Background: Group B Streptococcus [GBS] is a bacterium which transiently colonises the genital tract and can be transmitted from mother to baby at birth. Babies colonised with GBS can develop early-onset group B strep...Background: Group B Streptococcus [GBS] is a bacterium which transiently colonises the genital tract and can be transmitted from mother to baby at birth. Babies colonised with GBS can develop early-onset group B streptococcus disease [EOGBSD] which can lead to extended hospital stay, disability and death. One of the primary methods for determining which women are most likely to be GBS positive at the time of birth is antenatal universal culture-based screening. Recently Polymerase Chain Reaction [PCR] screening has emerged as a point-of-care method for screening women during the intrapartum period. This study will compare the diagnostic accuracy of this new technology and antenatal culture-based screening at 35 to 37 weeks gestational age, with the reference standard of formal culture-based testing in labour. Methods: This prospective observational study will take place in an Australian hospital. Consecutive women with one or more live fetuses, intending to have a vaginal birth will be asked to participate. Planned screening for GBS colonisation using microbiological culture on a self-collected specimen will occur at 35 to 37 completed weeks gestational age as per our usual hospital policy. A PCR GBS test by Xpert GBS (Cepheid) will be performed on admission to labour ward or at the time of rupture of membranes. The reference standard will be a formal GBS culture on a combined lower vaginal and perianal swab. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios will be estimated for both antenatal screening and the intrapartum Xpert GBS (Cepheid) point-of-care test and compared to the reference standard. Results: It is expected that the study will be completed by mid to late 2020. Conclusion: This study has the potential to improve the accuracy of GBS screening of pregnant women and therefore health outcomes for mothers and babies. There is also the potential for a cost savings to the health system.展开更多
目的:探讨新生儿B族链球菌(group B Streptococcus,GBS)败血症的临床特征及药物敏感情况,为临床诊治提供理论依据。方法:选取2010年1月—2020年12月在汕头大学医学院第一附属医院诊断为新生儿GBS败血症的40例患儿作为研究对象,根据发病...目的:探讨新生儿B族链球菌(group B Streptococcus,GBS)败血症的临床特征及药物敏感情况,为临床诊治提供理论依据。方法:选取2010年1月—2020年12月在汕头大学医学院第一附属医院诊断为新生儿GBS败血症的40例患儿作为研究对象,根据发病时间分为早发型(29例)和晚发型(11例),对患儿的临床资料进行回顾性分析。结果:早发型患儿呼吸道感染(62.07%)、弥散性血管内凝血(44.83%)、肌酸激酶同工酶升高(41.38%)、低钙血症(37.93%)、呼吸衰竭(34.48%)、肌酐升高(34.48%)、颅内出血(31.03%)发生率均高于晚发型患儿(P<0.05)。晚发型患儿发热(63.64%)、颅内感染(54.55%)发生率均高于早发型患儿(P<0.05)。药物敏感试验结果显示,GBS对阿奇霉素、克林霉素、四环素、米诺环素的耐药性高,而对青霉素、万古霉素、阿莫西林、利奈唑胺的敏感性高。结论:早发型新生儿GBS败血症临床主要表现为呼吸道感染,晚发型则主要表现为发热和颅内感染。GBS对青霉素、阿莫西林、万古霉素等抗菌药物的敏感性高。展开更多
目的探讨新生儿B族链球菌(group B streptococcus,GBS)败血症的临床特点、治疗及预后。方法回顾性分析本院2014年1月至2019年7月NICU收治的16例GBS败血症患儿的临床资料,分析围产期特点、临床表现、实验室检查、并发症及预后等。结果新...目的探讨新生儿B族链球菌(group B streptococcus,GBS)败血症的临床特点、治疗及预后。方法回顾性分析本院2014年1月至2019年7月NICU收治的16例GBS败血症患儿的临床资料,分析围产期特点、临床表现、实验室检查、并发症及预后等。结果新生儿科共收治新生儿7506例,确诊新生儿GBS败血症患儿16例,新生儿GBS败血症发生率为2.13‰(16/7506)。其中早发型GBS感染14例,发生率为1.87‰(14/7506),晚发型GBS感染2例,发生率为0.27‰(2/7506)。感染患儿中,7例孕母发生胎膜早破,2例孕母发生羊水Ⅲ度污染,4例孕母存在妊娠期糖尿病,1例孕母分娩前发热1例;2例迟发型GBS败血症患儿均为足月新生儿,14例早发型GBS败血症患儿发病时间均为出生后24 h内。临床症状主要为呼吸系统症状,其中6例患儿存在气促、呻吟,机体表现为反应差。2例迟发型GBS败血症患儿的发病时间为出生后第3周,临床症状主要为高热,并伴气促、拒奶、黄疸等症状。平均白细胞(14.57±6.18)×10^(9)/L,其中>20×10^(9)/L为3例,2例降低,平均C反应蛋白(33.24±13.17)mg/L,最高116.5 mg/L,4例正常。15例患儿有不同程度的代谢性酸中毒,1例患儿失代偿性代酸并呼吸性碱中毒。16例均在入院24 h内完善胸部X线检查,9例为重症肺炎表现;所有患儿在血培养结果出来后均使用大剂量青霉素,并根据患儿病情更换为头孢哌酮/舒巴坦治疗,其中5例给予丙种球蛋白支持治疗,3例患儿需呼吸机辅助呼吸,2例因病情危重转入上级医院继续治疗。其余6例患儿均临床治愈出院,8例好转出院。结论新生儿GBS感染的风险高,临床症状不典型,预后差,建议临床医生对35~37周孕产妇开展GBS筛查,制定针对性的预防策略,以降低新生儿GBS的感染率,改善预后。展开更多
目的探讨新生儿B族链球菌(group B Streptococcu,GBS)所致败血症的临床特征及易感因素。方法收集2014年6月1日-2017年6月31日在温州市人民医院阴道分娩并患有败血症的新生儿91例为研究对象,取血培养标本91例。根据血培养结果分为GBS阳...目的探讨新生儿B族链球菌(group B Streptococcu,GBS)所致败血症的临床特征及易感因素。方法收集2014年6月1日-2017年6月31日在温州市人民医院阴道分娩并患有败血症的新生儿91例为研究对象,取血培养标本91例。根据血培养结果分为GBS阳性组与非GBS组,对2组新生儿发病情况进行分析。结果 91例败血症新生儿GBS血培养阳性患者为25例,阴性66例。GBS阳性组新生儿惊厥、神经系统并发症、并发脑膜炎等临床表现方面发生率显著高于非GBS组;GBS阳性组新生儿外周血CRP>100 mg/L、白细胞计数<5×10~9/L、脑脊液白细胞>100×10~6/L高于非GBS组;GBS阳性组孕妇胎膜早破、孕期GBS感染的发生率高于非GBS组,差异均有统计学意义(P<0.05)。Logistic回归分析提示,孕妇生殖道GBS定植是新生儿GBS感染的独立危险因素(OR=34.21,95%CI:3.17~368.4,P<0.01)。结论新生儿GBS败血症并发症多,病情更加凶险,应对孕妇进行常规筛查并治疗,对孕妇有产科高危因素的新生儿应加强监测。展开更多
文摘Background: Group B Streptococcus [GBS] is a bacterium which transiently colonises the genital tract and can be transmitted from mother to baby at birth. Babies colonised with GBS can develop early-onset group B streptococcus disease [EOGBSD] which can lead to extended hospital stay, disability and death. One of the primary methods for determining which women are most likely to be GBS positive at the time of birth is antenatal universal culture-based screening. Recently Polymerase Chain Reaction [PCR] screening has emerged as a point-of-care method for screening women during the intrapartum period. This study will compare the diagnostic accuracy of this new technology and antenatal culture-based screening at 35 to 37 weeks gestational age, with the reference standard of formal culture-based testing in labour. Methods: This prospective observational study will take place in an Australian hospital. Consecutive women with one or more live fetuses, intending to have a vaginal birth will be asked to participate. Planned screening for GBS colonisation using microbiological culture on a self-collected specimen will occur at 35 to 37 completed weeks gestational age as per our usual hospital policy. A PCR GBS test by Xpert GBS (Cepheid) will be performed on admission to labour ward or at the time of rupture of membranes. The reference standard will be a formal GBS culture on a combined lower vaginal and perianal swab. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios will be estimated for both antenatal screening and the intrapartum Xpert GBS (Cepheid) point-of-care test and compared to the reference standard. Results: It is expected that the study will be completed by mid to late 2020. Conclusion: This study has the potential to improve the accuracy of GBS screening of pregnant women and therefore health outcomes for mothers and babies. There is also the potential for a cost savings to the health system.
文摘目的:探讨新生儿B族链球菌(group B Streptococcus,GBS)败血症的临床特征及药物敏感情况,为临床诊治提供理论依据。方法:选取2010年1月—2020年12月在汕头大学医学院第一附属医院诊断为新生儿GBS败血症的40例患儿作为研究对象,根据发病时间分为早发型(29例)和晚发型(11例),对患儿的临床资料进行回顾性分析。结果:早发型患儿呼吸道感染(62.07%)、弥散性血管内凝血(44.83%)、肌酸激酶同工酶升高(41.38%)、低钙血症(37.93%)、呼吸衰竭(34.48%)、肌酐升高(34.48%)、颅内出血(31.03%)发生率均高于晚发型患儿(P<0.05)。晚发型患儿发热(63.64%)、颅内感染(54.55%)发生率均高于早发型患儿(P<0.05)。药物敏感试验结果显示,GBS对阿奇霉素、克林霉素、四环素、米诺环素的耐药性高,而对青霉素、万古霉素、阿莫西林、利奈唑胺的敏感性高。结论:早发型新生儿GBS败血症临床主要表现为呼吸道感染,晚发型则主要表现为发热和颅内感染。GBS对青霉素、阿莫西林、万古霉素等抗菌药物的敏感性高。
文摘目的探讨新生儿B族链球菌(group B Streptococcu,GBS)所致败血症的临床特征及易感因素。方法收集2014年6月1日-2017年6月31日在温州市人民医院阴道分娩并患有败血症的新生儿91例为研究对象,取血培养标本91例。根据血培养结果分为GBS阳性组与非GBS组,对2组新生儿发病情况进行分析。结果 91例败血症新生儿GBS血培养阳性患者为25例,阴性66例。GBS阳性组新生儿惊厥、神经系统并发症、并发脑膜炎等临床表现方面发生率显著高于非GBS组;GBS阳性组新生儿外周血CRP>100 mg/L、白细胞计数<5×10~9/L、脑脊液白细胞>100×10~6/L高于非GBS组;GBS阳性组孕妇胎膜早破、孕期GBS感染的发生率高于非GBS组,差异均有统计学意义(P<0.05)。Logistic回归分析提示,孕妇生殖道GBS定植是新生儿GBS感染的独立危险因素(OR=34.21,95%CI:3.17~368.4,P<0.01)。结论新生儿GBS败血症并发症多,病情更加凶险,应对孕妇进行常规筛查并治疗,对孕妇有产科高危因素的新生儿应加强监测。
