Fakhraei Romina, Fell Deshayne B, El-Chaâr Darine, Thampi Nisha, Sander Beate, Brown Kevin Antoine, Crowcroft Natasha, Bolotin Shelly, Barrett Jon, Darling Elizabeth K, Fittipaldi Nahuel, Lamagni Theresa, McGeer Allison, Murti Michelle, Sadarangani Manish, Schwartz Kevin L, Yasseen Abdool, Tunis Matthew, Petrcich William, Wilson Kumanan
University of Ottawa, Canada.
Children's Hospital of Eastern Ontario Research Institute, Canada.
Lancet Reg Health Am. 2024 Oct 24;39:100914. doi: 10.1016/j.lana.2024.100914. eCollection 2024 Nov.
Group B (GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35-37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.
Our population-based cohort study included pregnant individuals and their offspring from April 2012 to March 2018, utilising the provincial birth registry linked to health administrative data. GBS cases were ascertained through culture results and diagnostic codes. We calculated incidence rates for early-onset disease (EOD: 0-6 days), late-onset disease (LOD: 7-89 days), and ultra-LOD (ULOD: 90-365 days). Adjusted incidence rate ratios (aIRR) were derived via log-binomial regression to compare infant GBS rates according to screening and IAP-receipt.
Among 776,148 liveborn infants, we identified 803 with GBS, with multiples exhibiting a threefold incidence increase. Incidence rates of EOD, LOD and ULOD were 0.49, 0.46 and 0.07 per 1000 livebirths, respectively. Of eligible pregnancies, 94% were screened; 23% screened positive, and 81% of them received IAP. Nearly 12% of term EOD infants had mothers who missed IAP despite screening positive. Maternal screening was associated with lower rates of any infant GBS disease (aIRR: 0.60; 95% CI: 0.45, 0.80). Among screen-positive births, IAP-receipt was associated with reduced rates of EOD (aIRR: 0.72, 95% CI: 0.48, 1.29) and LOD/ULOD (aIRR: 0.69; 95% CI: 0.46, 1.05), but confidence intervals included 1.0.
Our study, the largest Canadian investigation into infant GBS disease, highlights both widespread adoption and ongoing challenges of the current prevention strategy.
Canadian Institutes of Health Research.
B族链球菌（GBS）是新生儿败血症和脑膜炎的重要病因，全球报告的发病率各不相同，且基于人群的数据有限。我们估计了加拿大安大略省婴儿GBS疾病负担，并评估了孕妇GBS筛查（妊娠35 - 37周）和产时抗生素预防（IAP）与婴儿疾病发生率之间的关联。
我们基于人群的队列研究纳入了2012年4月至2018年3月期间的孕妇及其后代，利用省级出生登记系统与卫生行政数据相链接。GBS病例通过培养结果和诊断编码确定。我们计算了早发型疾病（EOD：0 - 6天）、晚发型疾病（LOD：7 - 89天）和超晚发型疾病（ULOD：90 - 365天）的发病率。通过对数二项回归得出调整发病率比（aIRR），以比较根据筛查和IAP接受情况的婴儿GBS发病率。
在776,148例活产婴儿中，我们确定了803例GBS病例，多胞胎的发病率增加了两倍。EOD、LOD和ULOD的发病率分别为每1000例活产0.49、0.46和0.07。在符合条件的妊娠中，94%进行了筛查；23%筛查呈阳性，其中81%接受了IAP。近12%的足月EOD婴儿的母亲尽管筛查呈阳性但未接受IAP。产妇筛查与任何婴儿GBS疾病的较低发病率相关（aIRR：0.60；95%CI：0.45，0.80）。在筛查呈阳性的分娩中，接受IAP与EOD（aIRR：0.72，95%CI：0.48，1.29）和LOD/ULOD（aIRR：0.69；95%CI：0.46，1.05）发病率降低相关，但置信区间包含1.0。
我们的研究是加拿大对婴儿GBS疾病进行的最大规模调查，突出了当前预防策略的广泛应用和持续挑战。
加拿大卫生研究院。
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