Hartvigsen C M, Nielsen S Y, Møller J K, Khalil M R
Department of Gynecology and Obstetrics, Kolding Sygehus, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.
Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus C, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2022 May;272:173-176. doi: 10.1016/j.ejogrb.2022.03.034. Epub 2022 Mar 18.
To investigate the impact of administering Intrapartum Antibiotic Prophylaxis (IAP) to laboring women with one or more risk factors for Early Onset Group B Streptococcal neonatal infection (EOGBS) based on the result of a rapid bedside test for Group B Streptococci (GBS).
Quality assessment study.
Three-hundred-sixty-six laboring women admitted to our maternity ward, with one or more risk factors for EOGBS, were prospectively included. Rectovaginal swab-samples were examined bedside by the GenomEra® GBS Polymerase Chain Reaction (PCR) assay upon admission. Time from administration of IAP to delivery was registered. According to national guidelines, one-hundred-two women mandatorily received IAP independent of the PCR test result fulfilling one of the following three risk factors: prior infant with EOGBS, preterm labor before 35 gestational week, temperature ≥ 38 °C during labor. Women with GBS bacteriuria during current pregnancy, rupture of membranes ≥ 18 h IAP, and preterm labor between 35 and 37 gestational week, received IAP solely if the PCR test was positive. Predictive values were calculated for each risk factor.
Previous GBS bacteriuria was strongly associated (PPV = 71%) with a positive GBS PCR test, whilst the corresponding positive percent of ROM > 18 h and of GA 35-37 was only PPV = 16% and 22%, respectively. Seventy-four women, 74/251 (31%), received IAP because they were GBS PCR positive. IAP was thus reduced by about two-thirds compared to the risk-based strategy of offering IAP to all women with one or more risk factors for EOGBS. Two women, 2/254 (0.8%), received inferior care, as they did not receive IAP within the recommended 4 h prior to delivery due to the extra time spend on the test procedure.
Bedside intrapartum PCR testing of women with risk factors for EOGBS effectively diminishes use of IAP during labor compared to the present risk factor-based strategy alone. In this project, the extra time spend on the PCR test procedure did not lead to noticeable delay in IAP.
基于B族链球菌（GBS）快速床旁检测结果，探讨对有一项或多项早发性B族链球菌新生儿感染（EOGBS）风险因素的分娩妇女给予产时抗生素预防（IAP）的影响。
质量评估研究。
前瞻性纳入366名入住我院产科病房、有一项或多项EOGBS风险因素的分娩妇女。入院时采用GenomEra® GBS聚合酶链反应（PCR）检测法对直肠阴道拭子样本进行床旁检测。记录从给予IAP到分娩的时间。根据国家指南，102名妇女无论PCR检测结果如何，若符合以下三项风险因素之一则必须接受IAP：前次婴儿患有EOGBS、妊娠35周前早产、分娩时体温≥38°C。当前妊娠期间有GBS菌尿、胎膜破裂≥18小时且接受IAP、妊娠35至37周早产的妇女，仅在PCR检测呈阳性时接受IAP。计算每个风险因素的预测值。
既往GBS菌尿与GBS PCR检测阳性密切相关（阳性预测值[PPV]=71%），而胎膜破裂>18小时和孕周35 - 37周时相应的阳性百分比仅分别为PPV = 16%和22%。74名妇女（74/251，31%）因GBS PCR检测呈阳性而接受IAP。因此，与对所有有一项或多项EOGBS风险因素的妇女采用基于风险的IAP策略相比，IAP的使用减少了约三分之二。两名妇女（2/254，0.8%）接受的护理较差，因为由于检测过程耗时较长，她们在分娩前推荐的4小时内未接受IAP。
与目前仅基于风险因素的策略相比，对有EOGBS风险因素的妇女进行床旁产时PCR检测可有效减少分娩期间IAP的使用。在本项目中，PCR检测过程额外花费的时间并未导致IAP出现明显延迟。
