Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis
Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis
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DOI：
10.1016/s0140-6736(11)61651-6
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发表时间：
2012-02-11
期刊：
影响因子：
168.9
通讯作者：
Heath, Paul T.
中科院分区：
文献类型：
--
作者：
Edmond, Karen M.;Kortsalioudaki, Christina;Heath, Paul T.
背景 尽管广泛使用产时抗生素预防，B 族链球菌仍然是欧洲、美洲和澳大利亚婴儿发病和死亡的主要原因。然而，无法获得这些地区以外许多国家的疾病负担估计。我们的目的是检查当前全球侵袭性疾病的负担以及 B 组链球菌分离株的血清型分布。 方法 我们检索了 Medline、Embase 和 Wholis 数据库，查找有关侵袭性早发型（第 0-6 天）和晚发型（第 7-89 天）B 组链球菌疾病的研究。合格的研究是那些描述发病率、死亡或血清型的研究。我们还审查了参考文献列表并联系了专家以寻找未发表的数据和我们搜索中遗漏的数据。采用随机效应荟萃分析来汇总数据。结果 74 项研究符合纳入标准； 56 项研究报告了发病率、29 项死亡病例和 19 项血清型分布。对自 1980 年 1 月 1 日起报告血清型分布的研究进行了额外检索，共获得 38 篇文章。只有五个低收入国家参与了审查，并为荟萃分析贡献了 5% 的权重。 47 项 (69%) 研究报告了使用任何产时抗生素预防措施。研究之间存在显着的异质性。 0-89 天婴儿中 B 族链球菌的平均发病率为每 1000 例活产 0.53 例 (95% CI 0.44-0.62)，平均病死率为 9.6% (95% CI 7.5-11.8)。早发型 B 族链球菌的发病率（每 1000 个活产 0.43 个[95% CI 0.37-0.49]）和病死率（12.1%，[6.2-18.3]）是晚发疾病的两倍。血清型 III (48.9%) 是所有有可用数据的地区中最常见的血清型，其次是血清型 Ia (22.9%)、Ib (7.0%)、II (6.2%) 和 V (9.1%)。与未使用预防措施的研究（每 1000 例活产 0.75 例 [0.58-0.89]）相比，报告使用任何产时抗生素预防的研究与早发型 B 族链球菌发生率较低相关（每 1000 例活产 0.23 例 [95% CI 0.13-0.59]）。 解释 需要更多高质量的研究来准确估计 B 族链球菌的全球负担，特别是在低收入国家。包含五种血清型（Ia、Ib、II、III、V）的结合疫苗可以预防全球大多数 B 组链球菌疾病。
Background Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mortality in infants in Europe, the Americas, and Australia. However, estimates of disease burden in many countries outside of these regions is not available. We aimed to examine the current global burden of invasive disease and the serotype distribution of group B streptococcus isolates.Methods We searched Medline, Embase, and Wholis databases for studies on invasive early-onset (day 0-6) and late-onset (day 7-89) group B streptococcal disease. Eligible studies were those that described incidence, deaths, or serotypes. We also reviewed reference lists and contacted experts to seek unpublished data and data missed by our search. Random effects meta-analysis was used to pool data.Findings 74 studies met the inclusion criteria; 56 studies reported incidence, 29 case fatality, and 19 serotype distribution. An additional search for studies that reported serotype distribution from Jan 1, 1980, yielded a total of 38 articles. Only five low-income countries were represented in the review and contributed 5% weight to the meta-analysis. 47 (69%) studies reported use of any intrapartum antibiotic prophylaxis. Substantial heterogeneity existed between studies. Mean incidence of group B streptococcus in infants aged 0-89 days was 0.53 per 1000 livebirths (95% CI 0.44-0.62) and the mean case fatality ratio was 9.6% (95% CI 7.5-11.8). Incidence of early-onset group B streptococcus (0.43 per 1000 livebirths [95% CI 0.37-0.49]) and case fatality (12.1%, [6.2-18.3]) were two-times higher than late-onset disease. Serotype III (48.9%) was the most frequently identified serotype in all regions with available data followed by serotypes Ia (22.9%), Ib (7.0%), II (6.2%), and V (9.1%). Studies that reported use of any intrapartum antibiotic prophylaxis were associated with lower incidence of early-onset group B streptococcus (0.23 per 1000 livebirths [95% CI 0.13-0.59]) than studies in which patients did not use prophylaxis (0.75 per 1000 livebirths [0.58-0.89]).Interpretation More high-quality studies are needed to accurately estimate the global burden of group B streptococcus, especially in low-income countries. A conjugate vaccine incorporating five serotypes (Ia, Ib, II, III, V) could prevent most global group B streptococcal disease.