Профилактика неонатальных инфекций стрептококковой группы В с ранним началом

R. G. Hughes, P. Brocklehurst, P. J. Steer, P. Heath, B. M. Stenson, C. О. Шурпяк


Целью этого руководства является предоставление рекомендаций для акушеров, акушерок и неонатологов по профилактике неонатальных инфекций стрептококковой группы В с ранним началом (EOGBS), а также предоставление информации женщинам, их партнерам и семьям. Профилактика заболевания стрептококковой группы B (GBS) с поздним началом и лечение установленного заболевания GBS в этом руководстве не рассматриваются.

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Lancefield RC. The antigenic complex of streptococcus hæmolyticus: I. Demonstration of a type‐specific substance in extracts of streptococcus hæmolyticus. J Exp Med 1928;47:91–103. https://doi.org/10.1084/jem.47.1.91

Royal College of Obstetricians and Gynaecologists. Audit of Current Practice in Preventing Early‐Onset Neonatal Group B Streptococcal Disease in the UK. First Report. RCOG: London; 2015. https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/gbs-audit-first-report.pdf

O'Sullivan C, Lamagni T, Efstratiou A, Patel D, Cunney R, Meehan M, et al. P3 Group B Streptococcal (GBS) disease In UK and Irish infants younger than 90 days, 2014–2015. Arch Dis Child 2016;101:A2. http://dx.doi.org/10.1136/archdischild-2016-310863.3

Verani JR, McGee L, Schrag SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease – revised guidelines from CDC, 2010. MMWR Recomm Rep 2010;59:1–36.

Lukacs SL, Schoendorf KC, Schuchat A. Trends in sepsis‐related neonatal mortality in the United States, 1985–1998. Pediatr Infect Dis J 2004;23:599–603. http://dx.doi.org/10.1097/01.inf.0000131633.74921.90

Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, et al. Epidemiology of Invasive Early‐Onset Neonatal Sepsis, 2005 to 2014. Pediatrics 2016;138. https://doi.org/10.1542/peds.2016-2013

Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev 2014;(6):CD007467. https://doi.org/10.1002/14651858.CD007467.pub4

Chaudhuri K, Gonzales J, Jesurun CA, Ambat MT, Mandal‐Chaudhuri S. Anaphylactic shock in pregnancy: a case study and review of the literature. Int J Obstet Anesth 2008;17:350–7. https://doi.org/10.1016/j.ijoa.2008.05.002

Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early‐onset sepsis in very‐low‐birth‐weight infants. N Engl J Med 2002;347:240–7. https://doi.org/10.1056/NEJMoa012657

Moore MR, Schrag SJ, Schuchat A. Effects of intrapartum antimicrobial prophylaxis for prevention of group‐B‐streptococcal disease on the incidence and ecology of early‐onset neonatal sepsis. Lancet Infect Dis 2003;3:201–13. https://doi.org/10.1016/S1473-3099(03)00577-2

UK National Screening Committee. Group B Streptococcus: The UK NSC Policy on Group B Streptococcus Screening in Pregnancy. London: NSC; 2008. www.screening.nhs.uk/groupbstreptococcus

Heyderman RS, Madhi SA, French N, Cutland C, Ngwira B, Kayambo D, et al. Group B streptococcus vaccination in pregnant women with or without HIV in Africa: a non‐randomised phase 2, open‐label, multicentre trial. Lancet Infect Dis 2016;16:546–55. https://doi.org/10.1016/S1473-3099(15)00484-3

McQuaid F, Jones C, Stevens Z, Plumb J, Hughes R, Bedford H, et al. Factors influencing women's attitudes towards antenatal vaccines, group B Streptococcus and clinical trial participation in pregnancy: an online survey. BMJ Open 2016;6:e010790. https://doi.org/10.1136/bmjopen-2015-010790

McQuaid F, Jones C, Stevens Z, Plumb J, Hughes R, Bedford H, et al. Attitudes towards vaccination against group B streptococcus in pregnancy. Arch Dis Child 2014;99:700–1. https://doi.org/10.1136/archdischild-2013-305716

Royal College of Obstetricians and Gynaecologists. Group B Streptococcus (GBS) Infection in Newborn Babies. Information for you. London: RCOG; 2017. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-gbs-pregnancy-newborn.pdf

UK National Screening Committee. UK NSC Group B Streptococcus (GBS) Recommendation. London: UK NSC; 2017.

Turrentine MA, Colicchia LC, Hirsch E, Cheng PJ, Tam T, Ramsey PS, et al. Efficiency of screening for the recurrence of antenatal group B streptococcus colonization in a subsequent pregnancy: a systematic review and meta‐analysis with independent patient data. Am J Perinatol 2016;33:510–17. https://doi.org/10.1055/s-0035-1569988

Tam T, Bilinski E, Lombard E. Recolonization of group B Streptococcus (GBS) in women with prior GBS genital colonization in pregnancy. J Matern Fetal Neonatal Med 2012;25:1987–9. https://doi.org/10.3109/14767058.2012.670331

Page‐Ramsey SM, Johnstone SK, Kim D, Ramsey PS. Prevalence of group B Streptococcus colonization in subsequent pregnancies of group B Streptococcus‐colonized versus noncolonized women. Am J Perinatol 2013;30:383–8. https://doi.org/10.1055/s-0032-1326981

Colicchia LC, Lauderdale DS, Du H, Adams M, Hirsch E. Recurrence of group B streptococcus colonization in successive pregnancies. J Perinatol 2015;35:173–6. https://doi.org/10.1038/jp.2014.185

Turrentine MA, Ramirez MM. Recurrence of group B streptococci colonization in subsequent pregnancy. Obstet Gynecol 2008;112:259–64. https://doi.org/10.1097/AOG.0b013e31817f5cb9

Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol 1996;88:811–5. https://doi.org/10.1016/0029-7844(96)00320-1

Colbourn T, Asseburg C, Bojke L, Philips Z, Claxton K, Ades AE, et al. Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost‐effectiveness and expected value of information analyses. Health Technol Assess 2007;11:1–226. https://doi.org/10.3310/hta11290

Carstensen H, Christensen KK, Grennert L, Persson K, Polberger S. Early‐onset neonatal group B streptococcal septicaemia in siblings. J Infect 1988;17:201–4. https://doi.org/10.1016/S0163-4453(88)96426-2

Faxelius G, Bremme K, Kvist‐Christensen K, Christensen P, Ringertz S. Neonatal septicemia due to group B streptococci‐‐perinatal risk factors and outcome of subsequent pregnancies. J Perinat Med 1988;16:423–30.

Christensen KK, Dahlander K, Linden V, Svenningsen N, Christensen P. Obstetrical care in future pregnancies after fetal loss in group B streptococcal septicemia. A prevention program based on bacteriological and immunological follow‐up. Eur J Obstet Gynecol Reprod Biol 1981;12:143–50. https://doi.org/10.1016/0028-2243(81)90069-1

Allen VM, Yudin MH, Bouchard C, Boucher M, Caddy S, Castillo E, et al.; Infectious Diseases Committee, Society of Obstetricians and Gynaecologists of Canada. Management of group B streptococcal bacteriuria in pregnancy. J Obstet Gynaecol Can 2012;34:482–6. https://doi.org/10.1016/S1701-2163(16)35246-X

Gardner SE, Yow MD, Leeds LJ, Thompson PK, Mason EO Jr, Clark DJ. Failure of penicillin to eradicate group B streptococcal colonization in the pregnant woman. A couple study. Am J Obstet Gynecol 1979;135:1062–5. https://doi.org/10.1016/0002-9378(79)90737-3

Kabiri D, Hants Y, Yarkoni TR, Shaulof E, Friedman SE, Paltiel O, et al. Antepartum membrane stripping in GBS carriers, is it safe? (The STRIP‐G Study). PLoS ONE 2015;10:e0145905. https://doi.org/10.1371/journal.pone.0145905

National Institute for Health and Clinical Excellence. Caesarean Section. NICE clinical guideline 132. London: NICE; 2011.

Ramus RM, McIntire DD, Wendel Jr GD. Antibiotic chemoprophylaxis for group B strep is not necessary with elective cesarean section at term. Am J Obstet Gynecol 1999;180:S85. https://doi.org/10.1016/S0002-9378(99)80084-2

Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, et al. International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes. Am J Obstet Gynecol 1998;179:635–9. https://doi.org/10.1016/S0002-9378(98)70056-0

National Institute for Health and Clinical Excellence. Inducing labour. NICE clinical guideline 70. London: NICE; 2008.

Oddie S, Embleton ND. Risk factors for early onset neonatal group B streptococcal sepsis: case–control study. BMJ 2002;325:308. https://doi.org/10.1136/bmj.325.7359.308

Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA, Watterberg K, et al.; Chorioamnionitis Workshop Participants. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016;127:426–36. https://doi.org/10.1097/AOG.0000000000001246

Hospital Episode Statistics Analysis, Health and Social Care Information Centre. Hospital Episode Statistics: Admitted Patient Care 2012‐13. Leeds: HES; 2013.

Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, Lefkowitz LB, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000;342:15–20. https://doi.org/10.1056/NEJM200001063420103

Phares CR, Lynfield R, Farley MM, Mohle‐Boetani J, Harrison LH, Petit S, et al.; Active Bacterial Care Surveillance/Emerging Infections Program Network. Epidemiology of invasive group B streptococcal disease in the United States, 1999‐2005. JAMA 2008;299:2056–65. https://doi.org/10.1001/jama.299.17.2056

O'Sullivan C, Heath PT, Lamagni T, Boyle M, Doherty L, Reynolds A, et al. Group B Streptococcal Disease in Infants <90 Days of Age. Unpublished 2015. www.rcpch.ac.uk/bpsu/gbs

Daniels JP, Gray J, Pattison HM, Gray R, Hills RK, Khan KS; GBS Collaborative Group. Intrapartum tests for group B streptococcus: accuracy and acceptability of screening. BJOG 2011;118:257–65. https://doi.org/10.1111/j.1471-0528.2010.02725.x

Zanetti‐Dällenbach RA, Holzgreve W, Hösli I. Neonatal group B streptococcus colonization in water births. Int J Gynaecol Obstet 2007;98:54–5. https://doi.org/10.1016/j.ijgo.2007.03.029

Thoeni A, Zech N, Moroder L, Ploner F. Review of 1600 water births. Does water birth increase the risk of neonatal infection? J Matern Fetal Neonatal Med 2005;17:357–61. https://doi.org/10.1080/14767050500140388

Zanetti‐Dällenbach R, Lapaire O, Maertens A, Holzgreve W, Hösli I. Water birth, more than a trendy alternative: a prospective, observational study. Arch Gynecol Obstet 2006;274:355–65. https://doi.org/10.1007/s00404-006-0208-1

Baecher L, Grobman W. Prenatal antibiotic treatment does not decrease group B streptococcus colonization at delivery. Int J Gynaecol Obstet 2008;101:125–8. https://doi.org/10.1016/j.ijgo.2007.10.012

Bland ML, Vermillion ST, Soper DE. Late third‐trimester treatment of rectovaginal group B streptococci with benzathine penicillin G. Am J Obstet Gynecol 2000;183:372–6. https://doi.org/10.1067/mob.2000.107668

Weeks JW, Myers SR, Lasher L, Goldsmith J, Watkins C, Gall SA. Persistence of penicillin G benzathine in pregnant group B streptococcus carriers. Obstet Gynecol 1997;90:240–3. https://doi.org/10.1016/S0029-7844(97)00247-0

National Institute of Health Care and Excellence. Preterm Labour and Birth. NICE guideline 25. London: NICE; 2015.

Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, et al.; PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre‐labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet 2016;387:444–52. https://doi.org/10.1016/S0140-6736(15)00724-2

Tajik P, van der Ham DP, Zafarmand MH, Hof MH, Morris J, Franssen MT, et al. Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials. BJOG 2014;121:1263–72; discussion 1273. https://doi.org/10.1111/1471-0528.12889

Public Health England. UK Standards for Microbiology Investigations. Detection of Carriage of Group B Streptococci. London: PHE; 2015.

Barber EL, Zhao G, Buhimschi IA, Illuzzi JL. Duration of intrapartum prophylaxis and concentration of penicillin G in fetal serum at delivery. Obstet Gynecol 2008;112:265–70. https://doi.org/10.1097/AOG.0b013e31817d0246

Lin FY, Brenner RA, Johnson YR, Azimi PH, Philips JB 3rd, Regan JA, et al. The effectiveness of risk‐based intrapartum chemoprophylaxis for the prevention of early‐onset neonatal group B streptococcal disease. Am J Obstet Gynecol 2001;184:1204–10. https://doi.org/10.1067/mob.2001.113875

de Cuito M, Sanchez MJ, Sampedro A, Miranda JA, Herruzo AJ, Rosa‐Fraile M. Timing of intrapartum ampicillin and prevention of vertical transmission of group B streptococcus. Obstet Gynecol 1998;91:112–14.

Fairlie T, Zell ER, Schrag S. Effectiveness of intrapartum antibiotic prophylaxis for prevention of early‐onset group B streptococcal disease. Obstet Gynecol 2013;121:570–7. https://doi.org/10.1097/AOG.0b013e318280d4f6

National Institute of Health Care and Excellence. Neonatal Infection (Early Onset): Antibiotics for Prevention and Treatment. NICE clinical guideline 149. London: NICE, 2012.

UK Obstetric Surveillance System. Anaphylaxis in Pregnancy. Oxford: UKOSS; 2015.

Mazzola G, Murphy K, Ross RP, Di GD, Biavati B, Corvaglia LT, et al. Early gut microbiota perturbations following intrapartum antibiotic prophylaxis to prevent group B streptococcal disease. PLoS ONE 2016;11:e0157527. https://doi.org/10.1371/journal.pone.0157527

Cassidy‐Bushrow AE, Sitarik A, Levin AM, Lynch SV, Havstad S, Ownby DR, et al. Maternal group B Streptococcus and the infant gut microbiota. J Dev Orig Health Dis 2016;7:45–53. https://doi.org/10.1017/S2040174415001361

Aloisio I, Quagliariello A, De Fanti S, Luiselli D, De Filippo C, Albanese D, et al. Evaluation of the effects of intrapartum antibiotic prophylaxis on newborn intestinal microbiota using a sequencing approach targeted to multi hypervariable 16S rDNA regions. Appl Microbiol Biotechnol 2016;100:5537–46. https://doi.org/10.1007/s00253-016-7410-2

Azad MB, Konya T, Persaud RR, Guttman DS, Chari RS, Field CJ, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG 2016;123:983–93. https://doi.org/10.1111/1471-0528.13601

Corvaglia L, Tonti G, Martini S, Aceti A, Mazzola G, Aloisio I, et al. Influence of intrapartum antibiotic prophylaxis for group B streptococcus on gut microbiota in the first month of life. J Pediatr Gastroenterol Nutr 2016;62:304–8. https://doi.org/10.1097/MPG.0000000000000928

Rachid R, Chatila TA. The role of the gut microbiota in food allergy. Curr Opin Pediatr 2016;28:748–53. https://doi.org/10.1097/MOP.0000000000000427

Mueller NT, Mao G, Bennet WL, Hourigan SK, Dominguez‐Bello MG, Appel LJ, et al. Does vaginal delivery mitigate or strengthen the intergenerational association of overweight and obesity? Findings from the Boston Birth Cohort. Int J Obes (Lond) 2017;41:497–501. https://doi.org/10.1038/ijo.2016.219

Paun A, Danska JS. Modulation of type 1 and type 2 diabetes risk by the intestinal microbiome. Pediatr Diabetes 2016;17:469–77. https://doi.org/10.1111/pedi.12424

Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, Salt A, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7‐year follow‐up of the ORACLE I trial. Lancet 2008;372:1310–8. https://doi.org/10.1016/S0140-6736(08)61202-7

Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, Salt A, et al. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7‐year follow‐up of the ORACLE II trial. Lancet 2008;372:1319–27. https://doi.org/10.1016/S0140-6736(08)61203-9

Marlow N, Bower H, Jones D, Brocklehurst P, Kenyon S, Pike K, et al. The ORACLE Children Study: educational outcomes at 11 years of age following antenatal prescription of erythromycin or co‐amoxiclav. Arch Dis Child Fetal Neonatal Ed 2017;102:F131–5. https://doi.org/10.1136/archdischild-2015-310144

Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early‐onset neonatal group B streptococcal infection. Cochrane Database Syst Rev 2014;(12):CD003520. https://doi.org/10.1002/14651858.CD003520.pub2

Escobar GJ, Li DK, Armstrong MA, Gardner MN, Folck BF, Verdi JE, et al. Neonatal sepsis workups in infants >/=2000 grams at birth: A population‐based study. Pediatrics 2000;106:256–63.

Heath PT, Balfour G, Weisner AM, Efstratiou A, Lamagni TL, Tighe H, et al.; PHLS Group B Streptococcus Working Group. Group B streptococcal disease in UK and Irish infants younger than 90 days. Lancet 2004;363:292–4. https://doi.org/10.1016/S0140-6736(03)15389-5


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