孕妇B族链球菌筛查,需不需要普及?
创作:Epi汪 审核:Epi汪 2020年01月24日
  • 新生儿早发型B族链球菌疾病(EOGBS)包括败血症、脑膜炎、肺炎等,可通过母亲产道GBS垂直传播;
  • 评估对产妇进行GBS普遍筛查或开展基于风险的筛查(对高风险人群进行筛查)的效果;
  • 共纳入17篇相关文章,GBS的定值率在7%到29%之间,有文献报道了GBS存在对红霉素和克林霉素的耐药;
  • 荟萃分析提示,相比于风险筛查方案,普遍筛查可以减低EOGBS的发病率;
  • 目前没有证据证明筛查会带来抗生素的滥用;
  • 在孕晚期进行GBS的普遍筛查或是有益的。
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Epi汪
目前认为孕妇阴道中B族链球菌(GBS)“定植”可能是新生儿发生感染等危险因素。一些协会指南建议,应该在孕晚期对所有孕妇开展普遍筛查,但业内仍存争议。本荟萃分析证明了普查对新生儿健康的重要意义。在讨论是否将GBS普查纳入到基本产检环节中,必不可少的一项是卫生经济学分析。期待相关更多的研究出现。
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Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset Group B streptococcal disease: a systematic review 

普遍筛检和基于风险的方案对预防早发型B族链球菌疾病的效果:一项系统综述和荟萃分析

10.1111/1471-0528.16085

2020-01-08, Article

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Abstract:收起
Background: Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria to identify eligible women for prophylaxis exist. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), while others employ risk-based protocols.
Search strategy: Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based.
Data collection and analysis: : Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects.
Main results:: 17 eligible studies were included. In this meta-analysis , screening was associated with a reduced risk against EOGBS disease compared either with risk-based protocols (10 studies, RR 0.43, 95% CI 0.32-0.56), or with no policy (4 studies, RR 0.31 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols vs. no policy (7 studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31% vs 29%).
Conclusions: Screening-based protocols were associated with lower incidences of EOGBS disease compared to risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking.

First Authors:
GF Hasperhoven

Correspondence Authors:
BWW Kramer

All Authors:
GF Hasperhoven,S Al-Nasiry,V Bekker,E Villamor,BWW Kramer

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