孕妇B族链球菌定植及其早产儿感染状况的研究
|
摘要
目的探讨孕妇B族溶血性链球菌(GBS)定植及其分娩早产儿的GBS感染状况,评估早产儿GBS定植的危险因素。方法采用前瞻性队列研究方法,纳入2017年1月至2018年1月分娩的859例早产孕妇作为研究对象。入院时采集孕妇阴道下段1/3和直肠拭子行GBS培养,其中515例行实时PCR GBS DNA检测。采集所纳入孕妇分娩的早产儿的口咽分泌物、胃液或血液进行GBS培养。取孕妇外周血及其分娩的早产儿脐血测定抗GBS荚膜多糖抗体水平。调查早产儿GBS感染情况和影响定植的围产因素。结果 859例孕妇阴道、直肠GBS培养阳性率为14.8%(127/859)。515例GBS DNA检测的阳性率为15.1%(78/515)。859例孕妇共分娩活产早产儿976例,其中43例(4.4%)GBS培养阳性;4例发生早发型GBS疾病,其中2例肺炎,2例早发型GBS败血症。127例GBS阳性孕妇分娩的127例早产儿中,34～<37周早产儿组GBS阳性率明显低于<34周早产儿组(P=0.013),抗GBS荚膜多糖抗体水平明显高于<34周早产儿组(P=0.001)。多因素logistic回归分析显示胎膜早破>18 h和绒毛膜羊膜炎是早产儿GBS定植的独立危险因素(分别OR=6.556、6.160,均P<0.05)。结论早产儿GBS阳性率及抗GBS荚膜多糖抗体水平与胎龄相关。胎膜早破>18 h和绒毛膜羊膜炎可增加早产儿GBS定植的风险。[中国当代儿科杂志,2019,21(6):567-572]
Objective To study the incidences of group B streptococcus(GBS) colonization in pregnant women and GBS infection in their preterm infants, and to investigate the risk factors for GBS colonization in preterm infants. Methods A total of 859 women who delivered before term from January 2017 to January 2018 were enrolled in this prospective cohort study. Bacterial culture was performed for GBS using the swabs collected from the rectum and the lower 1/3 of the vagina of the pregnant women on admission. A total of 515 of the above cases underwent real-time PCR assay for testing of GBS DNA. Bacterial culture was performed for GBS using the oropharyngeal secretion, gastric fluid or blood samples in preterm infants born to the 859 pregnant women. Peripheral blood samples from the pregnant women and umbilical cord blood samples from their preterm infants were collected to determine the level of anti-GBS capsular polysaccharide antibody. The incidence of GBS infection and perinatal risk factors for GBS colonization in the preterm infants were examined. Results The positive rate for GBS in the rectal and vaginal cultures was 14.8%(127/859) among the 859 pregnant women, and the positive rate in the GBS DNA testing was 15.1%(78/515). There were 976 livebirth preterm infants delivered by 859 pregnant women, and 4.4%(43/976) of whom were GBS positive. Four preterm infants had early-onset GBS diseases, including pneumonia in two cases and sepsis in two cases. In 127 preterm infants delivered by 127 GBS-positive pregnant women, the preterm infant group with a gestational age between 34 and 37 weeks had a significantly lower GBS positive rate and a significantly higher level of anti-GBS capsular polysaccharide antibody compared with the preterm infant group with a gestational age of less than 34 weeks(P=0.013 and 0.001 respectively). A multivariate logistic regression analysis revealed that premature rupture of membranes time >18 hours and chorioamnionitis were independent risk factors for GBS colonization in preterm infants(OR=6.556 and 6.160 respectively; P<0.05). Conclusions GBS positive rate and anti-GBS capsular polysaccharide antibody level in preterm infants are correlated with gestational age. premature rupture of membranes time >18 hours and chorioamnionitis may increase the risk of GBS colonization in preterm infants. [Chin J Contemp Pediatr, 2019, 21(6): 567-572]
Objective To study the incidences of group B streptococcus(GBS) colonization in pregnant women and GBS infection in their preterm infants, and to investigate the risk factors for GBS colonization in preterm infants. Methods A total of 859 women who delivered before term from January 2017 to January 2018 were enrolled in this prospective cohort study. Bacterial culture was performed for GBS using the swabs collected from the rectum and the lower 1/3 of the vagina of the pregnant women on admission. A total of 515 of the above cases underwent real-time PCR assay for testing of GBS DNA. Bacterial culture was performed for GBS using the oropharyngeal secretion, gastric fluid or blood samples in preterm infants born to the 859 pregnant women. Peripheral blood samples from the pregnant women and umbilical cord blood samples from their preterm infants were collected to determine the level of anti-GBS capsular polysaccharide antibody. The incidence of GBS infection and perinatal risk factors for GBS colonization in the preterm infants were examined. Results The positive rate for GBS in the rectal and vaginal cultures was 14.8%(127/859) among the 859 pregnant women, and the positive rate in the GBS DNA testing was 15.1%(78/515). There were 976 livebirth preterm infants delivered by 859 pregnant women, and 4.4%(43/976) of whom were GBS positive. Four preterm infants had early-onset GBS diseases, including pneumonia in two cases and sepsis in two cases. In 127 preterm infants delivered by 127 GBS-positive pregnant women, the preterm infant group with a gestational age between 34 and 37 weeks had a significantly lower GBS positive rate and a significantly higher level of anti-GBS capsular polysaccharide antibody compared with the preterm infant group with a gestational age of less than 34 weeks(P=0.013 and 0.001 respectively). A multivariate logistic regression analysis revealed that premature rupture of membranes time >18 hours and chorioamnionitis were independent risk factors for GBS colonization in preterm infants(OR=6.556 and 6.160 respectively; P<0.05). Conclusions GBS positive rate and anti-GBS capsular polysaccharide antibody level in preterm infants are correlated with gestational age. premature rupture of membranes time >18 hours and chorioamnionitis may increase the risk of GBS colonization in preterm infants. [Chin J Contemp Pediatr, 2019, 21(6): 567-572]
引文
[1]林新祝,吴健宁,张雪芹,等.晚孕期阴道B族链球菌定植与新生儿感染的关系[J].中华围产医学杂志,2016,19(7):491-496.
[2]Verani JR,McGee L,Schrag SJ,et al.Prevention of perinatal group B streptococcal disease-revised guidelines from CDC,2010[J].MMWR Recomm Rep,2010,59(RR-10):1-36.
[3]Phares CR,Lynfield R,Farley MM,et al.Epidemiology of invasive group B streptococcal disease in the United States,1999-2005[J].JAMA,2008,299(17):2056-2065.
[4]刘婉文.早产儿B族链球菌带菌情况研究[J].实用临床医药杂志,2016,20(1):181-183.
[5]Committee on Infectious Diseases;Committee on Fetus and Newborn;Baker CJ,et al.Policy statement-Recommendations for the prevention of perinatal group B streptococcal(GBS)disease[J].Pediatrics,2011,128(3):611-616.
[6]王丽娟,杜丽君,罗菲菲.新生儿重症监护室新生儿入院时多重耐药菌定植筛查[J].中国感染控制杂志,2014,13(12):714-716.
[7]Madrid L,Seale AC,Kohli-Lynch M,et al.Infant group Bstreptococcal disease incidence and serotypes worldwide:systematic review and meta-analyses[J].Clin Infect Dis,2017,65(Suppl 2):S160-S172.
[8]仝净净,姚开虎,杨永弘.新生儿B族链球菌感染预防策略的研究进展[J].中国当代儿科杂志,2014,16(10):1075-1080.
[9]Carrillo-ávila JA,Gutiérrez-Fernández J,González-Espín AI,et al.Comparison of qPCR and culture methods for group B Streptococcus colonization detection in pregnant women:evaluation of a new qPCR assay[J].BMC Infect Dis,2018,18(1):305.
[10]郑雪艳,韦红.实时荧光定量聚合酶链反应检测妊娠晚期孕妇和新生儿B族溶血性链球菌价值的系统评价和Meta分析[J].中国循证儿科杂志,2015,10(3):187-192.
[11]Van Dyke MK,Phares CR,Lynfield R,et al.Evaluation of universal antenatal screening for group B streptococcus[J].NEngl J Med,2009,360(25):2626-2636.
[12]Todorova-Christova M,Vacheva R,Decheva A,et al.A study on early-onset neonatal group B streptococcal infection,Bulgaria,2007-2011[J].Arch Pediatr,2014,21(9):953-960.
[13]Currie AJ,Curtis S,Strunk T,et al.Preterm infants have deficient monocyte and lymphocyte cytokine responses to group B streptococcus[J].Infect Immun,2011,79(4):1588-1596.
[14]Dangor Z,Kwatra G,Izu A,et al.Review on the association of Group B Streptococcus capsular antibody and protection against invasive disease in infants[J].Expert Rev Vaccines,2015,14(1):135-149.
[15]Baker CJ,Carey VJ,Rench MA,et al.Maternal antibody at delivery protects neonates from early onset group Bstreptococcal disease[J].J Infect Dis,2014,209(5):781-788.
[16]Christensen KK,Christensen P,Duc G,et al.Correlation between serum antibody-levels against group B streptococci and gestational age in newborns[J].Eur J Pediatr,1984,142(2):86-88.
[17]马延敏,申阿东,张桂荣,等.B组溶血性链球菌抗体对母婴预后的影响[J].中华围产医学杂志,2002,5(4):266-268.
[18]Chen J,Fu J,Du W,et al.Group B streptococcal colonization in mothers and infants in western China:prevalence and risk factors[J].BMC Infect Dis,2018,18(1):291.
[19]Surve MV,Anil A,Kamath KG,et al.Membrane vesicles of group B streptococcus disrupt feto-maternal barrier leading to preterm Birth[J].PLoS Pathog,2016,12(9):e1005816.
[2]Verani JR,McGee L,Schrag SJ,et al.Prevention of perinatal group B streptococcal disease-revised guidelines from CDC,2010[J].MMWR Recomm Rep,2010,59(RR-10):1-36.
[3]Phares CR,Lynfield R,Farley MM,et al.Epidemiology of invasive group B streptococcal disease in the United States,1999-2005[J].JAMA,2008,299(17):2056-2065.
[4]刘婉文.早产儿B族链球菌带菌情况研究[J].实用临床医药杂志,2016,20(1):181-183.
[5]Committee on Infectious Diseases;Committee on Fetus and Newborn;Baker CJ,et al.Policy statement-Recommendations for the prevention of perinatal group B streptococcal(GBS)disease[J].Pediatrics,2011,128(3):611-616.
[6]王丽娟,杜丽君,罗菲菲.新生儿重症监护室新生儿入院时多重耐药菌定植筛查[J].中国感染控制杂志,2014,13(12):714-716.
[7]Madrid L,Seale AC,Kohli-Lynch M,et al.Infant group Bstreptococcal disease incidence and serotypes worldwide:systematic review and meta-analyses[J].Clin Infect Dis,2017,65(Suppl 2):S160-S172.
[8]仝净净,姚开虎,杨永弘.新生儿B族链球菌感染预防策略的研究进展[J].中国当代儿科杂志,2014,16(10):1075-1080.
[9]Carrillo-ávila JA,Gutiérrez-Fernández J,González-Espín AI,et al.Comparison of qPCR and culture methods for group B Streptococcus colonization detection in pregnant women:evaluation of a new qPCR assay[J].BMC Infect Dis,2018,18(1):305.
[10]郑雪艳,韦红.实时荧光定量聚合酶链反应检测妊娠晚期孕妇和新生儿B族溶血性链球菌价值的系统评价和Meta分析[J].中国循证儿科杂志,2015,10(3):187-192.
[11]Van Dyke MK,Phares CR,Lynfield R,et al.Evaluation of universal antenatal screening for group B streptococcus[J].NEngl J Med,2009,360(25):2626-2636.
[12]Todorova-Christova M,Vacheva R,Decheva A,et al.A study on early-onset neonatal group B streptococcal infection,Bulgaria,2007-2011[J].Arch Pediatr,2014,21(9):953-960.
[13]Currie AJ,Curtis S,Strunk T,et al.Preterm infants have deficient monocyte and lymphocyte cytokine responses to group B streptococcus[J].Infect Immun,2011,79(4):1588-1596.
[14]Dangor Z,Kwatra G,Izu A,et al.Review on the association of Group B Streptococcus capsular antibody and protection against invasive disease in infants[J].Expert Rev Vaccines,2015,14(1):135-149.
[15]Baker CJ,Carey VJ,Rench MA,et al.Maternal antibody at delivery protects neonates from early onset group Bstreptococcal disease[J].J Infect Dis,2014,209(5):781-788.
[16]Christensen KK,Christensen P,Duc G,et al.Correlation between serum antibody-levels against group B streptococci and gestational age in newborns[J].Eur J Pediatr,1984,142(2):86-88.
[17]马延敏,申阿东,张桂荣,等.B组溶血性链球菌抗体对母婴预后的影响[J].中华围产医学杂志,2002,5(4):266-268.
[18]Chen J,Fu J,Du W,et al.Group B streptococcal colonization in mothers and infants in western China:prevalence and risk factors[J].BMC Infect Dis,2018,18(1):291.
[19]Surve MV,Anil A,Kamath KG,et al.Membrane vesicles of group B streptococcus disrupt feto-maternal barrier leading to preterm Birth[J].PLoS Pathog,2016,12(9):e1005816.