不同类型B群链球菌侵袭性感染的临床特点及药敏特征:一项多中心前瞻性研究

Q4 Medicine

中华围产医学杂志 Pub Date : 2019-08-16 DOI:10.3760/CMA.J.ISSN.1007-9408.2019.08.012

Xinzhu Lin, Yao Zhu, Ya-Lan Lin, Dengli Liu, Liping Xu, Rong-hua Zhong, Zhifang Liu, Dongmei Chen, Zhong-ling Huang, Hong Yang, Wenying Qiu, Chao Chen

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Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. \n \n \nResults \n(1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7% (46/67) vs 44.8% (13/29), 52.2% (35/67) vs 17.2% (5/29), 23.9% (16/67) vs 65.5% (19/29) and 7.5% (5/67) vs 48.3% (14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions. (2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3% (29/67) vs 20.7% (6/29), 9.0% (6/67) vs 17.2% (5/29), 0.0% (0/67) vs 3.4% (1/29), 0.0% (0/67) vs 6.9% (2/29), 31.3% (21/67) vs 13.8% (4/29), 6.0% (4/67) vs 31.0% (9/29) and 10.4% (7/67) vs 6.9% (2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fisher's exact test, all P<0.001). Compared with the GBS-LOD group, the GBS-EOD group had a higher incidence of pneumonia [85.1% (57/67) vs 41.4% (12/29), χ2=19.116, P<0.001] and a lower incidence of meningitis [16.4% (11/67) vs 41.4% (12/29), χ2=6.922, P=0.009]. Complications such as acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, shock and persistent pulmonary hypertension of the newborn (PPHN) occurred much more in the GBS-EOD group than the GBS-LOD group [28.4% (19/67) vs 6.9% (2/29), 13.4% (9/67) vs 0.0% (0/29), 11.9% (8/67) vs 10.3% (3/29), 4.5% (3/67) vs 0.0% (0/29), χ2=13.683, P<0.001]. (3) Among the 96 patients, 23 (24.0%) had meningitis and 73 (76.0%) developed pneumonia and sepsis. Meningitis resulted in a higher fatality rate [17.4% (4/23) vs 4.1% (3/73), χ2=4.564, P=0.035] and longer average hospital stay [(37.2±12.6) vs (14.1±5.3) d, t=7.831, P<0.001] than pneumonia and sepsis. Seven out of the 19 meningitis survivors developed intracranial complications. (4) The overall fatality rate in this study was 7.3% (7/96) and no significant difference was found between GBS-EOD and GBS-LOD group [7.5% (5/67) vs 6.9% (2/29), χ2=0.010, P=0.982]. Among the 67 GBS-EOD infants, 58 (86.6%) occurred within 24 h and five of them died, but no death was reported in the other nine cases occurred after 24 h. (5) Totally 96 strains of GBS were isolated with 100% sensitivity to penicillin, ampicillin, cefazolin and meropenem, and 97% to vancomycin. Around 79.3%-91.0% of GBS isolates were resistant to clindamycin and erythromycin. \n \n \nConclusions \nClinial features vary greatly in GBS-LOD and GBS-EOD cases. Infants with meningitis have poor prognosis. The drug resistance rate of GBS to erythromycin and clindamycin are relatively high. \n \n \nKey words: \nStreptococcus agalactiae; Streptococcal infections; Drug resistance, bacterial; Microbial sensitivity tests; Multicenter study","PeriodicalId":52320,"journal":{"name":"中华围产医学杂志","volume":"22 1","pages":"597-603"},"PeriodicalIF":0.0000,"publicationDate":"2019-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Clinical characteristics and antibiotic susceptibility features of different types of invasive infections caused by group B Streptococcus: a multicenter prospective study\",\"authors\":\"Xinzhu Lin, Yao Zhu, Ya-Lan Lin, Dengli Liu, Liping Xu, Rong-hua Zhong, Zhifang Liu, Dongmei Chen, Zhong-ling Huang, Hong Yang, Wenying Qiu, Chao Chen\",\"doi\":\"10.3760/CMA.J.ISSN.1007-9408.2019.08.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective \\nTo study the clinical manifestations and antibiotic sensitivity features of early- and late-onset invasive infections caused by group B Streptococcus (GBS). \\n \\n \\nMethods \\nA total of 96 infants with invasive GBS infections were enrolled prospectively from seven tertiary hospitals of GBS Infection Research Cooperative Group in southwest Fujian, such as Xiamen Maternal and Child Care Hospital, etc., from January 2016 to June 2018. According to the onset time of infection after birth, they were divided into early-onset GBS disease (GBS-EOD) group (<7 d, n=67) and the late-onset GBS disease (GBS-LOD) group (7-89 d, n=29). Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. \\n \\n \\nResults \\n(1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7% (46/67) vs 44.8% (13/29), 52.2% (35/67) vs 17.2% (5/29), 23.9% (16/67) vs 65.5% (19/29) and 7.5% (5/67) vs 48.3% (14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions. (2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3% (29/67) vs 20.7% (6/29), 9.0% (6/67) vs 17.2% (5/29), 0.0% (0/67) vs 3.4% (1/29), 0.0% (0/67) vs 6.9% (2/29), 31.3% (21/67) vs 13.8% (4/29), 6.0% (4/67) vs 31.0% (9/29) and 10.4% (7/67) vs 6.9% (2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fisher's exact test, all P<0.001). Compared with the GBS-LOD group, the GBS-EOD group had a higher incidence of pneumonia [85.1% (57/67) vs 41.4% (12/29), χ2=19.116, P<0.001] and a lower incidence of meningitis [16.4% (11/67) vs 41.4% (12/29), χ2=6.922, P=0.009]. Complications such as acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, shock and persistent pulmonary hypertension of the newborn (PPHN) occurred much more in the GBS-EOD group than the GBS-LOD group [28.4% (19/67) vs 6.9% (2/29), 13.4% (9/67) vs 0.0% (0/29), 11.9% (8/67) vs 10.3% (3/29), 4.5% (3/67) vs 0.0% (0/29), χ2=13.683, P<0.001]. (3) Among the 96 patients, 23 (24.0%) had meningitis and 73 (76.0%) developed pneumonia and sepsis. Meningitis resulted in a higher fatality rate [17.4% (4/23) vs 4.1% (3/73), χ2=4.564, P=0.035] and longer average hospital stay [(37.2±12.6) vs (14.1±5.3) d, t=7.831, P<0.001] than pneumonia and sepsis. Seven out of the 19 meningitis survivors developed intracranial complications. (4) The overall fatality rate in this study was 7.3% (7/96) and no significant difference was found between GBS-EOD and GBS-LOD group [7.5% (5/67) vs 6.9% (2/29), χ2=0.010, P=0.982]. 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引用次数: 1

摘要

目的探讨B群链球菌（GBS）早期和晚期侵袭性感染的临床表现及抗生素敏感性特点。方法从2016年1月至2018年6月，前瞻性选择厦门市妇幼保健院等闽西南地区七家GBS感染研究合作组三级医院的96例侵袭性GBS感染婴儿。根据出生后感染的发病时间，将其分为早发性GBS病（GBS-EOD）组（<7d，n=67）和晚发性GBS-LOD组（7-89d，n=29）。比较两组患者的临床表现、疾病谱、并发症及转归。药敏试验采用纸片扩散法。采用卡方检验或Fisher精确检验、两个独立样本t检验或Mann-Whitney U检验进行统计分析。结果（1）GBS-EOD组和GBS-LOD组的平均发病年龄分别为（15.8±6.7）h（0.5-142.0 h）和（25.0±8.1）d（9-89 d）。GBS-EOD和GBS-LOD组呼吸急促、面色苍白、发热和惊厥的发生率分别为68.7%（46/67）vs 44.8%（13/29）、52.2%（35/67）vs 17.2%（5/29）、23.9%（16/67）vs 65.5%（19/29）和7.5%（5/67）vs 48.3%（14/29），χ2值分别为6.282、10.199、15.146和21.237（均P<0.05），而GBS-LOD组的大多数患者出现发烧和抽搐。（2）肺炎、败血症、脑膜炎、败血症并发脓毒症关节、肺炎并发败血症、败血症并发脑膜炎和肺炎并发败血症和脑膜炎的发生率分别为43.3%（29/67）vs 20.7%（6/29）、9.0%（6/67）vs 17.2%（5/29）、0.0%（0/67）vs 3.4%（1/29）、0.0%（0/67%）vs 6.9%（2/29）、31.3%（21/67）vs 13.8%（4/29），GBS-EOD和GBS-LOD组分别为6.0%（4/67）对31.0%（9/29）和10.4%（7/67）对6.9%（2/29）。两组疾病谱差异有统计学意义（Fisher精确检验均P＜0.001），GBS-EOD组的肺炎发病率较高[85.1%（57/67）vs 41.4%（12/29），χ2=19.116，P=0.001]，脑膜炎发病率较低[16.4%（11/67）vs 41%（12/29，χ2=6.922，P=0.009]，GBS-EOD组新生儿休克和持续性肺动脉高压（PPHN）的发生率远高于GBS-LOD组[28.4%（19/67）vs 6.9%（2/29），13.4%（9/67）vs 0.0%（0/29），11.9%（8/67）vs 10.3%（3/29），4.5%（3/67）vs 0.0%（0/22），χ2=13.683，P<0.001]。（3）在96名患者中，23名（24.0%）患有脑膜炎，73名（76.0%）患有肺炎和败血症。与肺炎和败血症相比，脑膜炎的病死率[17.4%（4/23）vs 4.1%（3/73），χ2=4.564，P=0.035]更高，平均住院时间更长[（37.2±12.6）vs（14.1±5.3）d，t=7.831，P<0.001]。19名脑膜炎幸存者中有7人出现颅内并发症。（4）本研究的总病死率为7.3%（7/96），GBS-EOD组和GBS-LOD组之间没有显著差异[7.5%（5/67）vs 6.9%（2/29），χ2=0.010，P=0.982]，其余9例24小时后无死亡报告。（5）共分离到96株GBS，对青霉素、氨苄青霉素、头孢唑林和美罗培南的敏感性为100%，对万古霉素的敏感性为97%。GBS分离株对克林霉素和红霉素耐药率约为79.3%-91.0%。结论GBS-LOD和GBS-EOD患者的临床特征差异较大。患有脑膜炎的婴儿预后不良。GBS对红霉素和克林霉素的耐药率较高。关键词：无乳链球菌；链球菌感染；耐药性，细菌；微生物敏感性试验；多中心研究

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Clinical characteristics and antibiotic susceptibility features of different types of invasive infections caused by group B Streptococcus: a multicenter prospective study

Objective To study the clinical manifestations and antibiotic sensitivity features of early- and late-onset invasive infections caused by group B Streptococcus (GBS). Methods A total of 96 infants with invasive GBS infections were enrolled prospectively from seven tertiary hospitals of GBS Infection Research Cooperative Group in southwest Fujian, such as Xiamen Maternal and Child Care Hospital, etc., from January 2016 to June 2018. According to the onset time of infection after birth, they were divided into early-onset GBS disease (GBS-EOD) group (<7 d, n=67) and the late-onset GBS disease (GBS-LOD) group (7-89 d, n=29). Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. Results (1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7% (46/67) vs 44.8% (13/29), 52.2% (35/67) vs 17.2% (5/29), 23.9% (16/67) vs 65.5% (19/29) and 7.5% (5/67) vs 48.3% (14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions. (2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3% (29/67) vs 20.7% (6/29), 9.0% (6/67) vs 17.2% (5/29), 0.0% (0/67) vs 3.4% (1/29), 0.0% (0/67) vs 6.9% (2/29), 31.3% (21/67) vs 13.8% (4/29), 6.0% (4/67) vs 31.0% (9/29) and 10.4% (7/67) vs 6.9% (2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fisher's exact test, all P<0.001). Compared with the GBS-LOD group, the GBS-EOD group had a higher incidence of pneumonia [85.1% (57/67) vs 41.4% (12/29), χ2=19.116, P<0.001] and a lower incidence of meningitis [16.4% (11/67) vs 41.4% (12/29), χ2=6.922, P=0.009]. Complications such as acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, shock and persistent pulmonary hypertension of the newborn (PPHN) occurred much more in the GBS-EOD group than the GBS-LOD group [28.4% (19/67) vs 6.9% (2/29), 13.4% (9/67) vs 0.0% (0/29), 11.9% (8/67) vs 10.3% (3/29), 4.5% (3/67) vs 0.0% (0/29), χ2=13.683, P<0.001]. (3) Among the 96 patients, 23 (24.0%) had meningitis and 73 (76.0%) developed pneumonia and sepsis. Meningitis resulted in a higher fatality rate [17.4% (4/23) vs 4.1% (3/73), χ2=4.564, P=0.035] and longer average hospital stay [(37.2±12.6) vs (14.1±5.3) d, t=7.831, P<0.001] than pneumonia and sepsis. Seven out of the 19 meningitis survivors developed intracranial complications. (4) The overall fatality rate in this study was 7.3% (7/96) and no significant difference was found between GBS-EOD and GBS-LOD group [7.5% (5/67) vs 6.9% (2/29), χ2=0.010, P=0.982]. Among the 67 GBS-EOD infants, 58 (86.6%) occurred within 24 h and five of them died, but no death was reported in the other nine cases occurred after 24 h. (5) Totally 96 strains of GBS were isolated with 100% sensitivity to penicillin, ampicillin, cefazolin and meropenem, and 97% to vancomycin. Around 79.3%-91.0% of GBS isolates were resistant to clindamycin and erythromycin. Conclusions Clinial features vary greatly in GBS-LOD and GBS-EOD cases. Infants with meningitis have poor prognosis. The drug resistance rate of GBS to erythromycin and clindamycin are relatively high. Key words: Streptococcus agalactiae; Streptococcal infections; Drug resistance, bacterial; Microbial sensitivity tests; Multicenter study

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来源期刊

中华围产医学杂志 Medicine-Obstetrics and Gynecology

CiteScore

0.70

自引率

0.00%

发文量

4446

期刊介绍： Chinese Journal of Perinatal Medicine was founded in May 1998. It is one of the journals of the Chinese Medical Association, which is supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by Peking University First Hospital. Perinatal medicine is a new discipline jointly studied by obstetrics and neonatology. The purpose of this journal is to "prenatal and postnatal care, improve the quality of the newborn population, and ensure the safety and health of mothers and infants". It reflects the new theories, new technologies, and new progress in perinatal medicine in related disciplines such as basic, clinical and preventive medicine, genetics, and sociology. It aims to provide a window and platform for academic exchanges, information transmission, and understanding of the development trends of domestic and foreign perinatal medicine for the majority of perinatal medicine workers in my country.