广州地区低龄婴儿侵袭性B族链球菌的发病率及临床特征

Incidence and clinical characteristics of invasive group B streptococcal disease of young infants in Guangzhou

目的调查广州地区3个月内低龄婴儿侵袭性B族链球菌（GBS）感染的发病率及其临床特征，以评估本地区采取预防措施的必要性。方法以2011年1月至2014年12月在广州市妇女儿童医疗中心总出生活产儿为基础队列，无菌部位GBS培养阳性的低龄婴儿（0—89d）为研究对象，通过病案系统逐个查阅病历，填写统一的信息采集表后进行相关统计分析；根据发病时间，将病例分为早发型感染（出生0～6d）和晚发型感染（出生7～89d）。结果研究期间共62928例活产儿，确定GBS感染32例；其中早发型感染20例，晚发型感染12例。早发型感染以败血症并肺炎（7例）、败血症并脑膜炎（6例）为主，以气促、呻吟、发绀（13例）及发热（6例）为主要症状，其中12例围生期伴一个或以上的高危因素；晚发型感染以败血症（6例）、败血症并脑膜炎（5例）为主，10例以发热为首发表现，其中4例伴神经系统症状。32株侵袭性GBS对青霉素、万古霉素和利奈唑胺100％敏感，24株（75．0％）对红霉素耐药，14株（43．8％）对克林霉素耐药，且耐药率呈逐年上升趋势。早发型感染死亡3例，病死率为15．0％，平均住院时间为15d（1～42d），1例（5．9％）运动发育落后；晚发型感染无死亡病例，病死率为0，平均住院时间为31d（7—133d），1例（8．3％）听力受损。结论研究期间广州市3个月内婴儿侵袭性GBS感染的发病率明显高于亚洲平均水平，且早发型感染呈逐年上升趋势，应及时采取相关的预防措施，对围生期有高危因素者及早经验性用药，并行病原学检查，以减少并发症，降低病死率。

Objective To investigate the incidence and clinical features of invasive group B streptococcus （GBS） infection of young infants less than 3 months old in Guangzhou in order to evaluate the importance of preventive measures. Methods All infants born in Guangzhou Women and Children＇s Medical Center from January 2011 to De- cember 2014 formed the baseline population,while infants aged 0 -89 days from whom an isolate was derived from nor- mally sterile body site with any signs of clinical disease were included in this study. Through database searches,informa- tion of identified patients were reviewed and patients＇ data were recorded on a standardized data collection form. The da- ta were used for statistical analysis. Patients were divided into early -onset disease （EOD） （0 -6 days） and late -on- set disease （LOD） （7 - 89 days） according to their first positive culture occurrence time. Results Among the 62 928 alive - births, 32 cases of GBS infection were confirmed. There were 20 cases of early - onset infection, 12 cases of late -onset. Among infants with EOD ,7 cases were diagnosed as sepsis complicated with pneumonia,6 cases were com- plicated with meningitis, respiratory syndrome （ 13 cases）, fever （6 cases） and at least one of perinatal risk factors （ 12 cases） were recorded. In late -onset cases,6 cases manifested as sepsis,5 cases as sepsis associated with meningitis, 10 cases with fever as the initial manifestation and 4 cases accompanied by neurological symptoms. All invasive GBS strains were susceptible to Penicillin, Vancomycin and Linezolid; 24 isolates （75.0%） were resistant to Erythromycin and 14 （43.8%）resistant to Clindamycin, and the resistance of isolates to both drugs were increased year by year. Three cases died of early -onset infection, and the case fatality was 15.0% ,which was much higher than that of LOD （0）. The average hospital stay was 15 days （1 -42 days） and 31 days （7 - 133 days） ,respectively. There was 1 case （5.9%） of EOD that had the sequelae of nervous system, and 1 case （8.3%）of LOD had hearing impairment. Conclusions The incidence of invasive GBS among young infants less than 3 months old in Guangzhou is apparently higher than most Asian countries. Clinical attention should be paid to the perinatal risk factors, and early diagnosis and treatment with sensitive antibiotics is essential and effective.