Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
Pediatr Neonatol. 2021 Sep;62(5):491-498. doi: 10.1016/j.pedneo.2021.02.005. Epub 2021 May 17.
Nationwide group B Streptococcus agalactiae (GBS) antepartum screening was instituted in Taiwan in 2012. The impact of the policy on early-onset sepsis (EOS) has not been evaluated. This study aimed to examine the impact of the policy on the incidence of neonatal EOS.
This was a retrospective study conducted at MacKay Children's Hospital. Patients with culture-proven neonatal EOS were enrolled and divided by birth year in relation to the implementation of GBS prevention policy: Epoch 1, 2001-2004 pre-GBS screening; Epoch 2, 2005-2011 elective GBS screening; and Epoch 3, 2012-2018 universal GBS screening. The pathogens and antimicrobial resistance patterns were reviewed and analyzed. The incidence was modeled using Poisson regression.
A total of 128 neonates met the enrollment criteria. The observed incidence of EOS was 1.52‰. The incidence rates of EOS, GBS, and Escherichia coli (E. coli) sepsis were similar in Epoch 1 and Epoch 3. E. coli and non-Enterococcal group D Streptococcus (GDS) infection increased significantly in term infants, whereas the EOS-related mortality rate declined in preterm infants. Approximately 72% of the isolated E. coli were ampicillin-resistant, and the antimicrobial sensitivity remained unaltered during the studied period.
The overall EOS incidence has not changed from 2001 to 2018. However, changes in the causative pathogens were observed in both term and preterm infants. Clinicians should be aware of this evolving epidemiology to provide prompt appropriate perinatal management.
2012 年，台湾开始实施全国性 B 群链球菌（GBS）产前筛查。该政策对早发性败血症（EOS）的影响尚未评估。本研究旨在探讨该政策对新生儿 EOS 发病率的影响。
这是一项在马偕纪念医院进行的回顾性研究。收集经培养证实的新生儿 EOS 患者，并按 GBS 预防政策实施的出生年份分为三个时期：时期 1（2001-2004 年 GBS 筛查前）、时期 2（2005-2011 年选择性 GBS 筛查）和时期 3（2012-2018 年普遍 GBS 筛查）。回顾并分析病原体和抗生素耐药模式。使用泊松回归模型进行发病率建模。
共有 128 名新生儿符合纳入标准。EOS 的观察发病率为 1.52‰。EOS、GBS 和大肠杆菌（E. coli）败血症的发病率在时期 1 和 3 相似。足月婴儿 E. coli 和非肠球菌 D 组链球菌（GDS）感染显著增加，而早产儿 EOS 相关死亡率下降。分离出的 E. coli 约有 72%对氨苄西林耐药，在研究期间抗生素敏感性未发生改变。
自 2001 年至 2018 年，总体 EOS 发病率未发生变化。然而，足月和早产儿的病原体发生了变化。临床医生应了解这种不断变化的流行病学情况，以便提供及时适当的围产期管理。
