Öz
Giriş: Grup B streptokok (GBS), dünya çapında neonatal enfeksiyonların önemli bir nedeni olarak kabul edilmektedir. Bu çalışmada, Suudi Arabistan’ın doğu bölgesindeki bir hastanede erken başlangıçlı yenidoğan hastalığının yükü araştırıldı ve rutin GBS taramasının maliyeti değerlendirildi.
Gereç ve Yöntem: Grup B streptokok kolonizasyon oranının belirlenmesinde 2016-2017 dönemine ait gebelik bilgileri ve gebelere ait laboratuvar verileri kullanıldı. Grup B streptokok taşıyan ve hastanede doğum yapan gebelerde intrapartum antibiyotik profilaksisinin (IAP) etkinliği araştırıldı. Grup B streptokok rutin taramasının maliyeti, BBLTM LIM sıvı besiyerinde rektovajinal sürüntü zenginleştirme ve polimeraz zincir reaksiyonu ile doğrulama maliyeti temel alınarak tahmin edilmiştir. Vajinal ve invaziv neonatal izolatlar arasında erken başlangıçlı hastalık yükü ve antibiyotiklere direnç oranları 7 yıllık bir süre boyunca araştırılmıştır.
Bulgular: Bin yüz altmış iki hamile kadından alınan 2.476 numunenin iki yıllık bir süre boyunca taranması %23 (270/1162) GBS kolonizasyon oranını gösterdi. İki yüz yetmiş GBS pozitif kadından yalnızca 98’i (%37) hastanede doğum yaptı ve bunların %42’si IAP aldı. Sezaryenle doğum, anlamlı derecede daha yüksek IAP uygulama oranıyla ilişkilendirildi (olasılık oranı 5,2; p değeri 0,001). Erken başlangıçlı hastalığın yıllık insidansı 2012’de 1000 doğumda 0,5 olan başlangıç düzeyinden 2018’de 1.000 doğumda 3,9’a yükseldi. Bunlar arasında menenjit veya sepsis nedeniyle üç ölümcül olguyla birlikte 23 invazif enfeksiyon olgusu yer alıyordu (3/23, %13). Grup B streptokok izolatları penisilin ve vankomisine karşı eşit derecede duyarlı idi ancak klindamisine karşı %35,2 oranında direnç gösterdi. Rutin taramanın yıllık tahmini maliyeti, BD MAX™ sistemi ve GeneXpert® Sistemi için sırasıyla 110.880$ (doğum başına 41$) ve 161.280$ (doğum başına 60$) olarak belirlenmiştir.
Sonuç: Erken başlangıçlı GBS hastalığının görülme sıklığının arttığı gösterilirken, rutin GBS taramasının maliyet etkinliği hakkında bilgi vermek için IAP ile daha iyi uyum sağlanması gerekmektedir.
Anahtar Kelimeler: S. agalactiae, yenidoğan sepsis, klindamisin direnci, erken başlangıçlı
Kaynakça
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