engleski

Invasive group B streptococcal infections in nonpregnant adults ; a 10-year overview of hospitalized patients in a tertiary healthcare centre

Background: There is an increasing number of invasive group B streptococcal (GBS) infections reported in non-pregnant adults, particularly in elderly and those with underlying diseases. The aim of this study was to assess the clinical and microbiological features and outcomes of GBS infection in adult patients. Material/methods: A retrospective, cohort study of all non-pregnant adult patients diagnosed with invasive GBS infection was conducted at the University Hospital for Infectious Diseases Zagreb between January 2006 to December 2015. Invasive GBS disease was defined as a GBS isolated from a normally sterile site. We describe our data with frequencies and medians with first and third quartile. Results: A total of 84 adults had invasive GBS, of whom 3 (3.6%) had recurrent episodes, resulting in a total of 87 hospitalizations. The median age was 69 years (58–78) ; 43 (49.4%) patients were >70 years of age ; 44 (59.6%) were males and 6 (6.9%) were long-term care facility residents. GBS was isolated from blood cultures (85, 97.7%), urine cultures (4, 4.6%), joint fluid punctates (2, 2.3%), bacteriological swabs (2, 2.3%), and CSL (1, 1.2%). The most common presenting disease in all age groups was cellulitis/erysipelas (49, 56.3%), followed by bacteriaemia without a focus (19, 21.8%). The remaining cases had chronic skin ulcer (6, 6.9%), bone/joint infections (5, 5.8%), pneumonia (4, 4.6%), infective endocarditis (4, 4.6%), meningitis/meningoencephalitis (3, 3.5%), and urinary tract infection (1, 2.3%) ; there were 4 (4.6%) cases of two simultaneous forms (4.6%). The most common co-morbidities were diabetes (33, 37.9%), cardiovascular (29, 33.3%), peripheral vascular disease (24, 27.6%) and malignancy (24, 27.6%). On admission, the majority of patients had a 0 (34, 39.1%) or 1 (37, 42.5%) quick sepsis- related organ failure assessment score ; 69 (79.3%) had ≥2 SIRS criteria. The majority of patients were treated with penicillins (27, 31.0%), aminopenicillins (14, 16.1%) and cephalosporins (9, 10.4%) for a median duration of parenteral therapy of 13 days (8-19) and oral therapy of 7 (4-10.8) days. The median time of defervesence was 1 day (1-3) and the median duration of hospitalization was 13 days (8-19). 34 (39.1%) developed complications during hospitalization: 17 (20.0%) had a nosocomial infection, 6 (6.9%) heart failure and 2 (2.3%) renal failure. 14 (16.1%) were admitted in the ICU. The in-hospital mortality was 11.5% (10 patients: 6 with primary bacteriaemia, 2 cellulitis, 2 meningitis/meningoencephalitis). All GBS strains were susceptible to penicillin, ampicillin, ceftriaxone. Of the 27 strains analyzed, 7 (26%) showed resistance to macrolides, and out of 42 strains 3 (7%) to clindamycin. Conclusions: Our findings showed that invasive GBS disease in adults affects primarly elderly patients with significant comorbidity, particulary diabetes. Cellulitis/erysipelas was the most common clinical presentation. The mortality and morbidity of invasive GBS disease were significant.

group B streptococcal infections ; overview ; hospitalized patients ; tertiary healthcare centre

nije evidentirano