Schuchat A, Deaver-Robinson K, Plikaytis B D, Zangwill K M, Mohle-Boetani J, Wenger J D
Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Pediatr Infect Dis J. 1994 Jul;13(7):623-9. doi: 10.1097/00006454-199407000-00008.
Risk factors for early onset disease (EOD) caused by Group B streptococci (GBS) that are the foundation of prevention guidelines were identified in studies conducted in a few hospital centers. We investigated cases of EOD identified through laboratory-based active surveillance during 1991 and 1992 in a multistate population of 17 million. Ninety-nine cases were compared with 253 controls matched for hospital, date of birth and birth weight. Prematurity (< 37 weeks of gestation) was present in 28% of cases; 53% of case mothers had rupture of membranes > 12 hours; and 48% reported intrapartum fever. The incidence of EOD in each surveillance area was higher among blacks. By multivariate analysis, case mothers were more likely than controls to have rupture of membranes before labor onset (adjusted odds ratio 8.7, P < 0.001), intrapartum fever (adjusted odds ratio 11.9, P < 0.001), and history of urinary infection during pregnancy (adjusted odds ratio 4.3, P < 0.05). Young maternal age was also associated with risk of disease. Three-fourths of case mothers had intrapartum fever, < 37 weeks of gestation and/or prolonged rupture of membranes, indicators previously used to select high risk women for intrapartum chemoprophylaxis. Our findings extend data from single hospitals and suggest prenatal screening and selective intrapartum chemoprophylaxis of high-risk mothers could potentially prevent the majority of EOD in the United States.
在少数医院中心开展的研究中确定了B族链球菌（GBS）所致早发型疾病（EOD）的危险因素，这些危险因素是预防指南的基础。我们调查了1991年至1992年期间在1700万多州人口中通过基于实验室的主动监测确定的EOD病例。将99例病例与253例在医院、出生日期和出生体重方面匹配的对照进行比较。28%的病例为早产（妊娠<37周）；53%的病例母亲胎膜破裂>12小时；48%的病例报告有产时发热。各监测地区EOD的发病率在黑人中更高。通过多变量分析，病例母亲比对照更有可能在临产前胎膜破裂（调整后的优势比为8.7，P<0.001）、产时发热（调整后的优势比为11.9，P<0.001）以及孕期有泌尿系统感染史（调整后的优势比为4.3，P<0.05）。母亲年龄小也与患病风险相关。四分之三的病例母亲有产时发热、妊娠<37周和/或胎膜破裂时间延长，这些指标以前用于选择产时进行化学预防的高危妇女。我们的研究结果扩展了来自单一医院的数据，并表明对高危母亲进行产前筛查和选择性产时化学预防有可能预防美国大多数的EOD。
