埃塞俄比亚东部孕妇中B族链球菌的垂直传播及相关因素：一项横断面研究
Vertical transmission of group B and associated factors among pregnant women: a cross-sectional study, Eastern Ethiopia.
作者信息
Yadeta Tesfaye Assebe, Worku Alemayehu, Egata Gudina, Seyoum Berhanu, Marami Dadi, Berhane Yemane
机构信息
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
Infect Drug Resist. 2018 Mar 13;11:397-404. doi: 10.2147/IDR.S150029. eCollection 2018.
BACKGROUND
Vertically transmitted group B (GBS) causes fetal and neonatal infections. However, there is limited information on the vertical transmission of GBS in low-income countries. This study, therefore, aimed to determine the rate of vertical transmission of GBS and associated factors among pregnant women in Eastern Ethiopia.
SUBJECTS AND METHODS
A cross-sectional, facility-based study was conducted among pregnant women in Harar town, Eastern Ethiopia, from June to October, 2016. GBS positivity of pregnant women was confirmed by culture of rectovaginal swab. Vertical transmission at birth was confirmed by culture on swabs taken from the ear canal, umbilicus, axilla, groin, and nose within 6 hours after birth. Prevalence ratio (PR) along with 95% CI was estimated to examine factors associated with vertical transmission using log binomial regression analysis.
RESULTS
Out of 231 GBS-colonized pregnant women at delivery, 104 births were identified as GBS colonized with a vertical transmission rate of 45.02% and 95% CI: 38.49, 51.68. Of 104 vertical transmission cases, 65 (62.50%) received no intrapartum antibiotic prophylaxis (IAP), 28 (26.92%) received it <4 hours before delivery, and 11 (10.58%) received it ≥4 hours before delivery. Pre-labor rupture of membranes at term (PR: 1.93; 95% CI: 1.04, 3.57), prolonged rupture of the membrane ≥18 hours (PR: 1.76; 95% CI: 1.13, 2.74), intrapartum maternal fever (PR: 1.40; 95% CI: 1.13, 1.75), and IAP received ≥4 hours (PR: 0.17; 95% CI: 0.09, 0.30) were significantly associated with vertical transmission of GBS.
CONCLUSION
The magnitude of vertical transmission of GBS was very high. However, the rate of adequate IAP received by mothers was very low. Efforts need to be strengthened to screen pregnant women during antenatal care and IAP should be used as necessary. Furthermore, maternal vaccination may provide a feasible strategy to reduce the vertical transmission.
背景
B族链球菌（GBS）垂直传播可导致胎儿和新生儿感染。然而，在低收入国家，关于GBS垂直传播的信息有限。因此，本研究旨在确定埃塞俄比亚东部孕妇中GBS的垂直传播率及相关因素。
对象与方法
2016年6月至10月，在埃塞俄比亚东部哈勒尔镇的孕妇中开展了一项基于医疗机构的横断面研究。通过直肠阴道拭子培养确诊孕妇GBS阳性。出生时的垂直传播通过出生后6小时内从耳道、脐部、腋窝、腹股沟和鼻腔采集的拭子培养来确诊。使用对数二项回归分析估计患病率比（PR）及95%置信区间（CI），以检验与垂直传播相关的因素。
结果
在分娩时231例GBS定植的孕妇中，有104例新生儿被确定为GBS定植，垂直传播率为45.02%，95%CI为38.49，51.68。在104例垂直传播病例中，65例（62.50%）未接受产时抗生素预防（IAP），28例（26.92%）在分娩前<4小时接受了IAP，11例（10.58%）在分娩前≥4小时接受了IAP。足月前胎膜早破（PR：1.93；95%CI：1.04，3.57）、胎膜破裂延长≥18小时（PR：1.76；95%CI：1.13，2.74）、产时产妇发热（PR：1.40；95%CI：1.13，1.75）以及在分娩前≥4小时接受IAP（PR：0.17；95%CI：0.09，0.30）与GBS垂直传播显著相关。
结论
GBS垂直传播的程度非常高。然而，母亲接受充分IAP的比例非常低。需要加强产前检查中对孕妇的筛查，并在必要时使用IAP。此外，母体疫苗接种可能是降低垂直传播的一种可行策略。
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