新生儿 B 族链球菌感染现状：一项多中心前瞻性研究。
Current status of group B infection in neonates: a multicenter prospective study.
机构信息
Department of Neonatology, Women and Children's Hospital, School of Medcine, Xiamen University/Xiamen Maternal and Child Care Hospital/Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian 361003, China (Lin X-Z, Email: xinzhufj@ 163. com).
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2021;23(9):889-895. doi: 10.7499/j.issn.1008-8830.2105018.
OBJECTIVES
To investigate the incidence of maternal group B (GBS) colonization and neonatal early-onset GBS disease (GBS-EOD), and to study the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization.
METHODS
A total of 16 384 pregnant women and 16 634 neonates delivered by them were enrolled prospectively who had medical records in Xiamen Maternal and Child Care Hospital, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, and Zhangzhou Zhengxing Hospital from May 1, 2019 to April 30, 2020. Unified GBS screening time, culture method, and indication for intrapartum antibiotic prophylaxis (IAP) were adopted in the three hospitals. The incidence rates of maternal GBS colonization and neonatal GBS-EOD were investigated. A multivariate logistic regression analysis was used to identify the factors associated with the development of GBS-EOD in the offspring of pregnant women with GBS colonization.
RESULTS
In these three hospitals, the positive rate of GBS culture among the pregnant women in late pregnancy was 11.29% (1 850/16 384), and the incidence rate of neonatal GBS-EOD was 0.96‰ (16/16 634). The admission rate of live infants born to the GBS-positive pregnant women was higher than that of those born to the GBS-negative ones (<0.05). The live infants born to the GBS-positive pregnant women had a higher incidence rate of GBS-EOD than those born to the GBS-negative ones [6.38‰ (12/1 881) vs 0.27‰ (4/14 725), <0.05]. The multivariate logistic regression analysis showed that placental swabs positive for GBS and positive GBS in neonatal gastric juice at birth were independent predictive factors for the development of GBS-EOD (<0.05), while adequate IAP was a protective factor (<0.05) in the offspring of pregnant women with GBS colonization.
CONCLUSIONS
GBS colonization of pregnant women in late pregnancy has adverse effects on their offspring. It is important to determine prenatal GBS colonization status of pregnant women and administer with adequate IAP based on the indications of IAP to reduce the incidence of neonatal GBS-EOD. .
目的
调查孕妇群体 B 型链球菌（GBS）定植和新生儿早发型 GBS 病（GBS-EOD）的发生率，并研究与孕妇 GBS 定植的后代发生 GBS-EOD 相关的因素。
方法
本研究前瞻性纳入了 2019 年 5 月 1 日至 2020 年 4 月 30 日期间在厦门妇幼保健院、首都医科大学北京妇产医院和漳州正兴医院就诊并分娩的 16 384 名孕妇及其 16 634 名新生儿的病历资料。这三所医院采用了统一的 GBS 筛查时间、培养方法和用于产时抗生素预防（IAP）的指征。调查了孕妇 GBS 定植和新生儿 GBS-EOD 的发生率。采用多变量逻辑回归分析确定与孕妇 GBS 定植的后代发生 GBS-EOD 相关的因素。
结果
这三所医院中，妊娠晚期孕妇 GBS 培养阳性率为 11.29%（1 850/16 384），新生儿 GBS-EOD 的发生率为 0.96‰（16/16 634）。GBS 阳性孕妇所分娩的活产婴儿的入院率高于 GBS 阴性孕妇所分娩的活产婴儿（<0.05）。GBS 阳性孕妇所分娩的活产婴儿的 GBS-EOD 发生率高于 GBS 阴性孕妇所分娩的活产婴儿[6.38‰（12/1 881）比 0.27‰（4/14 725），<0.05]。多变量逻辑回归分析显示，胎盘拭子 GBS 阳性和新生儿胃液出生时 GBS 阳性是 GBS-EOD 发生的独立预测因素（<0.05），而孕妇 GBS 定植的后代中适当的 IAP 是一个保护因素（<0.05）。
结论
妊娠晚期孕妇 GBS 定植对其后代有不良影响。确定孕妇产前 GBS 定植状态，并根据 IAP 的指征给予适当的 IAP，以降低新生儿 GBS-EOD 的发生率非常重要。
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