Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia.
Pathology North, Hunter New England Local Health District, Newcastle, NSW, Australia.
Women Birth. 2018 Aug;31(4):244-253. doi: 10.1016/j.wombi.2017.10.012. Epub 2017 Nov 10.
In some countries, up to 30% of women are exposed to intrapartum antibiotic prophylaxis for prevention of early-onset group B Streptococcal infection. Intrapartum antibiotic prophylaxis aims to reduce the risk of neonatal morbidity and mortality from this infection. The intervention may adversely affect non-pathogenic bacteria which are passed to the newborn during birth and are considered important in optimising health. Since many women are offered intrapartum antibiotic prophylaxis, effectiveness and implications of this intervention need to be established. This review considers clinical trials and observational studies analysing the effectiveness of intrapartum antibiotic prophylaxis.
An integrative literature review was conducted. One systematic review, three clinical trials and five observational studies were identified for appraisal.
Randomised controlled trials found intrapartum antibiotic prophylaxis effective but all retrieved randomised clinical trials had significant methodological flaws. High quality observational studies reported high rates of effectiveness but revealed less than optimal adherence to screening and administration of the prophylaxis. Scant consideration was given to short term risks, and long-term consequences were not addressed.
Studies found intrapartum antibiotic prophylaxis to be effective. However, evidence was not robust and screening and prophylaxis have limitations. Emerging evidence links intrapartum antibiotic prophylaxis to adverse short and longer-term neonatal outcomes.
Our review found high quality evidence of the effectiveness of intrapartum antibiotic prophylaxis was limited. Lack of consideration of potential risks of the intervention was evident. Women should be enabled to make informed decisions about GBS management. More research needs to be done in this area.
在一些国家，多达 30%的女性接受产时抗生素预防用药，以预防早发型 B 组链球菌感染。产时抗生素预防用药旨在降低新生儿因该感染而出现发病和死亡的风险。该干预措施可能会对在分娩过程中传递给新生儿的非致病性细菌产生不利影响，而这些细菌被认为对优化新生儿健康很重要。由于许多女性都接受了产时抗生素预防用药，因此需要确定该干预措施的有效性及其影响。本综述考虑了分析产时抗生素预防用药有效性的临床试验和观察性研究。
进行了综合文献综述。共确定了一篇系统评价、三项临床试验和五项观察性研究进行评估。
随机对照试验发现产时抗生素预防用药有效，但所有检索到的随机临床试验均存在明显的方法学缺陷。高质量的观察性研究报告了较高的有效性，但发现筛查和预防用药的依从性并不理想。对短期风险的考虑甚少，也未解决长期后果。
研究发现产时抗生素预防用药有效。然而，证据并不充分，且筛查和预防用药存在局限性。新出现的证据表明产时抗生素预防用药与新生儿短期和长期不良结局相关。
本综述发现高质量证据表明产时抗生素预防用药有效，但存在局限性。显然，没有考虑干预措施的潜在风险。应该使女性能够对 GBS 管理做出知情决策。需要在这一领域开展更多研究。
