即时护理产时 B 组链球菌分子筛查：有效性和成本。
Point-of-Care Intrapartum Group B Streptococcus Molecular Screening: Effectiveness and Costs.
机构信息
Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, France-EA4043 Unité Bactéries Pathogènes et Santé, Université Paris-Sud Saclay, Chatenay-Malabry, Service de Néonatologie, Groupe Hospitalier Paris Saint-Joseph, Service de Gynécologie Obstétrique, Groupe Hospitalier Paris Saint-Joseph, France - UMR1153, Obstetrical, neonatal and pediatric epidemiology research team (EPOPé) - DHU Risk in pregnancy - Paris Descartes University, AP-HP Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France, Hôpital de l'Hôtel Dieu, ECEVE, UMR1123, Université Paris Est Créteil, Paris France.
出版信息
Obstet Gynecol. 2019 Feb;133(2):276-281. doi: 10.1097/AOG.0000000000003057.
OBJECTIVE
To assess outcomes and costs associated with around-the-clock point-of-care intrapartum group B streptococcus (GBS) polymerase chain reaction (PCR) screening.
METHODS
Intrapartum PCR screening was implemented in 2010. Intrapartum PCR was compared with antenatal culture screening in an uncontrolled, single institution, preintervention and postintervention study. The study periods included 4 years before and 6 years after the intervention, commencing in 2006 and concluding in 2015. The primary outcome measure was rate of early-onset neonatal GBS disease. Secondary outcomes included length of stay, days of antibiotics, and costs.
RESULTS
During the 4 years of antenatal culture screening, 11,226 deliveries were recorded compared with 18,835 in the 6 years of intrapartum GBS PCR screening, corresponding to 11,818 and 18,980 live births, respectively. During the antenatal culture period, 3.8% of term deliveries did not undergo GBS testing compared with 0.1% during the intrapartum PCR period (P<.001). Between the two periods, the rate of proven early-onset GBS disease cases decreased from 1.01/1,000 to 0.21/1,000 (P=.026) and probable early-onset GBS disease cases from 2.8/1,000 to 0.73/1,000 (P<.001); the risk ratio for both was 0.25, 95% CI (0.14-0.43). Total days of hospital and antibiotic therapy for early-onset GBS disease declined by 64% and 60%, respectively, with no significant difference for average length of stay or antibiotic duration preintervention and postintervention. The yearly cost of delivery and treatment of newborns with GBS infection was reduced from $41,875±6,823 to $11,945±10,303 (P<.001). The estimated extra cost to avoid one early-onset GBS disease was $5,819.
CONCLUSION
Point-of-care intrapartum GBS PCR screening was associated with a significant decrease in the rate of early-onset GBS disease and antibiotic use in newborns. The additional PCR costs were offset in part by the reduction in early-onset GBS disease treatment costs.
目的
评估与产时即时床边 B 组链球菌（GBS）聚合酶链反应（PCR）筛查相关的结局和成本。
方法
2010 年实施了产时 PCR 筛查。在一项无对照、单机构、干预前和干预后研究中，产时 PCR 筛查与产前培养筛查进行了比较。研究期间包括干预前的 4 年和干预后的 6 年，始于 2006 年，止于 2015 年。主要结局测量指标是早发性新生儿 GBS 病的发生率。次要结局包括住院时间、抗生素使用天数和成本。
结果
在产前培养筛查的 4 年期间，记录了 11226 次分娩，而在产时 GBS PCR 筛查的 6 年期间，记录了 18835 次分娩，分别对应于 11818 次和 18980 次活产。在产前培养期间，有 3.8%的足月分娩未进行 GBS 检测，而在产时 PCR 期间这一比例为 0.1%（P<.001）。在这两个时期之间，确诊的早发性 GBS 病病例发生率从 1.01/1000 降至 0.21/1000（P=.026），可能的早发性 GBS 病病例从 2.8/1000 降至 0.73/1000（P<.001）；两者的风险比均为 0.25，95%置信区间（0.14-0.43）。早发性 GBS 病的总住院天数和抗生素治疗天数分别下降了 64%和 60%，但干预前后的平均住院时间或抗生素使用时间无显著差异。新生儿 GBS 感染的分娩和治疗的年费用从 41875±6823 美元降至 11945±10303 美元（P<.001）。估计避免 1 例早发性 GBS 病的额外成本为 5819 美元。
结论
床边即时产时 GBS PCR 筛查与新生儿早发性 GBS 病发生率和抗生素使用的显著下降有关。PCR 检测的额外成本部分被早发性 GBS 病治疗成本的降低所抵消。
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