Abstract in Portuguese | Objetivo: Avaliar a aplicação do protocolo do Centers of
Disease Control (CDC, 2002) quanto à profilaxia da sepse
neonatal precoce por Streptococcus do grupo B (SGB).
Métodos: Estudo retrospectivo com revisão de prontuários de 125 gestantes colonizadas pelo SGB e 133 recém-nascidos, no período de janeiro/2003 a dezembro/2006.
A conduta intraparto foi considerada correta quando a
gestante recebia antibioticoprofilaxia pelo menos quatro
horas antes do parto, ou quando não recebia, mas era
submetida a parto cesáreo eletivo. A conduta intraparto
foi considerada incorreta quando a gestante recebia anti-bioticoprofilaxia menos de quatro horas antes do parto, a
prescrição antibiótica estava incorreta ou quando não havia
profilaxia prescrita.
Resultados: A prevalência de colonização materna pelo
SGB foi de 4,7%. A época de coleta do swab vaginal/retal
variou entre 14 e 40 semanas de gestação, com média de 32
semanas. Das gestantes colonizadas, 54 (43%) receberam
conduta intraparto correta. Dos 133 recém-nascidos estudados, 95 (71%) receberam avaliação diagnóstica corretamente,
17 (13%) evoluíram com sepse clínica e um (0,75%) apresentou sepse comprovada. A incidência de sepse foi maior
em recém-nascidos cujas mães não receberam profilaxia intraparto corretamente, porém esta associação não apresentou
diferença estatística significativa (18 versus 7%, p>0,05).
Conclusões: Apesar de o protocolo para prevenção de sepse precoce pelo SGB estar implementado na instituição,
ainda é possível observar falhas na profilaxia intraparto materna. Essas falhas representam oportunidades perdidas na
prevenção da sepse precoce pelo SGB. | pt_BR |
xmlui.metadata.dc.relation.isbasedon | 1. Baker CJ, Barrett FF, Gordon RC, Yow MD. Suppurative meningitis due
to streptococci of Lancefield group B: a study of 33 infants. J Pediatr
1973;82:724-9.
2. Barton LL, Feigin RD, Lins R. Group B beta hemolytic streptococcal meningitis
in infants. J Pediatr 1973;82:719-23.
3. Franciosi RA, Knostman JD, Zimmerman RA. Group B streptococcal neonatal
and infant infections. J Pediatr 1973;82:707-18.
4. McCracken GH Jr. Group B streptococci: the new challenge in neonatal
infections. J Pediatr 1973;82:703-6.
5. Regan JA, Klebanoff MA, Nugent RP. Vaginal infections and prematurity study
group. The epidemiology of group B streptococcal colonization in pregnancy.
Obstet Gynecol 1991;77:604-10.
6. Anthony BF, Eisenstadt R, Carter J, Kim KS, Hobel CJ. Genital and
intestinal carriage of group B streptococci during pregnancy. J Infect Dis
1981;143:761-6.
7. Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group
B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep
2002;51:1-22.
8. Centers for Disease Control and Prevention (CDC). Diminishing racial
disparities in early-onset neonatal group B streptococcal disease – United
States, 2000-2003. MMWR Morb Mortal Wkly Rep 2004;53:502-5.
9. Zangwill KM, Schuchat A, Wenger JD. Group B streptococcal disease in
the United States, 1990: report from a multistate active surveillance system.
MMWR CDC Surveill Summ 1992;41:25-32.
10. Vaciloto E, Richtmann R, Costa HP, Kusano EJ, Almeida MF, Amaro ER. A
survey of the incidence of neonatal sepsis by group B Streptococcus during
a decade in a Brazilian maternity hospital. Braz J Infect Dis 2002;6:55-62.
11. Beraldo C, Brito AS, Saridakis HO, Matsuo T. Prevalence of vaginal and
anorectal colonization by group B streptococcus in pregnant women in the
last three months of gestation. Rev Bras Ginecol Obstet 2004;26:543-9.
12. Pogere A, Zoccoli CM, Tobouti NR, Freitas PF, d’Acampora AJ, Zunino JN.
Prevalência de colonização pelo estreptococo do grupo B em gestantes atendidas
em ambulatório de pré-natal. Rev Bras Ginecol Obstet 2005;27:174-80.
13. Töllner U. Early diagnosis of septicemia in the newborn. Clinical studies and
sepsis score. Eur J Pediatr 1982;138:331-7.
14. St Geme JW Jr, Murray DL, Carter J, Hobel CJ, Leake RD, Anthony BF et al.
Perinatal bacterial infection after prolonged rupture of amniotic membranes:
an analysis of risk and management. J Pediatr 1984;104:608-13.
15. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for
nosocomial infections, 1988. Am J Infect Control 1988;16:128-40.
16. Donowitz LG. Nosocomial infection in neonatal intensive care units. Am J
Infect Control 1989;17:250-7.
17. Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH. Risk factors for neonatal
sepsis. Obstet Gynecol 1996;87:188-94.
18. Messer J, Eyer D, Donato L, Gallati H, Matis J, Simeoni U. Evaluation of
interleukin-6 and soluble receptors of tumor necrosis factor for early diagnosis
of neonatal infection. J Pediatr 1996;129:574-80.
19. Panero A, Pacifico L, Rossi N, Mancuso G, Stegagno M, Chiesa C. Interleukin
6 in neonates with early and late onset infection. Pediatr Infect Dis J
1997;16:370-5.
20. Silveira RC, Procianoy RS. Evaluation of interleukin-6, tumour necrosis factoralpha
and interleukin-1beta for early diagnosis of neonatal sepsis. Acta Paediatr
1999;88:647-50.
21. Benchetrit LC, Fracalanzza SE, Peregrino H, Camelo AA, Sanches LA.
Carriage of Streptococcus agalactiae in women and neonates and distribution
of serological types: a study in Brazil. J Clin Microbiol 1982;15:787-90.
22. Mocelin CO, Carvalho DA, Brites C, Christofolli D, Mocelin AO, Fracalanza
SE et al. Isolamento de Streptococcus agalactiae de gestantes na região
Londrina-PR. Rev Bras Ginecol Obstet 1995;17:915-8.
23. Schrag SJ, Zell ER, Lynfield R, Roome A, Arnold KE, Craig AS et al. A
population-based comparison of strategies to prevent early-onset group B
streptococcal disease in neonates. N Engl J Med 2002;347:233-9.
24. Apgar BS, Greenberg G, Yen G. Prevention of group B streptococcal disease
in the newborn. Am Fam Physician 2005;71:903-10.
25. McKenna DS, Iams JD. Group B streptococcus infections. Semin Perinatol
1998;22:267-76.
26. Gotoff SP, Boyer KM. Prevention of early-onset neonatal group B streptococcal
disease. Pediatrics 1997;99:866-9.
27. Puopolo KM, Madoff LC, Eichenwald EC. Early-onset group B streptococcal
disease in the era of maternal screening. Pediatrics 2005;115:1240-6.
28. Boyer KM, Gadzala CA, Kelly PD, Burd LI, Gotoff SP. Selective intrapartum
chemoprophylaxis of neonatal group B streptococcal early-onset disease. II.
Predictive value of prenatal cultures. J Infect Dis 1983;148:802-9.
29. Baker CJ, Edwards MS, Nizet V. Group B streptococcal infections. In:
Remington JS, Klein JO, editors. Infectious diseases of the fetus and newborn
infant. 6th ed. Philadelphia: Elsevier Saunders; 2006. p. 403-64.
30. Bromberger P, Lawrence JM, Braun D, Saunders B, Contreras R, Petitti DB.
The influence of intrapartum antibiotics on the clinical spectrum of earlyonset
group B streptococcal infection in term infants. Pediatrics 2000;106:
244-50. | pt_BR |