Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71-41124 Modena (MO), Italy.
Pediatrics. 2013 Feb;131(2):e361-8. doi: 10.1542/peds.2012-1231. Epub 2013 Jan 6.
There is insufficient population-based data on group B streptococcus (GBS) late-onset disease (LOD). Risk factors and routes of GBS transmission are poorly understood.
A prospective, cohort study was conducted to collect incidence data on LOD and evaluate GBS infections over an 8-year period (2003-2010). Starting from January 2007, maternal rectovaginal and breast milk cultures were routinely collected on confirmation of the LOD diagnosis to assess maternal GBS culture status.
The incidence rate of LOD was 0.32 per 1000 live births (1.4 and 0.24 per 1000 live births for preterm and term newborns, respectively). The registered cases of LOD (n = 100) were classified as sepsis (n = 57), meningitis (n = 36), or focal infection (n = 7). Thirty neonates were preterm (2 had recurrent infection); 68 were term. Four infants died (3 early preterm, 1 term). At the time the LOD diagnosis was confirmed, 3 (6%) of 53 mothers had GBS mastitis, and 30 (64%) of 47 carried GBS at the rectovaginal site. Early (7-30 days) LOD presentation was associated with neonatal brain lesions or death (odds ratio: 0.96 [95% confidence interval: 0.93-0.99]). Intrapartum antibiotic exposure was significantly associated with mild (12 of 22) rather than severe (11 of 45; P = .03) LOD.
Preterm neonates had the highest rates of LOD and mortality. Most mothers carried GBS at the time of the LOD diagnosis, whereas 6% had mastitis. Intrapartum antibiotics were associated both with delayed presentation of symptoms and milder LOD.
目前缺乏关于 B 组链球菌（GBS）晚发型疾病（LOD）的基于人群的数据。GBS 传播的危险因素和途径尚未完全清楚。
本前瞻性队列研究旨在收集 8 年间（2003-2010 年）的 LOD 发病率数据，并评估 GBS 感染情况。从 2007 年 1 月开始，在确诊 LOD 后，对产妇直肠阴道和母乳进行常规培养，以评估产妇 GBS 培养状态。
LOD 的发病率为 0.32/1000 活产儿（早产儿和足月儿分别为 1.4/1000 和 0.24/1000）。登记的 LOD 病例（n=100）分为败血症（n=57）、脑膜炎（n=36）或局部感染（n=7）。30 例新生儿为早产儿（2 例为复发性感染）；68 例为足月儿。4 例婴儿死亡（3 例为早期早产儿，1 例为足月儿）。在确诊 LOD 时，53 名母亲中有 3 名（6%）患有 GBS 乳腺炎，47 名中有 30 名（64%）直肠阴道部位携带 GBS。早期（7-30 天）LOD 发病与新生儿脑损伤或死亡相关（优势比：0.96[95%置信区间：0.93-0.99]）。产时抗生素暴露与轻症（22 例中的 12 例）而非重症（45 例中的 11 例；P=0.03）LOD 显著相关。
早产儿 LOD 发生率和死亡率最高。大多数母亲在 LOD 确诊时携带 GBS，而 6%患有乳腺炎。产时抗生素与症状延迟出现和轻症 LOD 均相关。
