艾米利亚-罗马涅大区普遍开展 B 组链球菌产前筛查。

Universal antenatal screening for group B streptococcus in Emilia-Romagna.

机构信息

Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico di Modena, Via del Pozzo, 71-41100 Modena (MO), Italy.

出版信息

J Med Screen. 2011;18(2):60-4. doi: 10.1258/jms.2011.011023.

DOI:10.1258/jms.2011.011023

PMID:21852697

Abstract

BACKGROUND

Group B streptococcus (GBS) is a leading cause of severe infections in newborns. Intrapartum antibiotic chemoprophylaxis (IAP) reduces the rate of early-onset disease. The aim of this study is to determine the degree of clinicians' compliance with the suggested protocol for GBS prevention in Emilia-Romagna (Italy).

METHODS

Characteristics of each delivery were prospectively recorded in the period between October 2005 to December 2005. Standardized pro-forma were used to collect data.

RESULTS

Among 5118 babies, 7.2% (369) were preterm and 92.3% were born at term (4749). Antenatal screening was performed in 86.6% of women who delivered at term, of which 18.1% were GBS culture-positive. Information regarding culture site was available in 93.2% of women screened and recto-vaginal cultures were documented in 42.7%. IAP was administered to 28.7% of 3937 women at term who had either spontaneous delivery or emergency caesarean section. In this cohort, 15.9% were diagnosed GBS culture-positive, of which 92.6% received IAP. Prophylaxis was also administered to 8.4% (331) of women for no apparent reason. Compared with tertiary level hospitals, women delivering in primary/secondary hospitals were more likely to be both GBS screened (P < 0.0001; OR 3.04; CI 2.33-3.97) and to receive prophylaxis ≥4 hours before delivery (P = 0.0025; OR 1.57; CI 1.17-2.12).

CONCLUSIONS

GBS screening was performed in >85% of women and >90% of culture-positive women received prophylaxis. However, there is a need to educate clinicians about protocol adherence, as most cultures were suboptimal and cases of unnecessary IAP were administered. The screening was more effective in hospitals with fewer deliveries.

摘要

背景

B 组链球菌（GBS）是导致新生儿严重感染的主要原因。产时抗生素预防（IAP）可降低早发型疾病的发生率。本研究旨在确定艾米利亚-罗马涅（意大利）实施 GBS 预防建议方案的临床医生的依从程度。

方法

在 2005 年 10 月至 12 月期间，前瞻性记录每个分娩的特征。使用标准化的表格收集数据。

结果

在 5118 名婴儿中，7.2%（369 名）为早产儿，92.3%为足月儿（4749 名）。在分娩时，86.6%的足月孕妇进行了产前筛查，其中 18.1%为 GBS 培养阳性。在接受筛查的 18.1%孕妇中，93.2%可获得关于培养部位的信息，42.7%记录了直肠阴道培养。在 3937 名足月分娩且自然分娩或紧急剖宫产的孕妇中，28.7%给予 IAP。在该队列中，15.9%诊断为 GBS 培养阳性，其中 92.6%接受了 IAP。还有 8.4%（331 名）的孕妇无明显原因给予了预防。与三级医院相比，在一级/二级医院分娩的妇女更有可能接受 GBS 筛查（P <0.0001；OR 3.04；95%CI 2.33-3.97），且更有可能在分娩前 4 小时内接受预防（P=0.0025；OR 1.57；95%CI 1.17-2.12）。