The Changing Face of Early-onset Neonatal Sepsis After the Implementation of a Maternal Group B Streptococcus Screening and Intrapartum Prophylaxis Policy-A Study in One Medical Center
The Changing Face of Early-onset Neonatal Sepsis After the Implementation of a Maternal Group B Streptococcus Screening and Intrapartum Prophylaxis Policy-A Study in One Medical Center
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DOI：
10.1016/j.pedneo.2011.02.001
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发表时间：
2011-04-01
影响因子：
2.1
通讯作者：
Chen, Chie-Pein
中科院分区：
文献类型：
--
作者：
Lin, Chia-Ying;Hsu, Chyong-Hsin;Chen, Chie-Pein
背景：早发型脓毒症（EOS）是新生儿发病和死亡的主要原因。我院于2004年对产妇进行了B族链球菌（GBS）筛查和产时预防性抗生素（IAP）。我们的目的是评估该计划的有效性和病原体和抗生素敏感性的变化。方法：2001年1月至2008年11月之间的母亲和婴儿EOS的病历进行了回顾性分析。EOS定义为出生后72小时内发生的败血症。从2001年1月到2004年9月，（第1阶段，无GBS筛查）和2004年10月至2008年11月（第2阶段，GBS筛查和IAP）。结果：GBS筛查率从2004年的10.11%提高到2008年的65%，IAP率从2004年的40%提高到2008年的90%。第1阶段最常见的EOS病原体为GBS（45.4%），第2阶段降至20%（p = 0.081;趋势p = 0.009）。第1阶段大肠埃希菌导致的EOS百分比为40.9%，但在第2阶段增加至70%（p = 0.059）。从第1阶段到第2阶段，体重为500-1000 g的极低出生体重早产儿的大肠杆菌EOS增加（p = 0.031）。氨苄西林耐药大肠埃希菌EOS的发生率较高，但实施GBS筛查和IAP后EOS的发生率无明显变化（88.9%vs.92.9%）。结论：GBS筛查联合IAP可有效降低GBS EOS的发生率，但大肠埃希菌引起的EOS的发生率有所增加。监测引起EOS的病原体对于有效治疗是重要的。版权所有（C）2011，台湾儿科医学会.出版社：Elsevier Taiwan LLC All rights reserved.
Background: Early-onset sepsis (EOS) is the major cause of neonatal morbidity and mortality. Maternal group B Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP) were implemented in our hospital in 2004. Our aim was to evaluate the effectiveness of the program and changes in pathogens and antibiotic susceptibility.Methods: The medical charts of mothers and infants with EOS between January 2001 and November 2008 were retrospectively reviewed. EOS was defined as sepsis occurring within 72 hours of birth. Data were pooled and compared for January 2001 through September 2004 (Period 1, without GBS screening) and October 2004 through November 2008 (Period 2, with GBS screening and IAP).Results: The GBS screening rate increased from 10.11% in 2004 to 65% in 2008 and the IAP rate increased from 40% in 2004 to 90% in 2008. The most common EOS pathogen in Period 1 was GBS (45.4%), which decreased to 20% in Period 2 (p = 0.081; trend p = 0.009). The percentage of EOS because of Escherichia coli in Period 1 was 40.9% but increased to 70% in Period 2 (p = 0.059). E coli EOS increased in extremely low birth weight premature babies weighing 500-1000 g from Period 1 to Period 2 (p = 0.031). The incidence of ampicillin-resistant E coli EOS was relatively high, but no significant change (88.9% vs. 92.9%) after implementation of GBS screening and IAP was noted.Conclusion: GBS screening plus IAP is effective in decreasing the incidence of GBS EOS; however, an increase in EOS caused by E coli was noted. Monitoring of pathogens causing EOS is important for effective treatment. Copyright (C) 2011, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.