title: Risk factors for group B streptococcal disease in adults.
abstract: OBJECTIVE
  To determine risk factors for community-acquired and nosocomial group B streptococcal disease in adults.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  3 metropolitan areas in the United States with an aggregate population of 6.6 million persons.
  
  
  METHODS
  219 nonpregnant adults with invasive group B streptococcal infection identified by a population-based surveillance in 1991 and 1992 and 645 hospital-matched controls.
  
  
  RESULTS
  The following conditions were associated with a significantly increased risk for community-acquired group B streptococcal infection after controlling for age in multivariate analysis: cirrhosis (odds 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 (odd ratio, 4.0 [CI, 1.6 to 9.8]; P = 0.002), and neurogenic bladder (odds ratio, 4.6 [CI, 1.4 to 15.1]; P = 0.01). Sixty-three percent of community case-patients had at least one of these conditions. Nosocomial infection (48 cases [22%]) was independently associated 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, and seizure disorder.
  
  
  CONCLUSIONS
  Several chronic conditions were independently associated with group B streptococcal disease, and most case-patients had at least one of these conditions. If group B streptococcal vaccines being developed for prevention of neonatal disease are protective in adults, a vaccination strategy targeting those at highest risk has the potential to substantially reduce the burden of invasive group B streptococcal infection in adults.
authors.affiliation: Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Jackson
authors.forename: R
authors.initials: R
authors.lastname: Hilsdon
authors.forename: M M
authors.initials: MM
authors.lastname: Farley
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: A L
authors.initials: AL
authors.lastname: Reingold
authors.forename: B D
authors.initials: BD
authors.lastname: Plikaytis
authors.forename: J D
authors.initials: JD
authors.lastname: Wenger
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000209:etiology* / Q000401:mortality; D003428:Cross Infection / Q000209:etiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013290:Streptococcal Infections / Q000209:etiology* / Q000401:mortality; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D013577:Syndrome; D014481:United States / Q000453:epidemiology