TAILIEUCHUNG - Chapter 130. Streptococcal and Enterococcal Infections (Part 10)

Infection in Neonates Two general types of GBS infection in infants are defined by the age of the patient at presentation. Early-onset infections occur within the first week of life, with a median age of 20 h at onset. Approximately half of these infants have signs of GBS disease at birth. The infection is acquired during or shortly before birth from the colonized maternal genital tract. Surveillance studies have shown that 5– 40% of women are vaginal or rectal carriers of GBS. Approximately 50% of infants delivered vaginally by carrier mothers become colonized, although only 1– 2% of those colonized. | Chapter 130. Streptococcal and Enterococcal Infections Part 10 Infection in Neonates Two general types of GBS infection in infants are defined by the age of the patient at presentation. Early-onset infections occur within the first week of life with a median age of 20 h at onset. Approximately half of these infants have signs of GBS disease at birth. The infection is acquired during or shortly before birth from the colonized maternal genital tract. Surveillance studies have shown that 540 of women are vaginal or rectal carriers of GBS. Approximately 50 of infants delivered vaginally by carrier mothers become colonized although only 12 of those colonized develop clinically evident infection. Prematurity and maternal risk factors prolonged labor obstetric complications and maternal fever are often involved. The presentation of early-onset infection is the same as that of other forms of neonatal sepsis. Typical findings include respiratory distress lethargy and hypotension. Essentially all infants with early-onset disease are bacteremic one-third to one-half have pneumonia and or respiratory distress syndrome and one-third have meningitis. Late-onset infections occur in infants 1 week to 3 months old mean age at onset 3-4 weeks . The infecting organism may be acquired during delivery as in early-onset cases or during later contact with a colonized mother nursery personnel or another source. Meningitis is the most common manifestation of late-onset infection and in most cases is associated with a strain of capsular type III. Infants present with fever lethargy or irritability poor feeding and seizures. The various other types of late-onset infection include bacteremia without an identified source osteomyelitis septic arthritis and facial cellulitis associated with submandibular or preauricular adenitis. Group B Streptococcal Infection in Neonates Treatment Penicillin is the agent of choice for all GBS infections. Empirical broadspectrum therapy for suspected bacterial

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