JAMA:早产和死胎与怀孕期间的细菌感染有关
据3月19日发表在《美国医学会杂志》上的一则研究披露,对一项从2009-2012年间在英格兰和威尔士对感染了流感嗜血杆菌这种细菌的育龄妇女的监测研究中,怀孕与发生这种感染的较大风险有关,后者则与诸如早产和死胎等不良妊娠后果有关。


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据3月19日发表在《美国医学会杂志》上的一则研究披露,对一项从2009-2012年间在英格兰和威尔士对感染了流感嗜血杆菌这种细菌的育龄妇女的监测研究中,怀孕与发生这种感染的较大风险有关,后者则与诸如早产和死胎等不良妊娠后果有关。

流感嗜血杆菌可引起的疾病包括呼吸道感染。根据文章的背景资料,某些研究提示,在怀孕时罹患侵袭性流感嗜血杆菌性疾病的风险会增加,尽管这些情况所基于的病例数较少。

伦敦英国公共卫生的Sarah Collins, M.P.H.及其同事在一个为期4年的时期中对育龄期妇女中的侵袭性流感嗜血杆菌疾病进行了调查。该研究包括了来自英国公共卫生的数据,该机构对英格兰和威尔士的侵袭性流感嗜血杆菌疾病开展了强化的全国性监测。在2009-2012年间治疗患有实验室确诊的侵入性流感嗜血杆菌疾病的15-44岁妇女的全科医生被要求在病人感染3个月后完成一个临床问卷。

实验室确诊的侵袭性流感嗜血杆菌疾病的发生率是低的——为10万分之0.50(171名妇女)。怀孕妇女之所以有着较高的感染风险主要是因为她们得的是无荚膜(一种类型的菌株)流感嗜血杆菌疾病。在怀孕头24周中的这一感染与胎儿流产(93.6%)和极度早产(6.4%)有关。在怀孕后半期中的无荚膜流感嗜血杆菌感染与28个病例中的28.6%的早产及7.1%的死胎有关。除了严重感染之外,这些婴儿还有发生早产儿长期并发症的风险。在侵入性流感嗜血杆菌疾病后发生流产要比英国的全国平均水平高2.9倍。

文章的作者写道,几乎所有的感染都与流产、死胎或早产有关的发现为人们提供了孕妇感染的严重性的证据。侵袭性流感嗜血杆菌疾病在没有怀孕的妇女中也是一种需要住院并在恰当的微生物学研究之后进行静脉内抗菌素注射及密切监测的严重感染,特别是考虑到在这一调查中的超过一半的没有怀孕的妇女患有一种并发的内科疾病。

研究人员指出,在这项研究中所报告的总体估计比率应被视作为最低值,因为只有实验室确诊的侵袭病例得到了随访。
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  • Risk of Invasive Haemophilus influenzae Infection During Pregnancy and Association With Adverse Fetal Outcomes


    Importance

    Unencapsulated Haemophilus influenzae frequently causes noninvasive upper respiratory tract infections in children but can also cause invasive disease, especially in older adults. A number of studies have reported an increased incidence in neonates and suggested that pregnant women may have an increased susceptibility to invasive unencapsulated H influenzae disease.

    Objective

    To describe the epidemiology, clinical characteristics, and outcomes of invasive H influenzae disease in women of reproductive age during a 4-year period.

    Design, Setting, and Participants

    Public Health England conducts enhanced national surveillance of invasive H influenzae disease in England and Wales. Clinical questionnaires were sent prospectively to general practitioners caring for all women aged 15 to 44 years with laboratory-confirmed invasive H influenzae disease during 2009-2012, encompassing 45 215 800 woman-years of follow-up. The final outcome was assessed in June 2013.

    Exposures

    Invasive H influenzae disease confirmed by positive culture from a normally sterile site.

    Main Outcomes and Measures

    The primary outcome was H influenzae infection and the secondary outcomes were pregnancy-related outcomes.

    Results

    In total, 171 women had laboratory-confirmed invasive H influenzae infection, which included 144 (84.2%; 95% CI, 77.9%-89.3%) with unencapsulated, 11 (6.4%; 95% CI, 3.3%-11.2%) with serotype b, and 16 (9.4%; 95% CI, 5.4%-14.7%) with other encapsulated serotypes. Questionnaire response rate was 100%. Overall, 75 of 171 women (43.9%; 95% CI, 36.3%-51.6%) were pregnant at the time of infection, most of whom were previously healthy and presented with unencapsulated H influenzae bacteremia. The incidence rate of invasive unencapsulated H influenzae disease was 17.2 (95% CI, 12.2-24.1; P < .001) times greater among pregnant women (2.98/100 000 woman-years) compared with nonpregnant women (0.17/100 000 woman-years). Unencapsulated H influenzae infection during the first 24 weeks of pregnancy was associated with fetal loss (44/47; 93.6% [95% CI, 82.5%-98.7%]) and extremely premature birth (3/47; 6.4% [95% CI, 1.3%-17.5%]). Unencapsulated H influenzae infection during the second half of pregnancy was associated with premature birth in 8 of 28 cases (28.6%; 95% CI, 13.2%-48.7%) and stillbirth in 2 of 28 cases (7.1%; 95% CI, 0.9%-23.5%). The incidence rate ratio for pregnancy loss was 2.91 (95% CI, 2.13-3.88) for all serotypes of H influenzae and 2.90 (95% CI, 2.11-3.89) for unencapsulated H influenzae compared with the background rate for pregnant women.

    Conclusions and Relevance

    Among women in England and Wales, pregnancy was associated with a greater risk of invasive H influenzae infection. These infections were associated with poor pregnancy outcomes.

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