Maternal colonisation with group B streptococcus and effectiveness of a culture-based protocol to prevent early-onset neonatal sepsis

This study was conducted to find out the group B streptococcus colonisation of pregnant women in Kocaeli, Turkey. A culture plus individualised high-risk-based antibiotic prophylaxis was compared with high-risk-based approach alone. The screening of women was performed via vaginal and anal cultures for group B streptococcus (GBS). The maternal GBS colonisation rate was found to be 6.5%. All colonised women or preterm labours with unavailable culture results until delivery received prophylactic antibiotics. Neonatal colonisation rate and early-onset neonatal sepsis due to GBS was 1/200. The unscreened 900 women received prophylactic antibiotics due to a risk factor-based approach. The neonatal colonisation rate was 17/900 (p = 0.1), and the rate of early-onset neonatal sepsis was 3/900 (p = 0.6). A culture plus individualised high-risk-based antibiotic prophylaxis provided an insignificant change in neonatal colonisation and early-onset neonatal sepsis with GBS when compared with high-risk-based approach alone.     

B群链球菌免疫层析法的建立及其临床应用

目的建立一种B群链球菌(GBS)的胶体金免疫层析检测方法,并进行临床应用评价。方法收集202例阴道分泌物标本,采用细菌分离培养法作为金标准对标本的GBS进行检测,同时采用以双抗体夹心法为基础研制出B群链球菌胶体金免疫层析试纸条检测作为对照,分析其灵敏度、特异度,计算Kappa值分析两种方法的一致性。结果免疫层析法检测GBS的敏感度为97.50%,特异度为97.54%;与细菌分离培养法的总符合率为97.52%,Kappa值为0.948。结论免疫层析法检测GBS具有较高的敏感度和特异度,且简便准确,对GBS的筛查和快速诊断具有重要的临床应用价值。     

Mediastinal,subcutaneous and multiple muscular abscesses caused by group B streptococcus serotype VIII in a type 2 diabetes mellitus patient

We report a case of mediastinal subcutaneous and multiple muscular abscesses caused by group B streptococcus serotype VIII in a type 2 diabetes mellitus patient. The patient arrived at the hospital with the chief complaint of immobility, and blood examination results suggested an acute infection and poorly controlled diabetes mellitus. Group B streptococcal bacteria were cultured from the patient's blood, and identified as serotype VIII upon further analysis. The patient recovered without any sequelae after percutaneous drainage, antibiotic therapy, and intensive glycemic control. Although the incidence of group B streptococcal infection in non-pregnant adults has recently increased in many developed countries, information on serotype VIII infection is quite limited. The reason is that serotype VIII group B streptococci are a Japan-specific serotype, and rarely cause invasive infections, even in Japan. Therefore, further surveillance and case reports should be documented in the future.     

新生儿B组溶血性链球菌败血症七例诊治分析

目的 分析新生儿B组溶血性链球菌败血症的临床特点及耐药性,为临床治疗提供依据.方法 对2001年1月至2011年8月在我科住院治疗经血培养确诊的7例新生儿B组溶血性链球菌败血症患儿的临床资料、药物敏感试验结果进行回顾性分析.结果 早发感染4例,晚发感染3例;白细胞减少6例,C反应蛋白升高6例,并发化脓性脑膜炎4例,感染性休克3例,弥散性血管内凝血2例.所有菌株对青霉素、万古霉素、利奈唑烷均敏感.结论 应重视新生儿B组溶血性链球菌败血症,青霉素及万古霉素对该菌敏感性较高.     

妊娠晚期B族链球菌带菌状况分析及其对妊娠结局的影响

目的：探讨妊娠晚期 B 族链球菌（GBS）带菌状况以及 GBS 带菌对妊娠结局及围生儿的影响。方法选择妊娠35～37周孕妇520例,取产前阴道下1/3分泌物及肛周分泌物,分娩后胎盘子面和新生儿咽、耳泌物进行 GBS 检测。对带菌状况以及 GBS 带菌对妊娠结局及围生儿的影响进行分析。结果（1）520例孕妇 GBS 阳性检出率为10.19％（53/520）。（2）新生儿 GBS 带菌率为8.85％（46/520）。GBS 阳性母亲的新生儿带菌率（22.64％,12/53）高于阴性母亲（7.28％,34/467）,差异有统计学意义（χ^2=13.928,P ＜0.05）。妊娠晚期 GBS 阳性者,其新生儿肺炎（20.75％,11/53）、上呼吸道感染（18.87％,10/53）发生率高于阴性者（8.57％,40/467;4.71％,22/467）。新生儿 GBS 阳性者的肺炎（21.73％,10/46）、上呼吸道感染（19.56％,9/46）发生率高于阴性者（8.65％,41/474;4.85％,23/474）,差异有统计学意义（χ^2值分别为8.121、15.717,P 均＜0.05）。（3）妊娠晚期 GBS 阳性者胎儿窘迫、宫内感染发生率分别为47.17％（25/53）、15.09％（8/53）,显著高于阴性者[分别为7.07％（33/467）、4.71％（22/467）],差异均有统计学意义（χ^2值分别为77.248、9.440,P 均＜0.05）;而胎膜早破、早产发生率 GBS 阳性者分别为28.30％（15/53）、3.77％（2/53）,与阴性者[分别为28.48％（133/467）、2.36％（11/467）]比较,差异无统计学意义（χ^2值分别为0.001、0.393,P 均＞0.05）。妊娠晚期 GBS 阳性者合并霉菌性阴道炎、前置胎盘比例[39.62％（21/53）、7.55％（4/53）]高于阴性者[20.56％（96/467）、1.93％（9/467）],差异均有统计学意义（χ^2值分别为9.922、6.168,P 均＜0.05）。结论妊娠晚期 GBS 带菌明显增加宫内感染、胎儿窘迫及新生儿感染的发生率,对妊娠结局造成不良影响,应对孕妇常规行 GBS 筛检。     

孕妇生殖道B群链球菌快速检测方法的建立和初步应用

目的建立一种快速、灵敏、特异的PCR检测孕妇生殖道GBS感染的方法。方法根据GBS保守序列:cfb设计特异性扩增引物,优化PCR反应,通过电泳判断结果,同时使用UNG酶,dUTP避免PCR产物污染。结果本研究通过PCR条件的反复摸索,优化了PCR检测方法。同微生物培养方法相比,PCR方法灵敏度更高,检测更快速。直接煮沸法和试剂盒法的DNA提取效率具有差别,试剂盒法更适合临床诊断使用。结论本研究成功建立了快速、灵敏、特异的孕妇生殖道GBSPCR检测方法。     

妊娠晚期B族链球菌感染对孕妇阴道清洁度及不良妊娠结局的影响

目的:探讨妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)感染与阴道清洁度及不良妊娠结局的关系。方法:选择2012年6月至2014年8月在上海市嘉定区妇幼保健院产科检查及分娩的孕35周以上的孕妇共1 864例,常规进行阴道清洁度检测及GBS培养。比较阴道清洁度异常组与正常组孕妇GBS带菌率的情况。观察GBS(+)组与GBS(-)组孕妇胎膜早破、早产、产褥感染的发生情况。结果:1 864例中,GBS阳性率5.15%(96/1 864)。阴道清洁度正常孕妇1 057例,其中GBS阳性率3.60%(38/1 057);阴道清洁度异常孕妇807例,其中GBS阳性率7.19%(58/807),差异有统计学意义(P=0.001)。GBS感染孕妇胎膜早破与产褥感染的发生增加(P0.05),发生风险[比值比(odds ratio,OR)]分别增加13.40倍、2.20倍。结论:阴道清洁度异常者GBS带菌率更高;妊娠晚期GBS感染对围产期结局有不良影响,妊娠晚期应加强GBS检测。     

A case of facial cellulitis caused by group B streptococcus in an extremely low birthweight infant

Group B streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Cellulitis is a rare presentation of late-onset neonatal GBS infection. We report the case of an extremely low birthweight infant with facial cellulitis caused by late-onset GBS infection. A 590-g male neonate was delivered by Cesarean section at 23 gestational weeks due to intrauterine GBS infection. Although he was effectively treated with 2 weeks of antimicrobial therapy for early-onset GBS sepsis, he subsequently developed facial and submandibular cellulitis caused by GBS at 44 days of age. He was treated with debridement and antibiotic therapy, and after 2 months his facial involvement had improved, but cosmetic issues remained. Neonatal GBS infection requires a prompt sepsis workup followed by the initiation of empiric antibiotic therapy. Additionally, lifesaving surgical debridement is sometimes necessary for cellulitis, even in premature infants.     

实时荧光 PCR 技术和细菌培养法检测妊娠晚期孕妇定植B 群链球菌临床分析

目的：探讨应用实时荧光 PCR 技术和细菌培养法检测妊娠晚期孕妇定植 B 群链球菌（GBS）的敏感性。方法采集孕妇生殖道-直肠分泌物拭子2份,一份标本用普通细菌培养法、另一份用实时荧光 PCR 技术检测生殖道 GBS。比较两种方法的准确性、快速性。308例孕妇根据实时荧光 PCR 检测分为 GBS 阳性组与 GBS 阴性组,通过对比较分析 GBS 与发生胎膜早破的关系。结果将308例孕妇进行生殖道 GBS 检测,用普通细菌培养法进行培养有18例阳性,阳性率5．8％（18/308）,实时荧光 PCR检测有29例阳性,阳性率9．4％（29/308）。在 PCR 检测 GBS 阳性组中,发生胎膜早破9例,发生率为31％。在 PCR 检测 GBS阴性组中,发生胎膜早破33例,发生率为11．83％。结论该次调查结果显示实时荧光 PCR 技术的阳性检出率明显高于细菌培养法,应用该法检测技术为 GBS 的快速诊断以及更加准确有效地进行抗菌药物预防提供了依据。     

乐清地区儿童肺炎链球菌耐药性及大环内酯类耐药表型和耐药基因型

目的：了解乐清地区儿童患者分离的肺炎链球菌耐药性及大环内酯类耐药表型和耐药基因型分布情况。方法对2014年乐清地区儿童患者分离的124株肺炎链球菌采用细菌鉴定分析仪进行9种抗菌药物的最低抑菌浓度（MIC）检测,同时对大环内酯类耐药肺炎链球菌用红霉素和克林霉素双纸片协同试验确定其耐药表型,用聚合酶链反应（PCR）扩增这些菌株的耐药基因ermB和mefE。结果124株肺炎链球菌中,红霉素、克林霉素、四环素和复方新诺明的耐药率依次为96.77％、93.55％、84.68％和81.45％;青霉素、氯霉素和左旋氧氟沙星的耐药率较低,分别为20.16％、5.65％和0.81％,未发现对阿莫西林/克拉维酸和万古霉素耐药的菌株。120株大环内酯类耐药肺炎链球菌中,大环内酯类耐药表型cMLS占96.67％、iMLS占0.83％、M型占2.50％;耐药基因ermB检出率为97.50％,mefE的检出率为6.67％。结论乐清地区儿童肺炎链球菌对大环内酯类抗生素的耐药性严重,ermB基因介导的cMLS型耐药是大环内酯类耐药的主要原因,大环内酯类抗生素已不是治疗乐清地区儿童肺炎链球菌感染的有效药物。     

Effects of selective decontamination on gram-negative colonisation, infections and development of bacterial resistance in esophageal resection

Patients undergoing an esophageal resection because of carcinoma are at risk of developing postoperative respiratory tract infections. These patients were studied with respect to preceding colonisation with gram-negative bacilli and the effect of selective decontamination (SD) in decreasing this phenomenon, thereby reducing gram-negative infections. We randomised prospectively 114 patients into a test group receiving SD-medication (n=56) and a control group receiving conventional prophylaxis. Postoperatively, all patients were admitted to the intensive care unit and mechanically ventilated. The preoperative administration of SD-medication resulted in adequate decontamination within 3–4 days in most patients, and SD could prevent gram-negative colonisation and infections effectively. Discontinuation of SD showed gram-negative (re-)colonisation, and resulted in 12 infections in 4 patients having late complications. This indicates that prolonged use in these patients might be beneficial. This new antibiotic prophylaxis proved effective, without causing an increase in bacterial resistance.     

母婴血型不合的新生儿溶血病发生情况及影响因素分析

目的了解母婴血型不合的新生儿溶血病发生情况,并探讨影响其发生的相关因素。方法选取2014年5月至2016年5月该院52例母婴血型不合的新生儿作为研究对象,采用系统性回顾法分析所有患儿的临床资料,统计所有患儿中ABO溶血病的发生情况,并比较所有患儿间年龄、性别等一般临床资料及相关临床检查结果的差异,研究可能影响新生儿ABO溶血病发生的相关因素。结果 (1)52例新生儿中出现新生儿溶血病的有30例(57.69%),发病率较高;(2)通过非条件单因素logistic回归模型分析可得体质量、身高、身体质量指数(BMI)、血红蛋白(HGB)、直接胆红素、间接胆红素、总胆红素和间接胆红素/总胆红素比值及出生时间均可能为影响新生儿溶血病发生的相关因素;(3)通过非条件多因素logistic回归模型分析可得HGB、直接胆红素、间接胆红素、总胆红素和间接胆红素/总胆红素比值及出生时间为新生儿溶血病发生的独立影响因素。结论母婴血型不合的新生儿溶血病发生率较高,患儿出生时间、HGB浓度和相关胆红素的表达水平可为母婴血型不合的新生儿溶血病发生的可能影响因素。     

Global antimicrobial resistance: from surveillance to stewardship. Part 1: surveillance and risk factors for resistance

22nd European Congress of Clinical Microbiology and Infectious Diseases

London, UK, 31 March–3 April 2012

As concerns about global antibiotic resistance shift from Gram-positive to Gram-negative bacteria, the annual congress of the European Society of Clinical Microbiology and Infectious Diseases, in London (UK) provided a valuable opportunity for the nearly 10,000 delegates to discuss the latest global trends. In this first report from the conference, the authors review data from the SMART trial, which recently marked a decade of monitoring antibiotic resistance of Gram-negative bacteria from intra-abdominal infections, and from the rapidly developing European Antimicrobial Resistance Surveillance Network. The authors also focus on the spread of nonmetallo-β-lactamase carbapenemases, and likely risk factors for resistance.     

鲁南地区围产期孕妇B群链球菌携带情况调查及对母婴预后影响的分析

目的:了解本地区在我院分娩的孕晚妇泌尿生殖系B群链球菌的携带状况及对母婴预后的临床影响并对耐药情况进行分析.方法:收集我院产科2015年1月~2016年12月住院孕妇的阴道分泌物、直肠拭子、羊水、中段尿等标本,采用普通培养和B群链球菌(GBS)显色平板并结合CAMP实验分离菌株,采用梅里埃VITEK-2Compact全自动微生物分析系统配套卡进行鉴定及药敏,并对红霉素耐药而克林霉素敏感或中介的菌株进行D实验.结果:共收集住院孕妇的标本2646份,检出B群链球菌147株,分离率5.6%,GBS显色平板的阳性率高于其普通培养(5.4%/4.5%),未发现对青霉素G、氨苄西林、头孢曲松、万古霉素及利奈唑胺耐药菌株,左氧氟沙星耐药率为55.1%,对红霉素(79.6%)及克林霉素(71.4%)耐药严重,其中14株D-试验阳性,其诱导率为9.5%;早产发生率6.8%,胎膜早破57.1%,羊水污染5.4%,产褥感染2.7%,新生儿肺炎1.4,上呼吸道感染10.2%,新生儿败血症3.4%,没有发生不良反应的占6.8%.结论:在分娩产妇对青霉素不过敏的情况下,对预防携带B群链球菌感染用药推荐使用青霉素或氨苄西林;应使临床孕晚产妇泌尿系及直肠内GBS的筛选成常态化,实验室应采用不同方法同时进行避免漏检,对分离的B群链球菌做常规药敏试验,为临床更有效更早期预防和治疗B群链球菌感染提供依据.     

Prevalence of cefotaxime resistance in group B streptococcus isolates from Osaka, Japan

 Streptococcus agalactiae (group B streptococcus; GBS) organisms are a major cause of severe infections, including bacteremia and meningitis in newborns. According to previous reports, GBS organisms are uniformly sensitive to penicillin G (PCG). The susceptibility of 117 strains isolated at Yodogawa Christian Hospital in Osaka, Japan, in 2001 was examined with the WalkAway system, using currently valid National Committee for Clinical Laboratory Standards (NCCLS) interpretive criteria. Twenty-one strains (18%) had intermediate susceptibility and 1 strain (1%) was resistant to PCG. Fifty-one strains (44%) had intermediate susceptibility to ampicillin (ABPC). No ABPC-resistant strain was found. Six GBS strains were selected from the 51 strains showing intermediate susceptibility to ABPC to determine the minimal inhibitory concentrations (MICs). The MICs of the 6 strains were: 1 μg/ml to ABPC, 0.25 μg/ml to PCG, 2 μg/ml to cefotaxime (CTX), 0.016 μg/ml to panipenem (PAPM), and more than 4 μg/ml to erythromycin (EM). These 6 strains were distinctly resistant to CTX. Peak concentrations in excess of three to ten times the bactericidal concentrations at the site of infection are associated with the best clinical response. In meningitis caused by GBS whose susceptibility is intermediate or resistant to PCG or ABPC, it is difficult to maintain a sufficient therapeutic concentration in cerebrospinal fluid after the administration of these two agents. It is preferable to use PAPM, because the efficacy and safety of PAPM in the treatment of purulent meningitis caused by penicillin-resistant Streptococcus pneumoniae were established in Japan. Received: August 12, 2002 / Accepted: December 25, 2002     

Imipenem-resistant Pseudomonas aeruginosa gastrointestinal carriage among hospitalized patients: risk factors and resistance mechanisms

Risk factors for imipenem (IMP)-resistant Pseudomonas aeruginosa (IRPA) digestive carriage were analyzed, and genetic events contributing to select resistant isolates in patients exposed to IMP were investigated. Among the 150 patients with hospital-acquired P. aeruginosa digestive carriage, 38 isolates were IRPA. DNA pulsotypes revealed 16 distinct clones. In 4 patients, a second P. aeruginosa isolate showed resistance to IMP compared with the initial susceptible isolate. By comparing the different oprD sequences between IMP-susceptible P. aeruginosa and IRPA strains, a genetic event was systematically found for each resistant isolate, leading to either the absence of OprD or a truncated porin. The multivariate analysis demonstrated that prior IMP exposure was associated with IRPA carriage. In summary, we confirmed that IMP use selects for IRPA in the gut flora. Cross-transmission, however, was frequently observed in intensive care units. Combining epidemiologic approach and molecular analysis is a powerful tool to delineate mechanisms of emerging resistance.     

Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study

Abstract

Purpose: The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) (“birth asphyxia”) in Uganda. Methods: Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. Findings: Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. Conclusion: Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants.

• Implications for Rehabilitation

• Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers.

• Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking.

• Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants.

     

南京地区健康军人鼻咽部肺炎链球菌定植及耐药性调查

目的　了解南京地区健康青年军人鼻咽部肺炎链球菌的定植状况及其耐药性。方法　2002 年 3 月-2003 年 7 月采集南京地区1 022名健康青年军人鼻咽拭子标本,分离培养肺炎链球菌。用琼脂稀释法测定菌株对6种抗菌药物的MIC。结果　南京地区健康青年军人鼻咽部肺炎链球菌携带率为10.9%(112/1 022)。其中2株(1.8%)菌株低耐青霉素(MIC分别为0.125和0.5 mg/L),青霉素对其他 110 株菌的 MIC在0.004~0.062 mg/L之间,未发现高耐青霉素菌株。所有菌株对阿莫西林、头孢噻肟和万古霉素均敏感,3株(2.7%)菌株低耐氧氟沙星(MIC均为 4 mg/L)。47 株(42%)菌株高耐红霉素并广泛分布于许多个调查单位,其中46株MIC>512 mg/L,仅1株为1 mg/L。结论　南京地区健康青年军人鼻咽部肺炎链球菌定植率处于中等水平。耐青霉素肺炎链球菌发生率很低。耐红霉素发生率较高,均为高度耐药,且分布范围广。     

1999-2008年浙江省东阳市农民工新生儿破伤风流行特征及其危险因素调查

目的了解1999-2008年浙江省东阳市农民工新生儿破伤风(neonatal tetanus,NT)流行病学特征及其危险因素。方法采用描述流行病学方法,对1999-2008年NT专报系统的监测资料和个案调查材料进行统计分析。结果东阳市1999-2008年共报告NT 124例,全年各月均有病例发生,5-10月高发,主要发病为5～9日龄。患儿男性多于女性,男女性别比为2.18∶1。病例主要集中在乡镇企业发达、流动人口聚集的吴宁、江北、白云街道和横店镇等地。患儿以在家中分娩,由未经培训的丈夫及接生婆助产为主,患儿母亲未接受破伤风疫苗(tetanus,vaccine,TV)接种者占90.32%,结论农民工非住院分娩,不清洁接生是发生NT的主要危险因素,卫生知识缺乏,免疫预防意识差是NT发病的另一个重要因素。