Neonatal early-onset blood stream infection caused by group B Streptococcus: analysis of 55 cases / 中华围产医学杂志

ABSTRACT

Objective To investigate the clinical characteristics,prenatal risk factors and antibiotic resistance of neonatal early-onset blood stream infection caused by group B Streptococcus (GBS) and to provide evidence for the management of GBS infection.Methods From January 1,2001 to May 31,2017,55 neonates diagnosed with GBS-associated early-onset blood stream infection in the International Peace Maternity & Child Health Hospital were enrolled.They were divided into two groupsGBS early-onset sepsis (GBS EOS) group (n=40) and bacteremia group (n=15).Clinical data were retrospectively analyzed and compared between the two groups with two independent-samples t test and Chi-square test.Results The incidence of neonatal GBS-associated early-onset blood stream infection was 0.31％o (55/179 738).Those neonates with bacteremia had no clinical manifestations.However,in the GBS EOS group,the main manifestations were respiratory abnormalities [respiratory distress (35％,14/40) and apnea (10％,4/40)],jaundice (40％,16/40) and poor perfusion [low blood pressure,etc.32％(13/40)],and the main abnormal results of blood routine test were increased C-reaction protein [＞10 mg/L,100％ (40/40)] and elevated white blood cell count [＞25 × 109/L,78％ (31/40)].Compared with GBS EOS group,bacteremia group had a lower rate of vaginal delivery [1/15 vs 52％ (21/40),x2=9.549,P-0.002] and higher rates of maternal fever [15/15 vs 55％ (22/40),x2=10.034,P=0.002],chorioamnionitis [15/15 vs 68％ (27/40),x2=6.384,P=0.012] and empirical administration of antibiotics to infants [15/15 vs 70％ (28/40),x2=5.759,P=0.016].All tested GBS strains were susceptible to penicillin,ampicillin and vancomycin,but resistant to clindamycin (42％,22/53) and erythromycin (46％,24/52).Conclusions GBS is one of the predominant pathogens causing neonatal early-onset blood stream infection.Respiratory distress,apnea,jaundice and poor perfusion are the main manifestations.Penicillin and ampicillin are the treatment choice for neonatal early-onset GBS infection.Active and appropriate intrapartum management of pregnancies with high risk of intrauterine GBS infection as well as prophylactic prescription of antibiotics to infants may help to prevent or alleviate the symptoms of neonatal early-onset blood stream infection.