From the Research
Group B Streptococcus (GBS) urinary tract infections in non-pregnant individuals should be treated with antibiotics to prevent serious complications such as pyelonephritis, bacteremia, and sepsis. The recommended treatment is penicillin G 24 million units IV daily for 10-14 days for severe infections, or amoxicillin 500 mg orally three times daily for 3-5 days for uncomplicated cases, as supported by the study 1. For penicillin-allergic patients, alternatives include ceftriaxone 1-2 g IV daily, clindamycin 600 mg IV every 8 hours, or vancomycin 15-20 mg/kg IV every 8-12 hours.
Key Considerations
- GBS UTIs require treatment even with low colony counts (>1,000 CFU/mL) as they can lead to serious complications, including pyelonephritis, bacteremia, and sepsis 1.
- Unlike asymptomatic GBS colonization in non-pregnant individuals, GBS in urine represents true infection rather than contamination and should not be ignored.
- Treatment is important because GBS possesses virulence factors that allow it to adhere to urinary tract epithelium and evade host immune responses, potentially causing ascending infections and systemic spread if left untreated.
Antibiotic Resistance
- GBS is still recognized as being universally susceptible to beta-lactam antibiotics, but there have been reports of reduced susceptibility to beta-lactams, including penicillin, in some countries 2.
- Resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst GBS, with several countries noting increased resistance rates in recent years 2.
- Vancomycin is administered in instances where patients are allergic to penicillin and second-line antibiotics are ineffective, and while it still remains largely effective, there have been two documented cases of vancomycin resistance in GBS 2.
Clinical Implications
- The overall mortality rate for GBS bacteremia in non-pregnant adults is 33.3%, and deaths are considered related to the GBS bacteremia in 25.5% of the cases 1.
- Factors for poor prognosis include central nervous system diseases, alcoholism, shock, renal failure, and consciousness impairment 1.
- Prompt treatment with appropriate antibiotics is crucial to prevent morbidity and mortality associated with GBS UTIs in non-pregnant individuals.