diseases. The severity of hepatic dysfunction plays an important role in the development of adverse events. Cirrhosis-specific scores such as the Child-Pugh class might be useful for predicting the prognosis of GBS bacteremia in LC patients.

Non-Alcoholic Fatty Liver Disease is Associated with an Increased Mortality in Adult Patients with Group B Streptococcus Invasive Disease

“…The incidence of GBS invasive disease among adult non-pregnant patients has been rising for several decades, and adults now account for nearly 90% of all invasive GBS diseases [9] . The well-defined risk factors for invasive GBS disease include elderly age and components of the metabolic syndrome; obesity and diabetes [10][11][12] . In addition, both diabetes mellitus and obesity were also shown to be independently associated with higher rates of group B streptococcal colonization [15] .…”

“…Patients with NAFLD might be particularly susceptible to severe disease as they carry a particular combination of previously mentioned risk factors. Firstly, the presence of type-2 diabetes confers susceptibility to infection and incidence of invasive GBS infections is even more increased among patients with poor glycaemic control [10][11][12] . Secondly, considering a high prevalence of cardiovascular disease, patients with NAFLD may show a decreased cardiac reserve that might be associated with increased mortality.…”

“…There is a plethora of studies which attempted to characterize the adults most susceptible to invasive GBS infection. While obesity and diabetes are most common underlying conditions associated with substantially increased risk of infection and mortality [10][11][12] , the role of NAFLD with GBS invasive disease outcomes has not been investigated.…”

Group B Streptococcus ( Streptococcus agalactiae )

“…However, rising levels of GBS resistance to clindamycin, erythromycin, and fluoroquinolones have been noted in a multitude of studies and these antibiotics should only be used for treatment if a penicillin or cephalosporin is not appropriate and susceptibility of the organism has been determined (162–166). Resistance to vancomycin in clinical isolates has been reported (167).…”

Recurrent Group B Streptococcus Septicemia Secondary to Portal Hypertensive Colopathy

“…We performed a review of the literature regarding risk factors pertaining to this presentation, by key word searching “group B streptococcus” in Scopus, CINAHL, Embase, and PubMed. The findings of the retrieved studies are presented in Table 2 1–28 . Group B streptococcal infections (GBSs) in nonpregnant adults have become an increasingly recognized entity.…”