Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010.
Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010.
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DOI：
10.1037/e548432006-001
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
J. Verani;Lesley McGee;S. Schrag
中科院分区：
文献类型：
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作者：
J. Verani;Lesley McGee;S. Schrag
尽管自 20 世纪 90 年代以来在预防围产期 B 族链球菌 (GBS) 疾病方面取得了重大进展，但 GBS 仍然是美国早发新生儿败血症的主要原因。 1996年，CDC与相关专业学会合作，出版了围产期B型链球菌病预防指南（CDC. Prevention of perinatal group B streptococcalise: a public health view. MMWR 1996;45[No. RR-7]）；这些指南于 2002 年更新并重新发布（CDC。预防围产期 B 型链球菌病：CDC 修订指南。MMWR 2002；51[编号 RR-11]）。 2009年6月，召开了临床和公共卫生代表会议，根据2002年指南发布后收集的数据重新评估预防策略。本报告介绍了 CDC 的最新指南，该指南已得到美国妇产科医生学会、美国儿科学会、美国护士助产士学会、美国家庭医师学会和美国微生物学会的认可。当现有证据充分时，建议是根据现有证据提出的；当现有证据不足时，建议是根据专家意见提出的。 2010 年指南的主要变化包括： • 扩大了用于鉴定 GBS 的实验室方法的建议， • 澄清了报告孕妇尿液中检测到的 GBS 所需的菌落计数阈值， • 更新了针对早产或早产胎膜早破妇女的 GBS 筛查和产时化学预防的算法， • 改变了用于化学预防的青霉素 G 的推荐剂量， • 更新了针对患有早产的妇女的预防方案。青霉素过敏，以及 • 针对早发性 GBS 疾病风险的新生儿管理修订算法。在妊娠 35-37 周时对母体 GBS 定植进行普遍筛查并使用产时抗生素预防已导致新生儿早发 GBS 疾病的负担大幅减轻。尽管近年来早发性 GBS 疾病已相对罕见，但自 20 世纪 70 年代以来，母体 GBS 定植率（以及因此在没有产时抗生素预防的情况下发生早发性 GBS 疾病的风险）保持不变。需要继续努力维持和改进在预防 GBS 疾病方面取得的进展。还需要监测产时抗生素预防的潜在不良后果（例如，细菌抗菌素耐药性的出现或非 GBS 新生儿病原体的发生率或严重程度增加）。在缺乏获得许可的 GBS 疫苗的情况下，普遍筛查和产时抗生素预防仍然是预防早发 GBS 疾病的基石。
Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45[No. RR-7]); those guidelines were updated and republished in 2002 (CDC. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR 2002;51[No. RR-11]). In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. This report presents CDC's updated guidelines, which have been endorsed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse-Midwives, the American Academy of Family Physicians, and the American Society for Microbiology. The recommendations were made on the basis of available evidence when such evidence was sufficient and on expert opinion when available evidence was insufficient. The key changes in the 2010 guidelines include the following: • expanded recommendations on laboratory methods for the identification of GBS, • clarification of the colony-count threshold required for reporting GBS detected in the urine of pregnant women, • updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm premature rupture of membranes, • a change in the recommended dose of penicillin-G for chemoprophylaxis, • updated prophylaxis regimens for women with penicillin allergy, and • a revised algorithm for management of newborns with respect to risk for early-onset GBS disease. Universal screening at 35-37 weeks' gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns. Although early-onset GBS disease has become relatively uncommon in recent years, the rates of maternal GBS colonization (and therefore the risk for early-onset GBS disease in the absence of intrapartum antibiotic prophylaxis) remain unchanged since the 1970s. Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. There also is a need to monitor for potential adverse consequences of intrapartum antibiotic prophylaxis (e.g., emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens). In the absence of a licensed GBS vaccine, universal screening and intrapartum antibiotic prophylaxis continue to be the cornerstones of early-onset GBS disease prevention.