产时抗菌药物预防治疗B族链球菌感染对早发型新生儿败血症发生率及病原菌分布的影响

Effect of intrapartum antibiotic prophylaxis of group B streptococcus infection on the incidence and bacteriological profile of early-onset neonatal sepsis

摘要:

目的 了解产时抗菌药物预防（intrapartum antibiotic prophylaxis，IAP）治疗B族链球菌（Group B streptococcus，GBS）感染对早发型新生儿败血症（early-onset neonatal sepsis，EONS）发生率及病原菌分布的影响。 方法 回顾性分析GBS筛查阳性的494例孕产妇及其所分娩的526例新生儿的临床资料。根据孕产妇是否接受IAP治疗将新生儿分为IAP组（304例）和对照组（222例），比较两组间的各项临床指标、EONS发生率、血培养病原菌分布情况。 结果 IAP组出现异常临床表现的患儿比例显著低于对照组（P<0.001）。IAP组EONS发生率显著低于对照组（P=0.022）。IAP组和对照组EONS患儿血培养检测病原菌种类最多分别为大肠埃希菌（2.3%）和GBS（3.2%）。IAP组氨苄青霉素耐药性大肠埃希菌的检出率显著高于对照组（P=0.029）。 结论 IAP治疗虽可降低GBS阳性孕产妇所娩新生儿的EONS发生率，但IAP治疗后氨苄青霉素耐药性大肠埃希菌感染率升高，提示应强化对EONS患儿血培养结果的监测，根据药敏试验结果及时调整诊疗计划。

Abstract:

Objective To study the effect of intrapartum antibiotic prophylaxis (IAP) of group B streptococcus (GBS) infection on the incidence and bacteriological profile of early-onset neonatal sepsis (EONS). Methods A retrospective analysis was performed on the medical data of 494 pregnant women with positive GBS screening results and 526 neonates born by these women. According to whether the pregnant woman received IAP, the neonates were divided into two groups: IAP (n=304) and control (n=222). The two groups were compared in terms of clinical indices, incidence rate of EONS, and distribution of pathogenic bacteria in blood culture. Results Compared with the control group, the IAP group had a significantly lower proportion of children with abnormal clinical manifestations (P<0.001) and a significantly lower incidence rate of EONS (P=0.022). In the IAP group, Escherichia coli (2.3%) was the most common type of pathogenic bacteria in blood culture of the neonates with EONS, while GBS (3.2%) was the most common type of pathogenic bacteria in the control group. The IAP group had a significantly higher detection rate of ampicillin-resistant Escherichia coli than the control group (P=0.029). Conclusions Although IAP can significantly reduce the incidence rate of EONS in neonates born to pregnant women with positive GBS screening results, the infection rate of ampicillin-resistant Escherichia coli may increase after IAP treatment. Therefore, it is needed to enhance the monitoring of blood culture results of neonates with EONS and timely adjust treatment plan according to drug susceptibility test results.