Group B Streptococcus Late-Onset Disease: 2003-2010
Group B Streptococcus Late-Onset Disease: 2003-2010
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DOI：
10.1542/peds.2012-1231
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发表时间：
2013-02-01
期刊：
影响因子：
8
通讯作者：
Ferrari, Fabrizio
中科院分区：
文献类型：
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作者：
Berardi, Alberto;Rossi, Cecilia;Ferrari, Fabrizio
背景：关于B组链球菌（GBS）迟发性疾病（LOD）的基于人群的数据不足。GBS传播的危险因素和途径知之甚少。方法：进行了一项前瞻性队列研究，以收集8年期间（2003-2010年）LOD的发病率数据，并评估GBS感染。从2007年1月开始，产妇直肠阴道和母乳培养定期收集确认的LOD诊断，以评估产妇GBS文化status.RESULTS：LOD的发病率为0.32每1000活产（1.4和0.24每1000活产早产儿和足月新生儿，分别）。登记的LOD病例（n = 100）被分类为败血症（n = 57）、脑膜炎（n = 36）或局灶性感染（n = 7）。30例新生儿为早产儿（2例复发感染）; 68例为足月儿。4例婴儿死亡（3例早期早产，1例足月）。在LOD诊断得到确认时，53名母亲中有3名（6%）患有GBS乳腺炎，47名母亲中有30名（64%）在直肠阴道部位携带GBS。早期（7-30天）LOD表现与新生儿脑损伤或死亡相关（比值比：0.96 [95%置信区间：0.93-0.99]）。产时抗生素暴露与轻度（12/22）而非重度（11/45; P = 0.03）LOD.CONCLUSIONS：早产儿LOD和死亡率最高。大多数母亲在LOD诊断时携带GBS，而6%患有乳腺炎。产时抗生素与延迟出现症状和轻度LOD相关。儿科2013;131：e361-e368
BACKGROUND: There is insufficient population-based data on group B streptococcus (GBS) late-onset disease (LOD). Risk factors and routes of GBS transmission are poorly understood.METHODS: A prospective, cohort study was conducted to collect incidence data on LOD and evaluate GBS infections over an 8-year period (2003-2010). Starting from January 2007, maternal rectovaginal and breast milk cultures were routinely collected on confirmation of the LOD diagnosis to assess maternal GBS culture status.RESULTS: The incidence rate of LOD was 0.32 per 1000 live births (1.4 and 0.24 per 1000 live births for preterm and term newborns, respectively). The registered cases of LOD (n = 100) were classified as sepsis (n = 57), meningitis (n = 36), or focal infection (n = 7). Thirty neonates were preterm (2 had recurrent infection); 68 were term. Four infants died (3 early preterm, 1 term). At the time the LOD diagnosis was confirmed, 3 (6%) of 53 mothers had GBS mastitis, and 30 (64%) of 47 carried GBS at the rectovaginal site. Early (7-30 days) LOD presentation was associated with neonatal brain lesions or death (odds ratio: 0.96 [95% confidence interval: 0.93-0.99]). Intrapartum antibiotic exposure was significantly associated with mild (12 of 22) rather than severe (11 of 45; P = .03) LOD.CONCLUSIONS: Preterm neonates had the highest rates of LOD and mortality. Most mothers carried GBS at the time of the LOD diagnosis, whereas 6% had mastitis. Intrapartum antibiotics were associated both with delayed presentation of symptoms and milder LOD. Pediatrics 2013;131:e361-e368