Benitz W E, Gould J B, Druzin M L
Department of Pediatrics, Stanford University, School of Medicine, Stanford, California 94305, USA.
Pediatrics. 1999 Jun;103(6):e77. doi: 10.1542/peds.103.6.e77.
To identify and to establish the prevalence of ORs factors associated with increased risk for early-onset group B streptococcal (EOGBS) infection in neonates. streptococcal (EOGBS) infection in neonates.
Literature review and reanalysis of published data.
Risk factors for EOGBS infection include group B streptococcal (GBS)-positive vaginal culture at delivery (OR: 204), GBS-positive rectovaginal culture at 28 (OR: 9.64) or 36 weeks gestation (OR: 26. 7), vaginal Strep B OIA test positive at delivery (OR: 15.4), birth weight </= 2500 g (OR: 7.37), gestation <37 weeks (OR: 4.83), gestation <28 weeks (OR: 21.7), prolonged rupture of membranes (PROM) >18 hours (OR: 7.28), intrapartum fever >37.5 degrees C (OR: 4.05), intrapartum fever, PROM, or prematurity (OR: 9.74), intrapartum fever or PROM at term (OR: 11.5), chorioamnionitis (OR: 6.43). Chorioamnionitis is reported in most (88%) cases in which neonatal infection occurred despite intrapartum maternal antibiotic therapy. ORs could not be estimated for maternal GBS bacteriuria during pregnancy, with preterm premature rupture of membranes, or with a sibling or twin with invasive GBS disease, but these findings seem to be associated with a very high risk. Multiple gestation is not an independent risk factor for GBS infection.
h Mothers with GBS bacteriuria during pregnancy, with another child with GBS disease, or with chorioamnionitis should receive empirical intrapartum antibiotic treatment. Their infants should have complete diagnostic evaluations and receive empirical treatment until infection is excluded by observation and negative cultures because of their particularly high risk for EOGBS infection. Either screening with cultures at 28 weeks gestation or identification of clinical risk factors, ie, PROM, intrapartum fever, or prematurity, may identify parturients whose infants include 65% of those with EOGBS infection. Intrapartum screening using the Strep B OIA rapid test identifies more at-risk infants (75%) than any other method. These risk identifiers may permit judicious selection of patients for prophylactic interventions.
确定并明确与新生儿早发型B族链球菌（EOGBS）感染风险增加相关的危险因素。
文献综述及对已发表数据的重新分析。
EOGBS感染的危险因素包括分娩时B族链球菌（GBS）阴道培养阳性（比值比：204）、孕28周（比值比：9.64）或36周时GBS直肠阴道培养阳性（比值比：26.7）、分娩时阴道B族链球菌OIA检测阳性（比值比：15.4）、出生体重≤2500g（比值比：7.37）、孕周<37周（比值比：4.83）、孕周<28周（比值比：21.7）、胎膜早破（PROM）>18小时（比值比：7.28）、产时发热>37.5℃（比值比：4.05）、产时发热、PROM或早产（比值比：9.74）、足月时产时发热或PROM（比值比：11.5）、绒毛膜羊膜炎（比值比：6.43）。在大多数（88%）尽管产时进行了母体抗生素治疗仍发生新生儿感染的病例中报告有绒毛膜羊膜炎。对于孕期母体GBS菌尿、伴有早产胎膜早破或有患侵袭性GBS疾病的同胞或双胞胎的情况，无法估计比值比，但这些发现似乎与极高风险相关。多胎妊娠不是GBS感染的独立危险因素。
孕期有GBS菌尿、有另一个患GBS疾病的孩子或有绒毛膜羊膜炎的母亲应在产时接受经验性抗生素治疗。由于其婴儿发生EOGBS感染的风险特别高，他们的婴儿应进行全面的诊断评估并接受经验性治疗，直至通过观察和阴性培养排除感染。孕28周时进行培养筛查或识别临床危险因素，即PROM、产时发热或早产，可识别出其婴儿占EOGBS感染婴儿65%的产妇。使用B族链球菌OIA快速检测进行产时筛查比其他任何方法能识别出更多有风险的婴儿（75%）。这些风险识别指标可允许明智地选择患者进行预防性干预。
