孕晚期B族链球菌筛查对预防新生儿早发型感染的效果

Screening of group B streptococcus in late pregnancy for the prevention of neonatal early-onset infection

目的探讨孕晚期孕妇B族链球菌(GBS)筛查及分娩期预防性应用抗生素(IAP)对预防新生儿早发型GBS(EOGBS)感染的效果。方法选取2013年3月至2019年10月在浙江大学医学院附属杭州市第一人民医院住院并分娩的33327例孕妇。根据医院开展GBS筛查的时机,分为未筛查期(2013年3月至2016年6月)孕妇17142例,筛查期(2016年7月至2019年10月)孕妇16185例。其中14641例筛查期孕妇在孕35~37周行GBS显色培养法筛查,并分析菌株耐药情况;另1544例孕28周后因早产或由外院转入而尚未行GBS筛查的孕妇,应用real-time PCR法筛查GBS定植情况。对GBS筛查阳性的孕妇在其临产后或胎膜破裂时给予IAP,比较开展筛查前后新生儿EOGBS感染的发生情况。结果14641例孕妇在孕35~37周行GBS显色培养法筛查,GBS定植率为10.6%;另1544例孕妇应用real-time PCR法筛查,GBS定植率为12.4%;两种方法筛查GBS的定植率比较差异有统计学意义(P=0.027)。1552株GBS药敏结果显示,青霉素、氨苄青霉素、万古霉素、利奈唑胺、替加环素敏感率均为100.0%;其余抗生素的敏感率由高到低依次是喹奴普汀/达福普汀99.4%、呋喃妥因84.3%、莫西沙星66.2%、左旋氧氟沙星65.5%、环丙沙星63.1%、克林霉素55.2%、四环素24.6%和阿奇霉素0.3%。开展GBS筛查前后新生儿EOGBS感染发生率分别为0.23‰(4/17311)和0.06‰(1/16329),两者比较差异无统计学意义(P=0.407)。结论新生儿EOGBS感染发生率较低,各地区可根据当地医疗条件和卫生经济学因素制定相应预防策略。

Objective To investigate the effects of group B streptococcus(GBS)screening in late pregnancy and intrapartum antibiotic prophylaxis(IAP)on neonatal early-onset GBS(EOGBS)infections.Methods A retrospective study was conducted to analyze the clinical data of 33327 pregnant women who were hospitalized and delivered in Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine.There were 17142 cases who were not screened for GBS(admitted during March 2013 to June 2016)and 16185 cases who were screened(admitted during July 2016 to October 2019).The low vaginal-rectal samples were tested for GBS in all 16185 cases,of whom 14641 cases were screened for GBS colonization rate by direct culture on chromogenic media in 35-37 weeks of gestation,then the isolated GBS was subjected to antimicrobial susceptibility testing.And 1544 cases underwent GBS DNA test by real-time fluorescent quantitative polymerase chain reaction after 28 weeks of gestation because of preterm birth or transfer from other hospitals without GBS screening.All GBS screening positive pregnant women were given IAP during labor or after rupture of membranes,and the incidence rates of neonatal EOGBS were compared between the unscreened group and the screening group.Results In the screening group,the positive rate of GBS was 10.6%(1552/14641)by colorimetric method,and 12.4%(192/1544)by real-time PCR assay(P=0.027).All GBS isolates(100.0%)were sensitive to penicillin,ampicillin,vancomycin,linezolid and tigecycline,while the sensitive rates to quinupristin/dalfopristin,nitrofurantoin,moxifloxacin,levofloxacin,ciprofloxacin,clindamycin,tetracycline and azithromycin were 99.4%,84.3%,66.2%,65.5%,63.1%,55.2%,24.6%and 0.3%,respectively.The incidence of neonatal EOGBS in the unscreened and screening groups was 0.23‰(4/17311)and 0.06‰(1/16329),respectively(P=0.407).Conclusion The incidence rate of neonatal EOGBS is low,and the corresponding prevention strategy should be adapted based on local socioeconomic factors.