Greenspoon J S, Rosen D J, Sumen A P
Department of Obstetrics and Gynecology Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Infect Dis Obstet Gynecol. 1994;1(5):210-5. doi: 10.1155/S1064744994000116.
The aim of this study was to evaluate the effect of a voluntary protocol for selective intrapartum chemoprophylaxis on the incidence of early onset group B streptococcal sepsis (GBS EOS).
Cases of GBS EOS were defined as a positive GBS culture from a normally sterile fluid obtained during the first 7 days of life. All cases of GBS EOS at an urban, university-affiliated community hospital were reviewed during 2 time periods. The 2-year period before instituting a resident education program to promote selective chemoprophylaxis (1988-89) was retrospectively reviewed; the 2-year period after the education program was introduced (1990-91) was prospectively recorded. The outcome measure was the incidence of GBS EOS.
The rate of GBS EOS was 7/14,335 deliveries (0.05%) before and 9/13,999 (0.064%) after the introduction of the education program (observed difference between proportions 0.016%, 95% confidence interval [CI] for the difference between the proportions -0.071% to 0.04%, P = not significant [NS]). The rate of GBS EOS in preterm infants was 5/1,331 (0.376%) before and 3/1,297 (0.23%) afterward (observed difference between proportions 0.14%, 95% CI -0.28% to 0.56%, P = NS). The incidence of GBS EOS did not decrease during the latter period due to failure of antepartum cultures to predict intrapartum GBS colonization (2 cases); non-compliance with voluntary recommendations to administer chemoprophylaxis (2 cases); failure of chemoprophylaxis or therapy for intraamniotic infection to prevent neonatal infection (3 cases); and occurrence of GBS EOS in infants without risk factors (2 cases).
An education program for resident physicians regarding chemoprophylaxis for GBS EOS did not significantly reduce the absolute incidence of disease. Alternative strategies are needed that redress the causes of failure inherent in the current guidelines. Some cases of GBS EOS are not preventable because the parturient does not have risk factors that indicate chemoprophylaxis.
本研究旨在评估一项选择性产时化学预防自愿方案对早发型B族链球菌败血症（GBS EOS）发病率的影响。
GBS EOS病例定义为出生后7天内从正常无菌体液中培养出GBS阳性。在两个时间段对一家城市大学附属医院的所有GBS EOS病例进行了回顾。回顾了实施住院医师教育计划以促进选择性化学预防之前的两年（1988 - 1989年）；前瞻性记录了引入教育计划后的两年（1990 - 1991年）。观察指标为GBS EOS的发病率。
实施教育计划前GBS EOS发生率为7/14335例分娩（0.05%），实施后为9/13999例（0.064%）（比例间观察差异为0.016%，比例差异的95%置信区间[CI]为 - 0.071%至0.04%，P = 无显著性差异[NS]）。早产儿GBS EOS发生率之前为5/1331例（0.376%），之后为3/1297例（0.23%）（比例间观察差异为0.14%，95% CI为 - 0.28%至0.56%，P = NS）。后期GBS EOS发病率未降低，原因包括产前培养未能预测产时GBS定植（2例）；未遵守化学预防的自愿建议（2例）；化学预防或羊膜内感染治疗未能预防新生儿感染（3例）；以及无危险因素婴儿发生GBS EOS（2例）。
针对住院医师的GBS EOS化学预防教育计划并未显著降低该病的绝对发病率。需要采取替代策略来纠正当前指南中固有的失败原因。部分GBS EOS病例无法预防，因为产妇没有提示化学预防的危险因素。
