一项关于产时抗生素预防以预防B族链球菌早发型疾病的基于区域的研究：进展与局限

An area-based study on intrapartum antibiotic prophylaxis for preventing group B streptococcus early-onset disease: advances and limitations.

作者信息

Berardi Alberto, Rossi Cecilia, Bacchi Reggiani Maria Letizia, Bastelli Annalisa, Capretti Maria Grazia, Chiossi Claudio, Fiorini Valentina, Gambini Lucia, Gavioli Sara, Lanari Marcello, Memo Luigi, Papa Irene, Pini Luana, Rizzo Maria Vittoria, Zucchini Andrea, Facchinetti Fabio, Ferrari Fabrizio

机构信息

a Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy.

b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy.

出版信息

J Matern Fetal Neonatal Med. 2017 Jul;30(14):1739-1744. doi: 10.1080/14767058.2016.1224832. Epub 2016 Sep 5.

DOI:10.1080/14767058.2016.1224832

PMID:27593156

Abstract

INTRODUCTION

The prevalence of maternal group-B-streptococcus (GBS) colonization and risk factors (RFs) for neonatal early-onset disease (EOD) in Europe are poorly defined. Large-scale information concerning adherence to recommendations for preventing GBS-EOD are lacking.

MATERIALS AND METHODS

This was a 3-month retrospective area-based study including all regional deliveries ≥35 weeks' gestation (in 2012). The sensitivity, specificity, positive and negative predictive values, odds ratio and receiver operating characteristic (ROC) curve for intrapartum antibiotic prophylaxis (IAP) among full-term and preterm deliveries and prolonged membrane rupture (PROM) were calculated.

RESULTS

Among 7133 women, 259 (3.6%) were preterm (35-36 weeks' gestation). Full-term women were 6874, and 876 (12.7%) had at least 1 RF. Most women (6495) had prenatal screening and 21.4% (1390) were GBS positive. IAP was given to 2369 (33.2%) women (preterm, n = 166; full term, n = 2203). Compared to full-term, preterm women were less likely to receive IAP when indicated (73.2% versus 90.3%, p < 0.01). Full-term women represented the largest area under the curve (AUC, 0.87). PROM showed the highest sensitivity (98.6%), but the lowest specificity (6.9%) and AUC (0.53).

CONCLUSIONS

Large-scale prenatal screening and IAP are feasible. Women delivering preterm are less likely to receive IAP when indicated. Most unnecessary antibiotics are given in cases of PROM.

摘要

引言

欧洲孕妇B族链球菌（GBS）定植率以及新生儿早发型疾病（EOD）的危险因素定义尚不明确。目前缺乏关于预防GBS-EOD建议依从性的大规模信息。

材料与方法

这是一项为期3个月的基于区域的回顾性研究，纳入了2012年所有孕周≥35周的区域分娩病例。计算了足月和早产分娩以及胎膜早破（PROM）时产时抗生素预防（IAP）的敏感性、特异性、阳性和阴性预测值、比值比以及受试者工作特征（ROC）曲线。

结果

在7133名女性中，259名（3.6%）为早产（孕周35 - 36周）。足月女性有6874名，其中876名（12.7%）有至少1个危险因素。大多数女性（6495名）进行了产前筛查，21.4%（1390名）GBS呈阳性。2369名（33.2%）女性接受了IAP（早产，n = 166；足月，n = 2203）。与足月分娩相比，早产女性在有指征时接受IAP的可能性较小（73.2%对90.3%，p < 0.01）。足月女性的曲线下面积最大（AUC，0.87）。PROM的敏感性最高（98.6%），但特异性最低（6.9%），AUC（0.53）。