Do we treat Group B Streptococcus (GBS) in urine in non-pregnant patients?

Treatment of Group B Streptococcus in Urine for Non-Pregnant Patients

Non-pregnant patients with Group B Streptococcus (GBS) in urine should be treated according to standard urinary tract infection protocols only if they are symptomatic or have underlying urinary tract abnormalities. 1, 2

Understanding GBS in Non-Pregnant Patients

GBS is primarily recognized as a pathogen of concern in pregnant women and neonates, but it can also cause significant infections in non-pregnant adults, particularly those with underlying conditions:

• GBS accounts for approximately 2% of positive urine cultures in non-pregnant adults 1
• In non-pregnant adults, GBS urinary tract infections are more common in:
  • Patients with urinary tract abnormalities (60% of cases) 1
  • Those with chronic renal failure (27% of cases) 1
  • Elderly individuals 3
  • Patients with underlying conditions such as liver disease, malignancies, and diabetes mellitus 4

Treatment Approach for Non-Pregnant Patients

Unlike in pregnant women, where any concentration of GBS bacteriuria requires treatment regardless of symptoms 5, the approach for non-pregnant adults differs:

• Symptomatic patients: Treat according to standard UTI protocols 1, 2
• Asymptomatic patients: Treatment is generally indicated only if:
  • Patient has significant urinary tract abnormalities 1
  • Patient has other risk factors such as immunocompromise or chronic renal failure 1, 3

Antibiotic Selection

When treatment is indicated for non-pregnant patients with GBS in urine:

• First-line treatment: Ampicillin is typically effective and has been shown to be successful when administered orally 2
• Alternative options: Most GBS isolates are susceptible to penicillin, cephalosporins, and vancomycin 4
• Caution with macrolides: Resistance to erythromycin has been reported and has increased over time (from 8% to 18% in one study), so macrolides should not be used empirically in penicillin-allergic patients 4

Clinical Considerations

• GBS in urine may signal the need for screening for urinary tract abnormalities in non-pregnant adults 1
• The presence of GBS in urine can be associated with poor outcomes in 18% of episodes despite treatment 1
• For patients with recurrent GBS UTIs, evaluation for structural abnormalities is warranted 1, 2

Common Pitfalls to Avoid

• Do not apply pregnancy protocols to non-pregnant patients: The CDC guidelines for universal treatment of any concentration of GBS in urine apply specifically to pregnant women to prevent neonatal disease 5
• Do not ignore GBS in urine: While asymptomatic bacteriuria may not always require treatment in non-pregnant patients, it should prompt consideration of underlying urinary tract abnormalities 1
• Do not use macrolides empirically: Due to increasing resistance patterns, macrolides should be avoided unless susceptibility testing confirms effectiveness 4