用于快速检测新生儿B族链球菌定植的实时聚合酶链反应
Real-time polymerase chain reaction for the rapid detection of group B streptococcal colonization in neonates.
作者信息
Natarajan Girija, Johnson Yvette R, Zhang Fan, Chen Kang Mei, Worsham Maria J
机构信息
Division of Neonatology, Children's Hospital of Michigan, Detroit, Michigan, USA.
出版信息
Pediatrics. 2006 Jul;118(1):14-22. doi: 10.1542/peds.2005-1594.
BACKGROUND
Group B streptococcal (GBS) infection remains a leading cause of neonatal sepsis. Currently, the management guidelines of neonates born to women with unknown GBS status at delivery are unclear. In this cohort, who undergo at least a 48-hour observation, a rapid method of detection of GBS colonization would allow targeted evaluation and treatment, as well as prevent delayed discharge.
OBJECTIVE
The goal of this research was to evaluate the validity of rapid fluorescent real-time polymerase chain reaction in comparison with standard culture to detect GBS colonization in infants born to women whose GBS status is unknown at delivery.
DESIGN/METHODS: Neonates at >32 weeks' gestation born to women whose GBS status was unknown at delivery were included. Samples were obtained from the ear, nose, rectum, and gastric aspirate for immediate culture and real-time polymerase chain reaction after DNA extraction using the LightCycler. Melting point curves were generated, and confirmatory agar gel electrophoresis was performed.
RESULTS
The study population (n = 94) had a mean +/- SD gestational age of 38 +/- 2 weeks and birth weight of 3002 +/- 548 g. The rates of GBS colonization by culture were 17% and 51% by real-time polymerase chain reaction. The 4 surface sites had comparable rates of GBS. The overall sensitivities, specificities, and positive and negative predictive values of real-time polymerase chain reaction were: 90%, 80.3%, 28%, and 98.9%.
CONCLUSIONS
Real-time polymerase chain reaction resulted in a threefold higher rate of detection of GBS colonization and had an excellent negative predictive value in a cohort of neonates with unknown maternal GBS status at delivery. Thus, real-time polymerase chain reaction would be a useful clinical tool in the management of those infants potentially at risk for invasive GBS infection and would allow earlier discharge for those found to be not at risk.
背景
B族链球菌（GBS）感染仍然是新生儿败血症的主要原因。目前，对于分娩时GBS状态不明的产妇所生新生儿的管理指南尚不清楚。在这个至少进行48小时观察的队列中，一种快速检测GBS定植的方法将有助于进行有针对性的评估和治疗，并防止延迟出院。
目的
本研究的目的是评估快速荧光实时聚合酶链反应与标准培养法相比，在检测分娩时GBS状态不明的产妇所生婴儿中GBS定植的有效性。
设计/方法：纳入分娩时GBS状态不明的孕周>32周的新生儿。在使用LightCycler提取DNA后，从耳、鼻、直肠和胃吸出物中获取样本进行即时培养和实时聚合酶链反应。生成熔解曲线，并进行验证性琼脂凝胶电泳。
结果
研究人群（n = 94）的平均±标准差孕周为38±2周，出生体重为3002±548 g。培养法检测GBS定植的发生率为17%，实时聚合酶链反应法为51%。4个体表部位的GBS发生率相当。实时聚合酶链反应的总体敏感性、特异性、阳性和阴性预测值分别为：90%、80.3%、28%和98.9%。
结论
在分娩时母亲GBS状态不明的新生儿队列中，实时聚合酶链反应检测GBS定植的发生率高出三倍，且具有出色的阴性预测值。因此，实时聚合酶链反应将是管理那些有侵袭性GBS感染潜在风险婴儿的有用临床工具，并能让那些被发现无风险的婴儿更早出院。
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