Lin F Y, Brenner R A, Johnson Y R, Azimi P H, Philips J B, Regan J A, Clark P, Weisman L E, Rhoads G G, Kong F, Clemens J D
National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-7510, USA.
Am J Obstet Gynecol. 2001 May;184(6):1204-10. doi: 10.1067/mob.2001.113875.
Our purpose was to evaluate the effectiveness of a risk-based intrapartum antibiotic prophylaxis strategy for the prevention of early-onset neonatal group B streptococcal disease.
Cases and controls were selected from infants born to women with one or more risk factors: preterm labor or rupture of membranes, prolonged rupture of membranes (>18 hours), fever during labor, or previous child with group B streptococcal disease. Cases were matched with controls by birth hospital and gestational age. Data abstracted from medical records were analyzed to estimate the effectiveness of intrapartum antibiotic prophylaxis.
We analyzed data from 109 cases and 207 controls. Nineteen (17%) case versus 69 (33%) control mothers received an acceptable regimen of intrapartum antibiotic prophylaxis. In adjusted analyses, the effectiveness of intrapartum antibiotic prophylaxis was 86% (95% confidence interval, 66%-94%). When the first dose of antibiotics was given > or =2 hours before delivery, the effectiveness increased to 89% (95% confidence interval, 70%-96%); when it was given within 2 hours of delivery, the effectiveness was 71% (95% confidence interval, -8%-92%). Effectiveness was lowest in mothers with intrapartum fever (72%, 95% confidence interval, -9%-93%). On the basis of a 70% prevalence of maternal risk factors expected among cases in the absence of intrapartum antibiotic prophylaxis, we estimate that the risk-based strategy could reduce early-onset group B streptococcal disease by 60%.
The risk-based approach to intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease. To achieve the maximum preventive effect, the first dose of antibiotics should be administered at least 2 hours before delivery.
我们的目的是评估基于风险的产时抗生素预防策略预防早发型新生儿B族链球菌病的有效性。
病例和对照选自有一个或多个风险因素的产妇所生婴儿：早产或胎膜破裂、胎膜破裂时间延长（>18小时）、产时发热或既往有B族链球菌病患儿。病例与对照按出生医院和胎龄进行匹配。对从病历中提取的数据进行分析，以评估产时抗生素预防的有效性。
我们分析了109例病例和207例对照的数据。19例（17%）病例母亲与69例（33%）对照母亲接受了可接受的产时抗生素预防方案。在调整分析中，产时抗生素预防的有效性为86%（95%置信区间，66%-94%）。当在分娩前≥2小时给予首剂抗生素时，有效性增至89%（95%置信区间，70%-96%）；当在分娩后2小时内给予时，有效性为71%（95%置信区间，-8%-92%）。产时发热的母亲中有效性最低（72%，95%置信区间，-9%-93%）。根据在无产时抗生素预防情况下病例中预计的70%的母亲风险因素患病率，我们估计基于风险的策略可将早发型B族链球菌病减少6……此处原文有误，应为60%。
基于风险的产时抗生素预防方法在预防早发型B族链球菌病方面是有效的。为实现最大预防效果，首剂抗生素应在分娩前至少2小时给药。
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