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婴幼儿和新生儿伴有/不伴有脑膜炎的复杂性脓毒症:临床、分子特征及转归

Complicated Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes.

作者信息

Lin Chih, Chu Shih-Ming, Wang Hsiao-Chin, Yang Peng-Hong, Huang Hsuan-Rong, Chiang Ming-Chou, Fu Ren-Huei, Tsai Ming-Horng, Hsu Jen-Fu

机构信息

Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung 204, Taiwan.

College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.

出版信息

Microorganisms. 2021 Oct 3;9(10):2094. doi: 10.3390/microorganisms9102094.

Abstract

BACKGROUND

(also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases.

METHODS

From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia.

RESULTS

During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes.

CONCLUSIONS

a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.

摘要

背景

(也称为B组链球菌,GBS)与婴儿的高死亡率和发病率相关,尤其是那些患有复杂GBS败血症的婴儿,复杂GBS败血症定义为患有脑膜炎、严重败血症和/或感染性休克的婴儿。我们旨在描述侵袭性GBS疾病新生儿的临床和分子特征以及不良结局的危险因素。

方法

2003年至2020年,纳入在三级新生儿重症监护病房(NICU)住院的所有侵袭性GBS疾病新生儿。对GBS分离株进行血清分型、多位点序列分型(MLST)和药敏试验。我们比较了复杂GBS败血症病例和非复杂GBS菌血症病例。

结果

在研究期间,共确定并纳入了188例(年龄小于6个月)侵袭性GBS疾病新生儿。其中,119例(63.3%)患有非复杂GBS菌血症,69例(36.7%)新生儿患有复杂GBS败血症,包括脑膜炎(25.5%,n = 48)和严重败血症或感染性休克。在患有复杂GBS败血症的新生儿中,45例(65.2%)有神经系统并发症,50例幸存者中有21例(42.0%)在出院时有神经后遗症。总体最终死亡率为10.1%(19例新生儿死亡)。III型/ST-17 GBS分离株占所有复杂GBS败血症的56.5%,占所有GBS脑膜炎的68.8%,但该菌株与更差的结局无显著相关性。在过去二十年中,侵袭性GBS分离株的耐药率明显上升。多因素逻辑回归分析后,血小板减少和呼吸衰竭的新生儿与最终不良结局独立相关。

结论

所有新生儿侵袭性GBS疾病中,共有36.7%与伴有或不伴有脑膜炎的复杂败血症相关。鉴于复杂GBS败血症新生儿的高死亡率和发病率,未来迫切需要进一步研究早期识别导致复杂GBS败血症的特定菌株、危险因素或遗传机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e3/8540989/e9de234e6513/microorganisms-09-02094-g001a.jpg

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