Brigham and Women's Hospital, Division of Maternal-Fetal Medicine, and Channing Laboratory and Department of Newborn Medicine,Harvard Medical School, and the Division of Newborn Medicine, Children's Hospital, Boston, Massachusetts.
Obstet Gynecol. 2013 Apr;121(4):812-818. doi: 10.1097/AOG.0b013e3182888032.
To define the microbial epidemiology and clinical risk factors associated with peripartum bacteremia in the era of group B streptococcus prophylaxis.
We identified all cases of maternal bacteremia occurring during the peripartum time period (defined as from 7 days before delivery until 30 days after delivery) in a large maternity center from 2000 to 2008. Chart review was performed to determine the clinical factors associated with bacteremia.
During the study period, blood cultures were obtained from 1,295 febrile peripartum women (1.6% of all parturients); 172 of 1,295 febrile peripartum women (13.3%) had bacteremia (2.2 cases per 1,000 deliveries) with 194 microbial isolates and 1 yeast. The most frequent bacterial isolates were Escherichia coli (35.9%), enterococci (23.6%), and anaerobic species (9.2%); group B streptococcus was isolated in only eight cases (4.1%). Clinical diagnoses among infected women included endometritis (56%), chorioamnionitis (21%), and urosepsis (8%). Among women with endometritis, 77% underwent cesarean delivery (compared with vaginal delivery; relative risk [RR] 10.85, 95% confidence interval [CI] 6.75-17.45) and 39% delivered at less than 37 weeks of gestation (compared with 37 weeks or more; RR 3.21, 95% CI 2.42-4.25). Severe maternal complications of bacteremia were noted; six women required intensive care unit admission, five women had development of ileus, and one death occurred because of urosepsis.
In the era of group B streptococcus prophylaxis, E coli and enterococci are the most frequent bacteria isolated in peripartum bacteremia. Group B streptococcus accounted for only 4% of cases.
III.
在 B 型链球菌预防时代，定义与围产期菌血症相关的微生物流行病学和临床危险因素。
我们在 2000 年至 2008 年期间从一家大型妇产中心确定了所有发生在围产期期间（定义为分娩前 7 天至分娩后 30 天）的产妇菌血症病例。通过病历回顾确定与菌血症相关的临床因素。
在研究期间，从 1295 名发热的围产期妇女中采集了血培养（占所有产妇的 1.6%）；1295 名发热的围产期妇女中有 172 名（13.3%）发生菌血症（每 1000 例分娩中有 2.2 例），共分离出 194 株微生物分离株和 1 株酵母。最常见的细菌分离株是大肠埃希菌（35.9%）、肠球菌（23.6%）和厌氧菌（9.2%）；仅分离出 8 株 B 型链球菌（4.1%）。感染妇女的临床诊断包括子宫内膜炎（56%）、绒毛膜羊膜炎（21%）和尿路感染败血症（8%）。在子宫内膜炎患者中，77%行剖宫产（与阴道分娩相比；相对风险 [RR] 10.85，95%置信区间 [CI] 6.75-17.45），39%在 37 周前分娩（与 37 周或以上分娩相比；RR 3.21，95% CI 2.42-4.25）。菌血症的严重产妇并发症也有报道；6 名妇女需要入住重症监护病房，5 名妇女发生肠梗阻，1 名妇女因尿路感染败血症死亡。
在 B 型链球菌预防时代，大肠杆菌和肠球菌是围产期菌血症中最常见的细菌。B 型链球菌仅占病例的 4%。
III。
