成人B群鏈球菌侵襲性感染在台灣流行病學之回顧

Epidemiology of Invasive Group B Streptococcal Infections in Non-pregnant Adults in Taiwan: A Literature Review

B群鏈球菌（Group B streptococcus, GBS）侵襲性感染在國內外有逐年增加之趨勢，本研究希望了解台灣成人GBS侵襲性感染之流行病學狀況。回顧台灣發表之成人GBS侵襲性感染及血清分型之文獻，至2013年止共十一篇。文獻中報告之感染個案發生於1991年至2009年間，本研究回顧分析其GBS血清型、體外抗生素藥物敏感性試驗、個案之潛在疾病、疾病之嚴重程度及臨床預後之相關性。GBS侵襲性感染患者多有潛在疾病，如糖尿病、心血管疾病、肝病及癌症；老年感染者之比率亦增加。南台灣血清型主要為第III、V及la型，但lb型有逐年增加之趨勢，而第VI型少於5%；中台灣以第V及lb型為主；北台灣則以第V、lb、及III型為主，第VI型近年高於10%。Penicillin仍為首選之抗生素，但erythromycin及clindamycin抗藥性逐年增加。軟組織感染者死亡率約7%，菌血症則為18.9～26.9%。台灣北中南皆發現醫療照護相關感染之個案，約佔GBS侵襲性感染5.7～26.7%，但國內目前尚無GBS群聚感染之報告。對於GBS侵襲性感染之病人，特別是老年人及合併有潛在疾病者，應及早提供適當合理抗生素之治療。照護病人時遵守感染管制措施，以減少醫療照護相關感染並避免群聚事件發生。由文獻分析可見GBS血清型南北趨勢不同，若有全國性之血清型持續調查，將有助於深入了解流行病學與發展疫苗。

The rate of invasive group B streptococcal (GBS) infection is increasing, especially in elderly patients or patients with underlying disease. We aimed to analyze literature published on the epidemiology of invasive GBS infection in non-pregnant adults in Taiwan during 1991-2013. We reviewed literature on adults with invasive GBS infection in Taiwan that was published through 2013. There were 11 reports of invasive infection and associated clinical conditions or tests of specimens during 1991-2009. We retrospectively analyzed the GBS serotypes, in vitro antibiotic susceptibility test results, underlying diseases, disease severity, and prognosis. Most of the patients had underlying diseases such as diabetes mellitus, cardiovascular disease, liver disease, and cancer. The incidence in older patients was higher. In southern Taiwan, serotypes III, V, and Ia were the predominant serotypes, and serotype Ib increased yearly; however, the incidence of infection with serotype VI remained at < 5%. In central Taiwan, serotypes V and Ib were the main serotypes causing invasive infection. In northern Taiwan, infections with serotypes V, Ib, and III were reported, and serotype VI increased to >10% in recent years. Penicillin remained the drug of choice for treatment, but the rates of resistance to erythromycin or clindamycin were high. Healthcare-associated infections accounted for 5.7%-26.7% of cases. The mortality rate among patients with soft-tissue infection was 7% and that among patients with bacteremia was 18.9%-26.9%. For patients with invasive GBS infection, especially elderly patients and those with underlying diseases, early and appropriate antibiotic treatment is necessary. Compliance with infection control measures could reduce the rate of healthcare-associated infections and prevent an outbreak of GBS infection. In addition, a continuous nationwide survey of GBS serotypes for the development of vaccines or other appropriate methods to prevent invasive GBS infection is warranted.