Effectiveness of Intrapartum Antibiotic Prophylaxis for Prevention of Early-Onset Group B Streptococcal Disease
Effectiveness of Intrapartum Antibiotic Prophylaxis for Prevention of Early-Onset Group B Streptococcal Disease
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DOI：
10.1097/aog.0b013e318280d4f6
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发表时间：
2013-03-01
影响因子：
7.2
通讯作者：
Schrag, Stephanie
中科院分区：
文献类型：
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作者：
Fairlie, Tarayn;Zell, Elizabeth R.;Schrag, Stephanie
目的：评估足月分娩和早产分娩、使用抗生素少于4小时的分娩以及接受克林霉素方案的分娩中分娩期抗生素预防对早发性B族链球菌（GBS）疾病的有效性。我们对2003年至2004年活跃细菌核心监测系统的7，691名出生居民进行了二次分析。我们使用与预防和早发性GBS疾病相关的协变量的倾向评分匹配来评估有效性（1-风险比）的具体分娩期抗生素预防方案对疾病的终点。青霉素或氨苄青霉素预防4小时或更长时间的有效性在足月妊娠中较高，（91%，95%置信区间[CI] +63%至+98%）和早产儿（86%，95% CI +38%至+97%）。克林霉素的有效性显著较低（22%，95% CI -53%至60%）。分娩前使用青霉素或氨苄青霉素预防性治疗2小时或更短至4小时以下的有效性（47%，95% CI -16%至+76%）和产前2小时内使用青霉素或氨苄青霉素预防的有效性（38%，95%CI-17%至+67%）均低于预防持续时间为4小时或更长的有效性。在分娩前4小时或更长时间给予β-内酰胺预防对于预防早发性GBS疾病非常有效。持续时间较短或使用克林霉素的预防效果较差，这加强了卫生保健提供者遵守预防建议的必要性，特别是对于早产、青霉素过敏的妇女和暴露于少于4小时的预防的新生儿。（Obstet Gynecol 2013;121：570-7）DOI：http：//10.1097/AOG.0b013e318280d4f6
OBJECTIVE: To estimate the effectiveness against early-onset group B streptococcal (GBS) disease of intrapartum antibiotic prophylaxis among term and preterm deliveries, deliveries with fewer than 4 hours of antibiotics, and deliveries receiving clindamycin regimens.METHODS: We performed a secondary analysis of the Birthnet cohort, a survey of 7,691 births to residents of the Active Bacterial Core surveillance system from 2003 to 2004. We used propensity score matching on covariates associated with prophylaxis and early-onset GBS disease to evaluate the effectiveness (1-risk ratio) of specific intrapartum antibiotic prophylaxis regimens against the disease end point.RESULTS: The effectiveness of 4 or more hours of prophylaxis with penicillin or ampicillin was high among term (91%, 95% confidence interval [CI] +63% to +98%) and preterm (86%, 95% CI +38% to +97%) neonates. Effectiveness was significantly lower for clindamycin (22%, 95% CI -53% to +60%). The effectiveness of 2 or fewer to fewer than 4 hours of prophylaxis with penicillin or ampicillin before delivery (47%, 95% CI -16% to +76%) and the effectiveness of prophylaxis with penicillin or ampicillin fewer than 2 hours before delivery (38%, 95% CI -17% to +67%) were both lower than the effectiveness of prophylaxis durations at 4 or more hours.CONCLUSION: Beta-lactam prophylaxis given 4 or more hours before delivery is highly effective for prevention of early-onset GBS disease. Prophylaxis of shorter durations or with clindamycin is less effective, reinforcing the need for health care providers to adhere to prevention recommendations, particularly for preterm deliveries, penicillin-allergic women, and neonates exposed to fewer than 4 hours of prophylaxis. (Obstet Gynecol 2013;121:570-7) DOI: http://10.1097/AOG.0b013e318280d4f6