早发性B组链球菌(EOGBS)疾病(包括败血症,脑膜炎,和肺炎)在全球范围内的新生儿中造成重大的发病率和死亡率。抗生素预防可以防止垂直链球菌传播,然而,没有统一的标准来确定合格的预防妇女。一些指南建议对妊娠晚期孕妇进行普遍的GBS筛查(基于筛查的方案),而其他人则采用基于风险的协议。
比较基于筛查与基于风险的方案在预防EOGBS疾病方面的有效性。
数据库搜索的关键词包括GBS,无乳链球菌,怀孕,筛选,以文化为基础,基于风险。
如果他们调查了新生儿的EOGBS疾病发病率,并将筛查或基于风险的方案与彼此或与对照进行比较,则纳入研究。
使用具有随机效应的Mantel-Haenszel分析确定风险比(RR)和95%置信区间(CI)。
纳入了17项符合条件的研究。在这个荟萃分析中,与基于风险的方案相比,筛查与EOGBS疾病风险降低相关(10项研究,RR0.43,95%CI0.32-0.56)或没有政策(四项研究,RR0.31,95%CI0.11-0.84)。荟萃分析不能证明基于风险的方案与没有政策的显著影响(七项研究,RR0.86,95%CI0.61-1.20)。在报告使用抗生素的研究中,筛查与较高的抗生素给药率无关(31%vs.29%).
与基于风险的方案相比,基于筛查的方案与更低的EOGBS发病率相关。虽然没有明显让女性过度使用抗生素。这些信息与未来的决策有关。
Meta分析:一般筛查与早期B组链球菌感染发生率较低相关。新生儿败血症与基于风险的方案比较.
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 exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), whereas others employ risk-based protocols.
To compare the effectiveness of screening-based versus risk-based protocols in preventing EOGBS disease.
Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based.
Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk-based protocols with each other or with controls.
Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects.
Seventeen eligible studies were included. In this meta-analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk-based protocols (ten studies, RR 0.43, 95% CI 0.32-0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols versus no policy (seven 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 versus 29%).
Screening-based protocols were associated with lower incidences of EOGBS disease compared with risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking.
Meta-analysis: general screening is associated with lower rates of early-onset group B strep. neonatal sepsis compared with risk-based protocols.