RISK-FACTORS FOR GROUP-B STREPTOCOCCAL DISEASE IN ADULTS

Objective: To determine risk factors for community-acquired and nosoco mial group B streptococcal disease in adults. Design: Case-control stu dy. Setting: 3 metropolitan areas in the United States with an aggrega te population of 6.6 million persons. Patients: 219 nonpregnant adults with invasive group B streptococcal infection identified by a populat ion-based surveillance in 1991 and 1992 and 645 hospital-matched contr ols. Results: The following conditions were associated with a signific antly increased risk for community-acquired group B streptococcal infe ction after controlling for age in multivariate analysis: cirrhosis (o dds ratio, 9.7 [95% CI, 3.5 to 26.9]; P <0.001), diabetes (odds ratio, 3.0 [CI, 1.9 to 4.7]; P <0.001), stroke (odds ratio, 3.5 [CI, 1.9 to 6.4]; P <0.001), breast cancer (odds ratio, 4.0 [CI, 1.6 to 9.8]; P =0 .002), decubitus ulcer (odds ratio, 4.0 [CI, 1.6 to 9.8]; P =0.002), a nd neurogenic bladder (odds ratio, 4.6 [CI, 1.4 to 15.1]; P =0.01). Si xty-three percent of community case-patients had at least one of these conditions. Nosocomial infection (48 cases [22%]) was independently a ssociated with the placement of a central venous line (odds ratio, 30. 9 [CI, 5.2 to 184.1]; P <0.001), diabetes, congestive heart failure, a nd seizure disorder. Conclusions: Several chronic conditions were inde pendently associated with group B streptococcal disease, and most case -patients had at least one of these conditions. If group B streptococc al vaccines being developed for prevention of neonatal disease are pro tective in adults, a vaccination strategy targeting those at highest r isk has the potential to substantially reduce the burden of invasive g roup B streptococcal infection in adults.