Katz P F, Hibbard J U, Ranganathan D, Meadows W, Ismail M
Department of Obstetrics and Gynecology, Chicago Lying-in Hospital, University of Chicago, USA.
J Perinatol. 1999 Jul-Aug;19(5):337-42. doi: 10.1038/sj.jp.7200191.
To determine if universal Group B Streptococcus (GBS) culturing and antibiotic prophylaxis of obstetric patients decreased the incidence of neonatal early-onset GBS sepsis and mortality and maternal chorioamnionitis.
A time series observational study was conducted to compare the cohort of all obstetric patients delivering at the University of Chicago neonatal center from January 1989 through December 1993, before a GBS surveillance policy existed, with the cohort delivering January 1994 through December 1996, after initiation of a GBS policy. Included in the policy were universal GBS cultures at 28 weeks' gestation, antibiotic prophylaxis at the time of labor for all those with positive cultures and for all with risk factors of preterm delivery, preterm premature rupture of membranes, prolonged rupture of membranes greater than 18 hours, and a previous child affected by GBS or maternal fever in labor. Predictor variables were GBS culturing and antibiotic usage; outcome variables were incidence of GBS sepsis and mortality in the neonates and maternal chorioamnionitis. chi-squared and Fisher exact analyses were used with p < 0.05 being significant.
Before the GBS policy, there were 16,272 deliveries with a 2.24/1000 deliveries rate of early-onset GBS sepsis (n = 35); after initiating the GBS policy, 9130 deliveries occurred with an early-onset GBS sepsis rate of 2.29/1000 (n = 20). Early-onset GBS sepsis case fatality rates before and after initiation of the policy were 14.3% and 0%, respectively (p = 0.09). Antibiotic use almost doubled (relative risk = 1.84; confidence interval, 1.74 to 1.93, p < 0.001) over the two time periods, and the relative risk of chorioamnionitis decreased to 0.95 (confidence interval, 0.73 to 0.99, p = 0.04).
Despite universal GBS culturing and very liberal use of antibiotics in labor, we were unable to effect a statistically significant change in the rate of early-onset GBS sepsis or mortality, and there was only a slightly decreased chorioamnionitis rate.
确定对产科患者进行普遍的B族链球菌（GBS）培养及抗生素预防措施是否能降低新生儿早发型GBS败血症的发病率、死亡率以及产妇绒毛膜羊膜炎的发生率。
开展一项时间序列观察性研究，比较1989年1月至1993年12月在芝加哥大学新生儿中心分娩的所有产科患者队列（当时尚无GBS监测政策）与1994年1月至1996年12月在GBS政策实施后分娩的队列。该政策包括在妊娠28周时进行普遍的GBS培养，对所有培养结果呈阳性以及所有有早产、胎膜早破、胎膜破裂时间超过18小时、既往有受GBS感染的儿童或产妇分娩时发热等危险因素的患者在分娩时进行抗生素预防。预测变量为GBS培养和抗生素使用情况；结果变量为新生儿GBS败血症的发病率和死亡率以及产妇绒毛膜羊膜炎。采用卡方检验和Fisher精确检验，p<0.05具有统计学意义。
在GBS政策实施前，有16272例分娩，早发型GBS败血症发生率为2.24/1000次分娩（n = 35）；GBS政策实施后，有9130例分娩，早发型GBS败血症发生率为2.29/1000（n = 20）。政策实施前后早发型GBS败血症的病死率分别为14.3%和0%（p = 0.09）。在两个时间段内，抗生素使用量几乎翻倍（相对危险度 = 1.84；可信区间为1.74至1.93，p<0.001），绒毛膜羊膜炎的相对危险度降至0.95（可信区间为0.73至0.99，p = 0.04）。
尽管进行了普遍的GBS培养且在分娩时大量使用抗生素，但我们未能使早发型GBS败血症的发生率或死亡率产生具有统计学意义的变化，绒毛膜羊膜炎的发生率仅略有下降。
