围产期B群链球菌病的预防——2010年CDC修订指南

IF 33.7 1区 医学 Q1 Medicine
Mmwr Recommendations and Reports Pub Date : 2010-11-19
Jennifer R Verani, Lesley McGee, Stephanie J Schrag
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引用次数: 0

摘要

尽管自20世纪90年代以来,围产期B族链球菌(GBS)疾病的预防取得了实质性进展,但GBS仍然是美国早发性新生儿败血症的主要原因。1996年,疾病预防控制中心与有关专业协会合作,出版了预防围产期B群链球菌病的指导方针。围产期B群链球菌病的预防:公共卫生视角。MMWR 1996; 45[不。RR-7]);这些指南于2002年更新并重新出版(疾病预防控制中心)。围产期B群链球菌病的预防:CDC修订指南。51 MMWR 2002;[不。RR-11])。2009年6月,举行了一次临床和公共卫生代表会议,根据2002年准则发布后收集的数据重新评估预防战略。本报告介绍了CDC的最新指南,该指南已得到美国妇产科医师学会、美国儿科学会、美国护士助产士学会、美国家庭医生学会和美国微生物学会的认可。这些建议是在现有证据充分的情况下根据这些证据提出的,在现有证据不足的情况下根据专家意见提出的。2010年指南的主要变化包括:•扩大了鉴定GBS的实验室方法的建议,•澄清了报告孕妇尿液中检测到的GBS所需的菌落计数阈值,•更新了GBS筛查和早产或早产早破妇女产时化学预防的算法,•改变了化学预防的青霉素- g推荐剂量,•更新了青霉素过敏妇女的预防方案,•关于早发性GBS疾病风险的新生儿管理的修订算法。在妊娠35-37周普遍筛查母体GBS定植和使用产时抗生素预防导致新生儿早发性GBS疾病负担大幅减少。尽管近年来早发性吉兰-巴氏综合征已变得相对罕见,但自20世纪70年代以来,母体吉兰-巴氏综合征定植率(因此,在没有产时抗生素预防的情况下,发生早发性吉兰-巴氏综合征的风险)保持不变。需要继续努力维持和改进在预防GBS疾病方面取得的进展。还需要监测产时抗生素预防的潜在不良后果(例如,细菌抗菌素耐药性的出现或非gbs新生儿病原体发病率或严重程度的增加)。在没有获得许可的GBS疫苗的情况下,普遍筛查和产时抗生素预防仍然是早发性GBS疾病预防的基石。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010.

Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45[No. RR-7]); those guidelines were updated and republished in 2002 (CDC. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR 2002;51[No. RR-11]). In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. This report presents CDC's updated guidelines, which have been endorsed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse-Midwives, the American Academy of Family Physicians, and the American Society for Microbiology. The recommendations were made on the basis of available evidence when such evidence was sufficient and on expert opinion when available evidence was insufficient. The key changes in the 2010 guidelines include the following: • expanded recommendations on laboratory methods for the identification of GBS, • clarification of the colony-count threshold required for reporting GBS detected in the urine of pregnant women, • updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm premature rupture of membranes, • a change in the recommended dose of penicillin-G for chemoprophylaxis, • updated prophylaxis regimens for women with penicillin allergy, and • a revised algorithm for management of newborns with respect to risk for early-onset GBS disease. Universal screening at 35-37 weeks' gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns. Although early-onset GBS disease has become relatively uncommon in recent years, the rates of maternal GBS colonization (and therefore the risk for early-onset GBS disease in the absence of intrapartum antibiotic prophylaxis) remain unchanged since the 1970s. Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. There also is a need to monitor for potential adverse consequences of intrapartum antibiotic prophylaxis (e.g., emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens). In the absence of a licensed GBS vaccine, universal screening and intrapartum antibiotic prophylaxis continue to be the cornerstones of early-onset GBS disease prevention.

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来源期刊
Mmwr Recommendations and Reports
Mmwr Recommendations and Reports PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
36.00
自引率
0.00%
发文量
3
期刊介绍: The MMWR series of publications is published by the Office of Science, Centers for Disease Control and Prevention (CDC), U.S. The MMWR Recommendations and Reports contain in-depth articles that relay policy statements for prevention and treatment in all areas in the CDC’s scope of responsibility (e.g., recommendations from the Advisory Committee on Immunization Practices).
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