B族链球菌不同侵袭性感染类型临床特征及药敏试验的多中心研究  

Clinical characteristics and antibiotic susceptibility features of different types of invasive infections caused by group B Streptococcus: a multicenter prospective study

作　　者：林新祝 祝垚 林雅茵 刘登礼[2] 许丽萍 钟荣华 刘志芳 陈冬梅[5] 黄仲玲 杨鸿 丘文英 陈超 Lin Xinzhu;Zhu Yao;Lin Yayin;Liu Dengli;Xu Liping;Zhong Ronghua;Liu Zhifang;Chen Dongmei;Huang Zhongling;Yang Hong;Qiu Wenying;Chen Chao(Department of Neonatology, Xiamen Maternal and Child Care Hospital, Xiamen 361003, China;Department of Neonatology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China;Department of Neonatology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China;Department of Neonatology, Quanzhou Maternal and Child Care Hospital, Quanzhou Children's Hospital, Quanzhou 362000, China;Department of Neonatology, Quanzhou Maternal and Child Care Hospital, Quanzhou Children's Hospital, Quanzhou 362000, China;Department of Neonatology, Zhangzhou Zhengxing Hospital, Zhangzhou 363000, China;Department of Neonatology, Longhai First Affiliated Hospital, Longhai 363100, China;Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China)

机构地区：[1]厦门市妇幼保健院新生儿科,361003 [2]厦门大学附属第一医院新生儿科,361003 [3]福建医科大学附属漳州市医院新生儿科,363000 [4]福建医科大学附属龙岩第一医院新生儿科,364000 [5]福建省泉州市妇幼保健院泉州市儿童医院新生儿科,362000 [6]福建省漳州正兴医院新生儿科,363000 [7]福建省龙海市第一医院新生儿科,363100 [8]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华围产医学杂志》2019年第8期597-603,共7页Chinese Journal of Perinatal Medicine

基　　金：福建省医学创新课题(2016-CXB-14);厦门市科技计划重大专项立项(3502Z20171006).

摘　　要：目的分析B族链球菌(group B Streptococcus, GBS)侵袭性早发型GBS感染(early-onset GBS disease, GBS-EOD)和晚发型GBS感染(late-onset GBS disease, GBS-LOD)的临床特征及药敏结果。方法前瞻性纳入2016年1月至2018年6月在由厦门市妇幼保健院等7家三级医院组成的闽西南GBS感染研究协作组住院治疗的96例GBS侵袭性感染患儿,其中,生后<7 d内发病患儿为GBS-EOD组(67例),生后7~89 d发病患儿为GBS-LOD组(29例)。记录GBS-EOD和GBS-LOD患儿的临床资料,对其临床表现、疾病谱、并发症及转归进行比较分析。同时采用纸片法对96株GBS菌株进行药敏试验分析。采用两独立样本t检验、Mann-Whitney U检验、χ2检验或Fisher精确概率法对数据进行统计学分析。结果(1)GBS-EOD组和GBS-LOD组患儿平均发病日龄分别为(15.8±6.7)h(0.5~142.0 h)及(25.0±8.1)d(9~89 d);气促、皮肤苍白、发热、抽搐的发生率分别为68.7%(46/67)与44.8%(13/29)、52.2%(35/67)与17.2%(5/29)、23.9%(16/67)与65.5%(19/29)、7.5%(5/67)与48.3%(14/29),χ2值分别为6.282、10.199、15.146及21.237,GBS-EOD组以气促、皮肤苍白为主,GBS-LOD组以发热、抽搐为主(P值均<0.05)。(2)GBS-EOD组和GBS-LOD组患儿的肺炎、败血症、脑膜炎、败血症+髋关节脓肿、肺炎+败血症、败血症+脑膜炎及肺炎+败血症+脑膜炎的发生率分别为43.3%(29/67)与20.7%(6/29)、9.0%(6/67)与17.2%(5/29)、0.0%(0/67)与3.4%(1/29)、0.0%(0/67)与6.9%(2/29)、31.3%(21/67)与13.8%(4/29)、6.0%(4/67)与31.0%(9/29)、10.4%(7/67)与6.9%(2/29),疾病谱比较差异有统计学意义(Fisher精确概率法,P值均<0.001),其中,GBS-EOD组肺炎的发生率高于GBS-LOD组[85.1%(57/67)与41.4%(12/29),χ2=19.116,P<0.001],但脑膜炎的发生率低于GBS-LOD组[16.4%(11/67)与41.4%(12/29),χ2=6.922,P=0.009]。GBS-EOD组患儿急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)、肺出血、休克、新生儿持续肺动脉高压(persistent pulmonary hypertension of the newborn, PPHObjective To study the clinical manifestations and antibiotic sensitivity features of early- and late-onset invasive infections caused by group B Streptococcus (GBS). Methods A total of 96 infants with invasive GBS infections were enrolled prospectively from seven tertiary hospitals of GBS Infection Research Cooperative Group in southwest Fujian, such as Xiamen Maternal and Child Care Hospital, etc., from January 2016 to June 2018. According to the onset time of infection after birth, they were divided into early-onset GBS disease (GBS-EOD) group (<7 d, n=67) and the late-onset GBS disease (GBS-LOD) group (7-89 d, n=29). Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. Results (1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7%(46/67) vs 44.8%(13/29), 52.2%(35/67) vs 17.2%(5/29), 23.9%(16/67) vs 65.5%(19/29) and 7.5%(5/67) vs 48.3%(14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions.(2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3%(29/67) vs 20.7%(6/29), 9.0%(6/67) vs 17.2%(5/29), 0.0%(0/67) vs 3.4%(1/29), 0.0%(0/67) vs 6.9%(2/29), 31.3%(21/67) vs 13.8%(4/29), 6.0%(4/67) vs 31.0%(9/29) and 10.4%(7/67) vs 6.9%(2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fishe

关 键 词：无乳链球菌 链球菌感染 抗药性 细菌 微生物敏感性试验 多中心研究 

分 类 号：R446.5[医药卫生—诊断学] R722.13[医药卫生—临床医学]