Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Healthcare-Associated Infection and Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
J Infect. 2019 Dec;79(6):521-527. doi: 10.1016/j.jinf.2019.11.008. Epub 2019 Nov 13.
To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals.
Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where 'cluster' was defined as ≥2 linked cases. PROSPERO CRD42018096297.
Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset (<7 days of life; n = 3), late-onset (7-90 days; n = 13) index case or colonized infant (n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3-17, range 0-50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified.
Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics.
描述医院侵袭性 B 群链球菌（iGBS）疾病的暴发情况。
系统综述使用电子数据库，以确定描述 iGBS 暴发/聚集或在医疗机构中发生交叉感染/获得的研究，其中“聚集”定义为≥2 例相关病例。PROSPERO CRD42018096297。
共纳入 25 篇参考文献，描述了 1966 年至 2019 年期间 11 个国家的 30 个医院聚集（26 例新生儿，4 例成人）。在 19 个聚集中，有 19 个聚集报告了无关联的新生儿之间的交叉感染，涉及早发性（<7 天；n=3）、晚发性（7-90 天；n=13）的指数病例或定植婴儿（n=3），随后出现一个或多个晚发性病例（中位连续间隔 9 天（IQR 3-17，范围 0-50 天，n=45））；在 3 个聚集中通过噬菌体分型确定了关联性，在 8 个聚集中通过 PFGE/MLST/PCR、4 个聚集中通过 WGS、4 个聚集中通过非分子方法确定了关联性。新生儿聚集的推测传播途径是通过临床人员和设备，特别是在拥挤和高患者与护士比例的时期。在 4 个成人聚集中，有一个归因于呼吸道病例之间的飞沫传播，一个归因于血液透析导管的处理，还有两个未指明。
大多数聚集病例之间存在较长的间隔时间，这一特征可能会阻碍没有基因组学支持的增强监测的情况下对 GBS 医院暴发的检测。
