中性粒细胞与淋巴细胞比值对妊娠晚期B族链球菌感染孕妇发生胎膜早破的影响

 目的 探讨中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对妊娠晚期B族链球菌(group B streptococcus,GBS)感染孕妇发生胎膜早破的影响。方法 收集2017年6-11月在医院就诊的114例GBS阳性者为研究对象,根据是否发生胎膜早破将其分为胎膜早破组(31例)和非胎膜早破组(83例)。比较两组孕妇NLR的差异。结果 胎膜早破组NLR值(中位数为4.10,四分位数间距3.34~4.78)高于非胎膜早破组NLR值(中位数为3.56,四分位数间距2.86~4.36),差异具有统计学意义(P=0.019)。多因素logistic分析显示,NLR是GBS孕妇发生胎膜早破的独立预后因素,高NLR值患者发生胎膜早破的风险是低NLR值患者的3.029倍(95%CI为1.203～7.632)(P=0.019)。结论 NLR是GBS阳性孕妇发生胎膜早破的独立预后因素,对于GBS感染的高NLR孕妇应加强管理,及早采取预防措施,预防胎膜早破的发生。     

Evaluation of 5-day therapy with telithromycin, a novel ketolide antibacterial, for the treatment of tonsillopharyngitis

A pooled analysis of two double-blind, multicentre, Phase III studies compared oral telithromycin 800 mg once-daily for 5 days with penicillin V 500 mg three-times-daily or clarithromycin 250 mg twice-daily for 10 days in the treatment of Streptococcus pyogenes (group A beta-haemolytic streptococcus; GABHS) tonsillopharyngitis. Patients aged > or = 13 years with acute GABHS tonsillopharyngitis were randomised to receive telithromycin (n = 430), penicillin (n = 197) or clarithromycin (n = 231). Clinical isolates of S. pyogenes (n = 590) obtained from throat swab samples on study entry were tested for their in-vitro susceptibility to telithromycin, clarithromycin and azithromycin. Telithromycin demonstrated in-vitro activity against the clinical isolates of S. pyogenes (MIC50/90 0.03/0.06 mg/L) higher than clarithromycin or azithromycin (MIC50/90 0.06/0.06 mg/L and 0.12/0.25 mg/L, respectively), including erythromycin-resistant strains. At the post-therapy/test of cure (TOC) visit (days 16-23), satisfactory bacteriological outcome was demonstrated for 88.3% (234/265) and 88.6% (225/254) of telithromycin- and comparator-treated patients, respectively (per-protocol population). Overall, GABHS eradication rates were 88.7% (235/265) for telithromycin and 89.0% (226/254) for comparators. The clinical cure rates at the post-therapy/TOC visit were 93.6% (248/265) and 90.9% (220/242) for telithromycin and pooled comparators, respectively. Telithromycin was generally well-tolerated. Most adverse events considered to be possibly related to study medication were gastrointestinal and of mild intensity. Discontinuations as a result of adverse events were few in both treatment groups. In conclusion, telithromycin 800 mg once-daily for 5 days was as effective as penicillin V or clarithromycin for 10 days in the treatment of GABHS tonsillopharyngitis.     

Measuring resistance to phagocytosis of group A and G streptococci: comparison of direct bactericidal assay and flow cytometry

M protein is thought to contribute to the ability of non-opsonized group A and group G streptococci (GAS and GGS, respectively) to resist phagocytosis by polymorphonuclear leukocytes. In previous studies, correlation between M protein expression and phagocytosis was determined by incubating these pathogens in human blood and comparing colony-forming bacterial counts prior to and after exposure to blood (direct bactericidal assay; DBA). Here, we report the application of flow cytometry to measure GAS and GGS resistance to phagocytosis. The results of the assays were in complete agreement with those from DBAs. Nevertheless, flow cytometry was regarded as superior to DBA because of its speed and potential uses for quantitative studies. In addition, the use of anti-CD1 1b monoclonal antibody for granulocyte staining guaranteed a non-compromized granulocyte function. The optimized protocol for flow cytometry presented here could be utilized to directly measure the involvement of individual protein types in bacterial resistance to phagocytosis     

Cost-effectiveness of a potential group B streptococcal vaccine for pregnant women in the United States

BackgroundIn the U.S., intrapartum antibiotic prophylaxis (IAP) for pregnant women colonized with group B streptococcus (GBS) has reduced GBS disease in the first week of life (early-onset/EOGBS). Nonetheless, GBS remains a leading cause of neonatal sepsis, including 1000 late-onset (LOGBS) cases annually. A maternal vaccine under development could prevent EOGBS and LOGBS.MethodsUsing a decision-analytic model, we compared the public health impact, costs, and cost-effectiveness of five strategies to prevent GBS disease in infants: (1) no prevention; (2) currently recommended screening/IAP; (3) maternal GBS immunization; (4) maternal immunization with IAP when indicated for unimmunized women; (5) maternal immunization plus screening/IAP for all women. We modeled a pentavalent vaccine covering serotypes 1a, 1b, II, III, and V, which cause almost all GBS disease.ResultsIn the base case, screening/IAP alone prevents 46% of EOGBS compared to no prevention, at a cost of $70,275 per quality-adjusted life-year (QALY) from a healthcare and $51,249/QALY from a societal perspective (2013 US$). At coverage rates typical of maternal vaccines in the U.S., a pentavalent vaccine alone would not prevent as much disease as screening/IAP until its efficacy approached 90%, but would cost less per QALY. At vaccine efficacy of ≥70%, maternal immunization together with IAP for unimmunized women would prevent more disease than screening/IAP, at a similar cost/QALY.ConclusionsGBS maternal immunization, with IAP as indicated for unvaccinated women, could be an attractive alternative to screening/IAP if a pentavalent vaccine is sufficiently effective. Coverage, typically low for maternal vaccines, is key to the vaccine’s public health impact.     

儿童A族链球菌致链球菌中毒性休克综合征4例临床分析及文献回顾

目的 提高临床医生对A族链球菌(group A streptococcus,GAS)所致链球菌中毒性休克综合征(streptococcal toxic shock syndrome,STSS)的认识.方法 对首都医科大学附属北京儿童医院儿童重症监护病房(PICU)2011年1月至2016年12月明确诊断为GAS感染相关性STSS患儿的临床病例进行回顾性分析;同时对国内相关疾病的文献报道进行总结回顾.结果 我院PICU共收治4例GAS致STSS患儿,均发生于2013-2014年冬季,年龄0.6～6岁.初诊时均无特异性临床表现,第2次就诊时已进展至失代偿性休克且合并多脏器损害.本组4例GAS均对β内酰胺类药物敏感,对大环内酯类、林可霉素类药物耐药.最终3例患儿痊愈出院,1例患儿死亡.结论 STSS的诊断依赖临床医生对其高度的警惕性,并重视在疾病早期收集可疑感染部位的病原学证据,存在休克、脏器损害表现的可疑GAS感染患儿应立即开始治疗.     

冠心病人口腔龈下菌斑中血链球菌、中间普氏菌的比较研究

目的:探讨口腔龈下菌斑中血链球菌、中间普氏菌与冠心病的关系。方法:检查与记录60例研究对象(冠心病组与对照组各30例)的牙龈指数(GI)、菌斑指数(PLI)、牙周袋探诊深度(PD)。应用生化法检测两组研究对象龈下菌斑中的血链球菌数,并用定性随机引物酶链反应法对两组研究对象龈下菌斑中的中间普氏菌进行了鉴定。结果:冠心病组的PD、PLI和龈下菌斑中的血链球菌数及中间普氏菌检出率明显高于对照组(P(0.05)。结论:冠心病组的牙周健康状况相对更差,与冠心病有关的口腔细菌除血链球菌外,龈下菌斑中的中间普氏菌也与冠心病的发病关系密切。     

新生儿B族链球菌侵袭性感染54例临床分析

目的：探讨新生儿B族链球菌（GBS）侵袭性感染的临床特征、围产期危险因素、耐药性、治疗及归转。方法：收集2014年1月至2020年6月温州医科大学附属第二医院育英儿童医院新生儿科收治的54例经血液、脑脊液等无菌腔隙培养确诊为GBS侵袭性感染的新生儿的临床资料,回顾性分析其围产期危险因素、临床表现、体外药物敏感试验结果、治疗与归转。结果：54例新生儿GBS侵袭性感染患儿中早发型感染28例,晚发型感染26例。13例在血液和脑脊液样本中同时检出GBS,36例仅在血液中检出GBS,4例仅在脑脊液中检出GBS。早发型感染以发绀、呻吟、气促及发热为主要症状,易合并肺炎,少数合并化脓性脑膜炎;晚发型感染以发热、喂养差为首发症状,易合并化脓性脑膜炎。早发型宫内感染比例高于晚发型,差异有统计学意义（P＜0.05）;死亡的3例新生儿均有一项或多项围产期危险因素。GBS药敏结果显示对青霉素、氨苄青霉素、万古霉素、利奈唑胺均100%敏感。经治疗后,47例治愈出院,4例未愈出院（家属放弃治疗）,3例死亡（均为早发型,病死率5.5%）。平均住院时间（25.5±15.6）d。结论：对GBS侵袭性感染的新生儿,根据临床特征应尽早行实验室病原学检查以明确诊断,将青霉素作为首选用药,后根据病情联合其他抗生素抗感染。围产期危险因素可能为新生儿GBS感染的重要危险因素,对孕妇开展GBS筛查和产时抗生素预防措施可有效降低新生儿GBS感染的发生。     

深圳市婴儿感染B族链球菌的克林霉素诱导型耐药研究

目的:了解婴儿感染B族链球菌(GBS)的红霉素、克林霉素耐药率及大环内酯鄄林可酰胺鄄链阳菌素B(MLSB)类抗菌药 物耐药表型。方法:采用纸片扩散法检测婴儿感染GBS菌株对红霉素、克林霉素的敏感性,D试验检测红霉素对克林霉素的诱 导耐药性。结果:本研究纳入的患儿中男16例,女15例,年龄3 h~5个月。GBS 对红霉素、克林霉素的耐药率分别为80.6%、 77.4%;对红霉素、克林霉素同时敏感的GBS 3株,占9.7%;对红霉素耐药、对克林霉素敏感的2 株,占6.5%。23 例(92.0%) 内在型耐药(cMLSB),2 例(8.0%)M 型耐药,未发现诱导型耐药。结论:婴儿感染的B 族链球菌对红霉素、克林霉素耐药率高, MLSB 耐药表型以cMLSB 为主,未发现诱导型耐药。