超早产儿复发性B族链球菌败血症一例并文献复习

Recurrent late-onset group B Streptococcus sepsis in extremely preterm infant:a case report and literature review

目的探讨母乳在新生儿晚发型B族链球菌(group B Streptococcus,GBS)感染中的作用。方法2016年9月,香港大学深圳医院收治一例胎龄22周+6超早产儿,发生复发性晚发型GBS败血症,很可能为母乳传播。复习"母乳传播的晚发型GBS感染"相关文献,讨论母乳是否为GBS感染的传播途径。结果(1)病例资料:患儿胎龄22周^+6,母乳喂养,生后100 d发生第1次GBS败血症合并脑膜炎,母亲直肠阴道GBS筛查阴性,由于母亲无乳腺炎表现,未检测母乳。经14 d抗生素治疗,第1次GBS感染痊愈后,继续母乳喂养。生后126 d,患儿发生第2次GBS败血症。查找感染源发现母乳GBS培养阳性,药敏结果与患儿血GBS相同。经10 d抗生素治疗,患儿第2次GBS败血症痊愈,继续部分母乳喂养,未再发生GBS感染。(2)文献复习:国内数据库未检索到"母乳传播的GBS感染"相关文献。通过Pubmed检索到"母乳传播的GBS感染"患儿有64例,连本例共65例。母乳传播的GBS感染复发率很高,2次感染率为25%,3次感染率为7%。结论含GBS的母乳可能是晚发型GBS败血症的潜在感染源之一,但母乳传播GBS的机制不明,需要进一步研究。

ObjectiveTo discuss the controversial role of breast milk in late-onset group B Streptococcus(GBS)infections.MethodsThis study reported a case of recurrent late-onset GBS sepsis with the suspicion of breast milk transmission in an extremely preterm infant born at 22^+6 weeks who was treated at the University of Hong Kong-Shenzhen Hospital in September 2016.Literatures about late-onset GBS cases associated with contaminated breast milk were reviewed to investigate whether GBS could be transmitted through breast milk.Results(1)Case report:A breast-fed extremely preterm infant born at 22^+6 gestational weeks suffered from GBS sepsis along with meningitis for the first time on 100 d.The mother was negative for rectovaginal GBS screening.Breast milk wasn't tested as no signs of mastitis were found.The neonate recovered from the first GBS sepsis after 14 days of antibiotic treatment,then returned to breastfeeding.On 126 d,GBS sepsis reoccurred in this baby.Fresh breast milk culture yielded GBS which was identical with the GBS strains isolated from the neonatal blood in antimicrobial susceptibility.After recovery from the second episode,the baby was partially breastfed again without further relapses of late-onset GBS sepsis.(2)Literature review:64 cases of late-onset GBS infections that transmitted via breast milk were retrieved from PubMed,while no Chinese cases had been reported.Clinical data of the 65 cases(including this case)were reviewed and the results revealed that contaminated breast milk was associated with late-onset GBS infections.The reported relapse rate of GBS infections transmitted via breast milk was 25%for two episodes and 7%for three episodes.ConclusionsGBS contaminated breast milk could potentially cause late-onset GBS sepsis in infants and further studies are required to identify the underlying mechanisms.