10例孕母GBS筛查阴性新生儿GBS败血症或合并脑膜炎病例临床分析
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摘要
目的分析孕母筛查B族链球菌(GBS)阴性而新生儿发生GBS败血症或合并脑膜炎的诊治及预后情况。方法回顾性分析2014年6月—2016年10月某院新生儿科收治的10例母亲GBS筛查阴性,新生儿GBS败血症或合并脑膜炎的临床资料。结果 10例新生儿中,早发型7例,晚发型3例。新生儿降钙素原均升高,其中7例为败血症合并脑膜炎,2例头颅MRI平扫示脑膜强化,1例脑白质密度减低。1例单用阿莫西林/舒巴坦治疗,其余均联合用药。1例出生24 h后死亡,其余随访24个月,2例发育落后,其余7例正常。检出的10株GBS对氨苄西林、万古霉素、呋喃妥因、替加环素、青霉素均敏感,对克林霉素、四环素均耐药,对左氧氟沙星、环丙沙星均有3株耐药。结论孕期产前GBS筛查仍有漏诊可能,新生儿GBS败血症或合并脑膜炎病情重,进展迅速,需及时发现并针对性抗感染治疗,必要时联合抗感染治疗。
Objective To analyze the diagnosis,treatment and prognosis of group B streptococcus(GBS)septicemia or combined with meningitis in newborns whose mothers were with negative GBS screening during pregnant period.Methods Clinical data of 10 cases of maternal negative GBS screening but neonatal GBS septicemia or combined with meningitis in department of neonatology from June 2014 to October 2016 were retrospectively analyzed.Results Of the 10 newborns,7 had early onset and 3 had late onset.Neonatal procalcitonin increased in all cases,including 7 cases of septicemia or combined with meningitis,brain MRI showed 2 cases were with meningeal enhancement,and 1 case had decreased white matter density.One case was treated with amoxicillin/sulbactam alone,others were treated with combination of drugs.One case died 24 hours after birth,others were followed up for 24 months,2 cases were underdeveloped and the other 7 cases were normal.Ten strains of GBS were sensitive to ampicillin,vancomycin,furantoin,tigecycline and penicillin,but resistant to clindamycin and tetracycline,levofloxacinand ciprofloxacin-resistant isolates were both 3 strains.Conclusion Prenatal screening during pregnancy is still likely to be missed,neonatal GBS septicemia or combined with meningitis is serious and progresses rapidly,it is necessary to detect and give targeted anti-infective treatment,give combined anti-infective treatment if necessary.
Objective To analyze the diagnosis,treatment and prognosis of group B streptococcus(GBS)septicemia or combined with meningitis in newborns whose mothers were with negative GBS screening during pregnant period.Methods Clinical data of 10 cases of maternal negative GBS screening but neonatal GBS septicemia or combined with meningitis in department of neonatology from June 2014 to October 2016 were retrospectively analyzed.Results Of the 10 newborns,7 had early onset and 3 had late onset.Neonatal procalcitonin increased in all cases,including 7 cases of septicemia or combined with meningitis,brain MRI showed 2 cases were with meningeal enhancement,and 1 case had decreased white matter density.One case was treated with amoxicillin/sulbactam alone,others were treated with combination of drugs.One case died 24 hours after birth,others were followed up for 24 months,2 cases were underdeveloped and the other 7 cases were normal.Ten strains of GBS were sensitive to ampicillin,vancomycin,furantoin,tigecycline and penicillin,but resistant to clindamycin and tetracycline,levofloxacinand ciprofloxacin-resistant isolates were both 3 strains.Conclusion Prenatal screening during pregnancy is still likely to be missed,neonatal GBS septicemia or combined with meningitis is serious and progresses rapidly,it is necessary to detect and give targeted anti-infective treatment,give combined anti-infective treatment if necessary.
引文
[1]朱煜,阚清,周晓玉.新生儿B组链球菌感染的危险因素及预防[J].中国新生儿科杂志,2016,31(3):231-234.
[2]陈红波,孟祥莲,王谢桐.围生期B族链球菌感染的研究现状[J].现代妇产科进展,2015,24(2):149-151.
[3]戴怡蘅,曾立军,高平明.新生儿B族链球菌败血症16例临床分析[J].中国新生儿科杂志,2012,27(1):44-46.
[4]Michael Wessels,蒋佩茹,曹云.围生期新生儿B族链球菌感染[J].中国循证儿科杂志,2011,6(4):241-244.
[5]王海东,王爱华,尹立琴,等.新生儿血清B族链球菌表面蛋白SCPB抗体检测[J].临床儿科杂志,2010,28(3):233-236.
[6]孙丹华,李宣,杨翠芳,等.妊娠晚期B族链球菌带菌状况分析及其对妊娠结局的影响[J].中国综合临床,2014,30(7):764-767.
[7]张梅娟,卢洪萍,袁天明.妊娠晚期B族溶血性链球菌带菌状况对产妇和新生儿的影响[J].中国新生儿科杂志,2017,32(5):365-367.
[8]陈学兵,王沛.孕妇生殖道B群链球菌快速诊断方法探讨[J].中华医院感染学杂志,2010,20(3):443-444.
[9]侯海静.无乳链球菌感染致新生儿化脓性脑膜炎、败血症1例[J].温州医科大学学报,2016,46(11):856-857.
[10]陈丽,吴本清,程涵蓉,等.新生儿B族链球菌败血症合并化脓性脑膜炎五例临床分析[J].中国全科医学,2013,16(8B):2750-2752.
[11]Edmond KM,Kortsalioudaki C,Scott S,et al.Group B streptococcal disease in infants aged younger than 3 months:systematic review and meta-analysis[J].Lancet,2012,379(9815):547-566.
[12]潘千,余加林.新生儿早发型B组链球菌感染的预防和管理[J].儿科药学杂志,2016,22(11):48-52.
[13]王爱华,沈叙庄.新生儿B族链球菌感染分子机制研究进展[J].国际儿科学杂志,2008,35(2):134-136.
[14]Hughes RG,Brocklehurst P,Steer PJ,et al.Stenson BM on behalf of the Royal College of Obstetricians and Gynaecologists.Prevention of early-onset neonatal group B streptococcal disease[S].Green-top Guideline,2017,124:280-305.
[15]Baker CJ,Byington CL,Polin RA,et al.Policy statement-recommendations for the prevention of perinatal group B streptococcal(GBS)disease[J].Pediatrics,2011,128(3):611-616.
[16]何国才,白清,李高.妊娠晚期孕妇B族链球菌感染的研究状况[J].医学综述,2012,18(14):2255-2257.
[17]沈定树,周雪艳.无乳链球菌的研究进展[J].中国微生态学杂志,2008,20(5):518-519.
[18]苏锦珍,吴本清.新生儿溶血链球菌感染的流行病学与病因学进展[J].广东医学,2016,37(16):2505-2507.
[19]申阿东,张桂荣,杨永弘.新生儿B族链球菌感染发病机制及治疗[J].实用儿科临床杂志,1996,11(6):360-361.
[2]陈红波,孟祥莲,王谢桐.围生期B族链球菌感染的研究现状[J].现代妇产科进展,2015,24(2):149-151.
[3]戴怡蘅,曾立军,高平明.新生儿B族链球菌败血症16例临床分析[J].中国新生儿科杂志,2012,27(1):44-46.
[4]Michael Wessels,蒋佩茹,曹云.围生期新生儿B族链球菌感染[J].中国循证儿科杂志,2011,6(4):241-244.
[5]王海东,王爱华,尹立琴,等.新生儿血清B族链球菌表面蛋白SCPB抗体检测[J].临床儿科杂志,2010,28(3):233-236.
[6]孙丹华,李宣,杨翠芳,等.妊娠晚期B族链球菌带菌状况分析及其对妊娠结局的影响[J].中国综合临床,2014,30(7):764-767.
[7]张梅娟,卢洪萍,袁天明.妊娠晚期B族溶血性链球菌带菌状况对产妇和新生儿的影响[J].中国新生儿科杂志,2017,32(5):365-367.
[8]陈学兵,王沛.孕妇生殖道B群链球菌快速诊断方法探讨[J].中华医院感染学杂志,2010,20(3):443-444.
[9]侯海静.无乳链球菌感染致新生儿化脓性脑膜炎、败血症1例[J].温州医科大学学报,2016,46(11):856-857.
[10]陈丽,吴本清,程涵蓉,等.新生儿B族链球菌败血症合并化脓性脑膜炎五例临床分析[J].中国全科医学,2013,16(8B):2750-2752.
[11]Edmond KM,Kortsalioudaki C,Scott S,et al.Group B streptococcal disease in infants aged younger than 3 months:systematic review and meta-analysis[J].Lancet,2012,379(9815):547-566.
[12]潘千,余加林.新生儿早发型B组链球菌感染的预防和管理[J].儿科药学杂志,2016,22(11):48-52.
[13]王爱华,沈叙庄.新生儿B族链球菌感染分子机制研究进展[J].国际儿科学杂志,2008,35(2):134-136.
[14]Hughes RG,Brocklehurst P,Steer PJ,et al.Stenson BM on behalf of the Royal College of Obstetricians and Gynaecologists.Prevention of early-onset neonatal group B streptococcal disease[S].Green-top Guideline,2017,124:280-305.
[15]Baker CJ,Byington CL,Polin RA,et al.Policy statement-recommendations for the prevention of perinatal group B streptococcal(GBS)disease[J].Pediatrics,2011,128(3):611-616.
[16]何国才,白清,李高.妊娠晚期孕妇B族链球菌感染的研究状况[J].医学综述,2012,18(14):2255-2257.
[17]沈定树,周雪艳.无乳链球菌的研究进展[J].中国微生态学杂志,2008,20(5):518-519.
[18]苏锦珍,吴本清.新生儿溶血链球菌感染的流行病学与病因学进展[J].广东医学,2016,37(16):2505-2507.
[19]申阿东,张桂荣,杨永弘.新生儿B族链球菌感染发病机制及治疗[J].实用儿科临床杂志,1996,11(6):360-361.