Department of pediatrics, University Hospital Center, 8 avenue Dominique Larrey, Limoges, France.
Department of Microbiology, University Hospital Center, 8 avenue Dominique Larrey, Limoges, France.
Arch Pediatr. 2024 Oct;31(7):461-466. doi: 10.1016/j.arcped.2024.05.002. Epub 2024 Sep 10.
Early-onset neonatal sepsis represents a diagnostic challenge, as it is a cause of neonatal mortality and morbidity. Guidelines for the prevention of group B streptococcus (GBS) infection recommend that all pregnant women must be screened for GBS carriage at the end of pregnancy, with intrapartum antibiotic prophylaxis being provided for GBS carriers. If vaginal culture is not available, GBS polymerase chain reaction (GBS-PCR) is an alternative option for this type of screening. In our unit, GBS-PCR is performed when pregnant women present to the delivery room with ongoing labor and with no results of culture GBS screening available. The main objective of this study was to evaluate the impact of the results of GBS-PCR on monitoring modifications in newborns of mothers with unknown GBS status. The secondary objectives were to confirm the feasibility of a GBS-PCR-based screening method in everyday practice and to evaluate the impact of GBS-PCR results on the modification of intrapartum antibiotic therapy in pregnant women.
A retrospective, single-center, observational study was conducted for 1 year. For dyads with GBS-PCR performed, changes concerning intrapartum antibiotic therapy and the newborn's monitoring were recorded. The feasibility of the method was evaluated by the delay between the GBS-PCR realization and the availability of the result; in addition, the number of GBS-PCR tests that could not be realized were collected.
Overall, 60 GBS-PCR samples were tested for 60 pregnant women. Results were obtained for all samples, and the median duration to obtaining the GBS-PCR results was 70 min (60.8-87.2). These results were positive for 11 (18.3 %) women and led to monitoring modifications for two infants. In total, 27 pregnant women (45 %) had modifications in their antibiotic therapy due to the GBS-PCR results.
GBS-PCR was quickly available and the results led to changes in maternal antibiotic prophylaxis and in the monitoring level of the newborns.
早发型新生儿败血症是新生儿死亡和发病的一个原因，这对其诊断提出了挑战。预防 B 组链球菌（GBS）感染的指南建议所有孕妇在妊娠末期都必须进行 GBS 带菌筛查，对 GBS 带菌者进行产时抗生素预防。如果无法进行阴道培养，GBS 聚合酶链反应（GBS-PCR）是这种筛查的替代方法。在我们的单位，当孕妇在有产程且没有 GBS 筛查培养结果的情况下进入产房时，会进行 GBS-PCR。本研究的主要目的是评估 GBS-PCR 结果对监测未知 GBS 状态的产妇新生儿的监测结果的影响。次要目标是确认基于 GBS-PCR 的筛查方法在日常实践中的可行性，并评估 GBS-PCR 结果对孕妇产时抗生素治疗修改的影响。
进行了为期 1 年的回顾性、单中心、观察性研究。对进行 GBS-PCR 的母婴对，记录了与产时抗生素治疗和新生儿监测相关的变化。通过 GBS-PCR 实现与结果可用之间的延迟来评估方法的可行性；此外，还收集了无法实现的 GBS-PCR 测试数量。
共有 60 名孕妇的 60 个 GBS-PCR 样本进行了测试。所有样本均获得了结果，获得 GBS-PCR 结果的中位时间为 70 分钟（60.8-87.2）。结果显示 11 名（18.3%）女性为阳性，导致 2 名婴儿的监测发生改变。共有 27 名（45%）孕妇因 GBS-PCR 结果改变了抗生素治疗。
GBS-PCR 快速可用，结果导致产妇抗生素预防和新生儿监测水平发生变化。
