新生儿B族链球菌感染现状的多中心前瞻性研究

Current status of group B Streptococcus infection in neonates: a multicenter prospective study

摘要:

目的 了解孕妇B族链球菌（group B Streptococcus，GBS）定植及新生儿早发型GBS疾病（early-onset GBS disease，GBS-EOD）的发生情况，并探讨GBS定植孕妇的子代发生GBS-EOD的影响因素。 方法 前瞻性纳入2019年5月1日至2020年4月30日在厦门市妇幼保健院、首都医科大学附属北京妇产医院和漳州正兴医院建档的16 384例孕妇及其分娩的16 634例新生儿作为研究对象。各研究中心采用统一的GBS筛查时间、培养方法和产时抗生素预防（intrapartum antibiotic prophylaxis，IAP）适应证，调查孕妇GBS定植率和新生儿GBS-EOD发生率，并应用多因素logistic回归分析评估GBS定植孕妇的子代发生GBS-EOD的影响因素。 结果 3所医院妊娠晚期孕妇GBS培养阳性率为11.29%（1 850/16 384），新生儿GBS-EOD发生率为0.96‰（16/16 634）。GBS阳性组孕妇分娩活产儿收住院率高于GBS阴性组（P<0.05）。GBS阳性组孕妇分娩活产儿的GBS-EOD发生率［6.38‰（12/1 881）］高于GBS阴性组［0.27‰（4/14 725）］（P<0.05）。多因素logistic回归分析显示，胎盘拭子培养GBS阳性和新生儿出生时胃液培养GBS阳性是GBS定植孕妇子代发生GBS-EOD的独立预测因素（P<0.05），而充分IAP为保护因素（P<0.05）。 结论 孕妇妊娠晚期GBS定植对其子代有不良影响。明确孕妇产前GBS定植状态，并依据IAP适应证给予充分IAP是减少其子代发生GBS-EOD的重要措施。 引用格式:

Abstract:

Objective To investigate the incidence of maternal group B Streptococcus (GBS) colonization and neonatal early-onset GBS disease (GBS-EOD), and to study the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization. Methods A total of 16 384 pregnant women and 16 634 neonates delivered by them were enrolled prospectively who had medical records in Xiamen Maternal and Child Care Hospital, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, and Zhangzhou Zhengxing Hospital from May 1, 2019 to April 30, 2020. Unified GBS screening time, culture method, and indication for intrapartum antibiotic prophylaxis (IAP) were adopted in the three hospitals. The incidence rates of maternal GBS colonization and neonatal GBS-EOD were investigated. A multivariate logistic regression analysis was used to identify the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization. Results In these three hospitals, the positive rate of GBS culture among the pregnant women in late pregnancy was 11.29% (1 850/16 384), and the incidence rate of neonatal GBS-EOD was 0.96‰ (16/16 634). The admission rate of live infants born to the GBS-positive pregnant women was higher than that of those born to the GBS-negative ones (P<0.05). The live infants born to the GBS-positive pregnant women had a higher incidence rate of GBS-EOD than those born to the GBS-negative ones [6.38‰ (12/1 881) vs 0.27‰ (4/14 725), P<0.05]. The multivariate logistic regression analysis showed that placental swabs positive for GBS and positive GBS in neonatal gastric juice at birth were independent predictive factors for the development of GBS-EOD (P<0.05), while adequate IAP was a protective factor (P<0.05) in the offspring of pregnant women with GBS colonization. Conclusions GBS colonization of pregnant women in late pregnancy has adverse effects on their offspring. It is important to determine prenatal GBS colonization status of pregnant women and administer with adequate IAP based on the indications of IAP to reduce the incidence of neonatal GBS-EOD. Citation: