新生儿B族链球菌侵袭性感染54例临床分析

doi:10.3969/j.issn.2095-9400.2021.04.006

Abstract
Figure/Table
References (20)
Related Citation (15)

Download: PDF (1405 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: To explore the clinical characteristics, perinatal risk factors, drug resistance, treatment and regression of neonatal group B streptococcus (GBS) invasive infection. Methods: Clinical data of 54 neonates, who were admitted to the department of neonatology from January 2014 to June 2020, diagnosed with GBS invasive infection by sterile lacunar culture of blood and cerebrospinal fluid were collected and their perinatal risk factors, clinical manifestations, in vitro drug sensitivity test results, treatment and return were retrospectively analyzed. Results: Of 54 infants with GBS invasive infection, 28 had early-onset infection and 26 had late-onset infection. GBS was detected in both blood and cerebrospinal fluid samples in 13 cases, while GBS was detected only in blood in 36 cases and only in cerebrospinal fluid in 4 cases. Early-onset infections had cyanosis, groaning, shortness of breath and fever as the main symptoms, and were prone to pneumonia, and a small number of them have purulent meningitis. Late-onset infections had fever and poor feeding as the first symptoms, and were easily associated with purulent meningitis. The proportion of early-onset intrauterine infection was higher than late-onset, with significant difference (P<0.05). Three newborns who died had one or more perinatal risk factors. GBS drug susceptibility results showed 100% sensitivity to penicillin, ampicillin, vancomycin, and linezolid. After treatment, 47 cases were cured and discharged, 4 cases were discharged unhealed (due to family give-up), and 3 cases died (all early onset, with fatality rate of 5.5%). The average length of hospital stay was (25.5±15.6)d. Conclusion: For neonates with invasive GBS infection, laboratory pathogenic examinations should be performed according to the clinical characteristics as soon as possible to confirm the diagnosis. Penicillin should be the first choice, and combined with other antibiotics to fight against the infection according to the condition. Perinatal risk factors may be important for neonatal GBS infection. GBS screening and intrapartum antibiotic prevention (IAP) measures for pregnant women can effectively reduce the incidence of neonatal GBS infection.

Key words： neonate group B streptococcus streptococcal infection purulent meningitis perinatal period

Received: 20 October 2020

	Service
	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	LIU Jiahui
	LIU Caixia
	ZHANG Ying
	YANG Jinhong
	JIN Susu
	LI Fangqu

URL:

https://xb.wmu.edu.cn/EN/10.3969/j.issn.2095-9400.2021.04.006 OR https://xb.wmu.edu.cn/EN/Y2021/V51/I4/287

参考文献：
[1] 关小珊, 刘海英, 钟华敏, 等. 广州地区低龄婴儿侵袭性B族链球菌的发病率及临床特征[J]. 中华实用儿科临床杂志, 2016, 31(10): 765-768.
[2] YING Q,WANG S,LOU X,et al.Burden and risk feactors of invasive group B streptococcus disease among neonates in a Chinese maternity hospital[J]. BMC Infeet Dis,2019,19(1): 123.
[3] RUSSELL N J, SEALE A C, O'SULLIVAN C, et al. Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide: systematic review and meta-analyses[J]. Clin Infect Dis, 2017, 65(Suppl2): S152- S159.
[4] KOBAYASHI M, SCHRAG S J, ALDERSON M R, et al. WHO consultation on group B streptococcus vaccine development: report from a meeting held on 27-28 April 2016[J]. Vaccine, 2019, 37(50): 7307-7314.
[5] 中华医学会儿科学分会新生儿学组, 中国医师协会新生儿科医师分会感染专业委员会. 新生儿败血症诊断及治疗专家共识(2019 年版)[J]. 中华儿科杂志, 2019, 57(4): 252-257.
[6] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 466-480, 632-640.
[7] 王莹超, 陆文香, 周莉靖. 新生儿无乳链球菌感染的危险因素及药敏分析[J]. 国际检验医学杂志, 2015(8): 1065- 1067.
[8] 刘泽滨, 陆学东, 林立鹏, 等. 无乳链球菌的研究现状及进展[J]. 检验医学与临床, 2016, 13(14): 2057-2058, 2073.
[9] REINHEIMER C, KEMPF V A, WITTEKINDT B E, et al. Group B streptococcus infections in neonates admitted to a German NICU: Emphasis on screening and adherence topreanalytical
recommendations[J]. Early Hum Dev, 2016, 103: 37-41.
[10] JOUBREL C, TAZI A, SIX A, et al. Group B streptococcus neonatal invasive infections, France 2007-2012[J]. Clin Microbiol Infect, 2015, 21(10): 910-916.
[11] TAMINATO M, FRAM D, TORLONI M R, et al. Screening for group B streptococcus in pregnant women: a systematic review and meta-analysis[J]. Rev Lat Am Enfermagem, 2011, 19(6): 1470-1478.
[12] 李丽红, 肖泽兰, 莫培晖, 等. 糖尿病患者妊娠期感染及免疫状态变化观察[J]. 中华医院感染学杂志, 2016, 26(17): 4047-4049.
[13] BORGHESI A, STRONATI M, FELLAY J. Neonatal group B streptococcal disease in otherwise healthy infants: failure of specific neonatal immune responses[J]. Front Immunol, 2017, 8(4): 215.
[14] VERANI J R, MCGEE L, SCHRAG S J, et al. Prevention of perinatal group B s-treptococcal disease——revised guidelines from CDC, 2010[J]. MMWR Recomm Rep, 2010, 59(RR-10): 1-36.
[15] CAGNO C K, PETTIT J M, WEISS B D. Prevention of perinatal group B streptococcal disease: updated CDC guideline[J]. Am Fam Physician, 2012, 86(1): 59-65.
[16] 时春艳, 曲首辉, 杨磊, 等. 妊娠晚期孕妇B族链球菌带菌状况的检测及带菌对妊娠结局的影响[J]. 中华妇产科杂志, 2010, 45(1): 12-16.
[17] ANTHONY B F, OKADA D M, HOBEL C J. Epidemiology of group B streptococcus: longitudinal observations during pregnancy[J]. J Infect Dis, 1978, 137(5): 524-530.
[18] ZIMMERMANN P, GWEE A, CURTIS N. The controversial role of breast milk in GBS late-onset disease[J]. J Infect, 2017, 74 Suppl 1: S34-S40.
[19] HEATH P T, BALFOUR G, WEISNER A M, et al. Group B streptococcal disease in UK and Irish infants younger than 90 days[J]. Lancet, 2004, 363(9405): 292-294.
[20] MATTHEW A W. Performance standards for antimicrobial susceptibility testing: Sixteenth information supplement [M]. New York: CLSI, 2006: 66-68.