Illuzzi Jessica L, Bracken Michael B
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Obstet Gynecol. 2006 Nov;108(5):1254-65. doi: 10.1097/01.AOG.0000241539.86451.11.
To examine published evidence regarding duration of intrapartum antibiotic prophylaxis administered to pregnant women colonized with group B Streptococcus (GBS) to reduce infant colonization with GBS and to prevent early-onset GBS sepsis.
A search was conducted in The Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to January 2006), EMBASE (1980 to January 2006), CINAHL (1982 to January 2006), and in protocols and guidelines of the Centers for Disease Control and Prevention, American Academy of Pediatrics, and American College of Obstetrics and Gynecology.
All randomized controlled trials and observational studies in which duration of intrapartum antibiotic prophylaxis is reported relative to subsequent neonatal GBS colonization or sepsis were considered. Case series and study designs using historical cohorts or controls for comparison were excluded.
TABULATION, INTEGRATION, AND RESULTS: Three prospective cohort studies and one case-control study met inclusion criteria. Heterogeneity of study design and assembly of cohorts precluded meta-analysis. A systematic review of the individual studies was performed. All studies were rated as fair or poor validity with regard to their ability to evaluate duration of intrapartum prophylaxis and transmission of GBS to the newborn. All 4 studies were largely composed of women with existing risk factors for GBS disease of the newborn. One study supported more than 1 hour of prophylaxis, two studies supported more than 2 hours of prophylaxis, and one was inconclusive.
Despite unequivocal clinical guidelines recommending at least 4 hours of intrapartum antibiotic prophylaxis, there are no well-designed studies examining duration of intrapartum antibiotic prophylaxis for prevention of early-onset GBS disease of the newborn. We recommend continuing to initiate intrapartum prophylaxis according to the American College of Obstetricians and Gynecologists guidelines; however, the transmission of GBS to neonates exposed to less than 4 hours of intrapartum prophylaxis and their subsequent management require further study.
审查已发表的关于对携带B族链球菌（GBS）的孕妇进行产时抗生素预防的持续时间的证据，以减少婴儿GBS定植并预防早发性GBS败血症。
检索了Cochrane对照试验中央注册库（Cochrane图书馆，2006年第1期）、MEDLINE（1966年至2006年1月）、EMBASE（1980年至2006年1月）、CINAHL（1982年至2006年1月），以及疾病控制和预防中心、美国儿科学会和美国妇产科医师学会的方案和指南。
纳入所有报告了产时抗生素预防持续时间与随后新生儿GBS定植或败血症相关的随机对照试验和观察性研究。排除病例系列以及使用历史队列或对照进行比较的研究设计。
制表、整合与结果：三项前瞻性队列研究和一项病例对照研究符合纳入标准。研究设计和队列组成的异质性妨碍了荟萃分析。对各项研究进行了系统评价。就评估产时预防持续时间和GBS传播给新生儿的能力而言，所有研究的有效性均被评为一般或较差。所有4项研究主要由具有新生儿GBS疾病现有危险因素的女性组成。一项研究支持预防超过1小时，两项研究支持预防超过2小时，一项研究结果不明确。
尽管明确的临床指南推荐产时抗生素预防至少4小时，但尚无设计良好的研究来检验产时抗生素预防持续时间对预防新生儿早发性GBS疾病的作用。我们建议继续按照美国妇产科医师学会的指南开始产时预防；然而，对于产时预防少于4小时的新生儿中GBS的传播及其后续管理，仍需要进一步研究。
