466. Elevated Risk of Invasive Group B Streptococcal Infection Among Veterans with Poorly Controlled Diabetes Mellitus or at Extremes for Body Mass Index

Abstract

BackgroundDiabetes mellitus (DM) and obesity have been identified as risk factors for invasive Group B Streptococcal (GBS) infection in non-pregnant adults. We used data from the US Veterans Health Administration (VHA) to confirm these findings and determine if poor diabetic control (elevated hemoglobin A1C (HbA1c)) or extreme weight (body mass index (BMI)) impacted risk.MethodsWe examined the VHA Corporate Data Warehouse to identify veterans active in VHA between 2008 and 2017 with invasive GBS infection according to the US Centers for Disease Control and Prevention surveillance definitions. We used International Classification of Disease (ICD) codes to determine a diagnosis of DM and stratified veterans by the highest HbA1c and first BMI in a given year. Absent HbA1c among those with DM were recorded as such. For years without BMI, the most recent BMI was carried forward.ResultsBetween 2008 and 2017, the rate of invasive GBS infection for veterans with HbA1C ≥9.5% ranged from 55 to 104 /100,000 person-years (Figure 1). Rates in the next-highest risk group (HbA1c 7.5%–9.4%) were 24 to 36/100,000 person-years. Veterans with a BMI ≥40 (extremely obese; n = 798) or ≤18.5 (underweight; n = 99) had similarly elevated rates of invasive GBS infection (26 to 37/100,000 and 15 to 33/100,000 person-years, respectively) while those with BMI of 18.5–40 ranged from 6 to 13/100,000 person-years (Figure 2). Among those with HbA1c ≥9.5%, the most common type of infection was osteomyelitis (500/1,182; 42%; Table 1). Pneumonia was most common among patients with a BMI, Table 2.ConclusionOur study confirms that DM and obesity are notable risk factors for invasive GBS infection among veterans. The risk is substantially increased in patients with poorly controlled DM and morbid obesity. The high rate of invasive GBS infections among the small proportion of underweight veterans may reflect long-standing type 1 DM or other chronic diseases. Effective interventions to reduce the burden of invasive GBS infection among veterans should target individuals with poorly controlled DM, morbid obesity and those markedly underweight. Disclosures All authors: No reported disclosures.