妊娠晚期B族链球菌感染对妊娠结局的影响及耐药性分析
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摘要
目的了解妊娠晚期妇女生殖道B族链球菌(group B streptococcus,GBS)感染率,探讨GBS感染对妊娠结局的影响;对分离培养出的GBS行耐药性分析。方法选择2016年3月至2017年6月在西安交通大学医学部附属三二〇一医院分娩的3 674例孕妇,于入院时行阴道分泌物GBS培养。将GBS阳性孕妇63例设为观察组,阴性孕妇3 611例设为对照组,比较两组妊娠结局;分析GBS耐药性。结果妊娠晚期妇女生殖道GBS感染率为1.71%。两组早产、新生儿窒息率比较,差异无统计学意义(P>0.05);观察组胎膜早破率(36.5%)、产褥感染率(7.9%)、新生儿感染率(6.3%)高于对照组(15.6%、0.3%、1.3%),差异均有统计学意义(P<0.05)。对分离培养出的GBS行药敏试验:对青霉素、头孢菌素、美洛培南、利奈唑胺、万古霉素敏感率100%;阿莫西林敏感率98.4%;红霉素、左氧氟沙星、克林霉素、阿奇霉素敏感率分别为11.1%、39.7%、14.8%、12.5%。结论妊娠晚期妇女生殖道GBS感染增加不良妊娠结局发生率,妊娠晚期可常规行GBS筛查。GBS对青霉素及头孢菌素敏感,对大环内酯类及喹诺酮类药物耐药率高,GBS感染应首选青霉素及头孢菌素。
Objective To explore the prevalence of group B streptococcus(GBS) in the reproductive tract of women in late pregnancy. To investigate the effect of GBS infection on pregnancy outcomes,and to analyze the drug resistance of GBS. Methods From March 2016 to June 2017, 3 674 pregnant women who delivered in 3201 Hospital Affiliated of Xi'an Jiaotong University Medicine Center were selected to perform vaginal secretion GBS bacterial culture at the time of admission. The GBS-positive pregnant women were set as the observation group and the GBS-negative pregnant women were set as the control group. The pregnancy outcomes of the two groups were compared and the GBS resistance was analyzed. Results The rate of GBS infection in the reproductive tract of women in late pregnancy was 1.71 %. There was no significant difference in the rates of preterm delivery and neonatal asphyxia between the observation group and the control group(P>0.05). The premature rupture rate(36.5 %), puer infection rate(7.9 %), and neonatal infection rate(6.3 %) were higher in the observation group than those in the control group(15.6 %, 0.3 %, 1.3 %). The differences were statistically significant(P<0.05).Drug susceptibility tests for isolated and cultured GBS: sensitivity to penicillin, cephalosporin, meropenem, linezolid, vancomycin were 100 %;amoxicillin sensitivity was 98.4 %;the sensitivity rates to erythromycin, levofloxacin, clindamycin and azithromycin were 11.1 %, 39.7 %, 14.8 % and 12.5 %. Conclusions GBS infection in the reproductive tract of women during the third trimester increases the incidence of adverse pregnancy outcomes. GBS screening may be routinely performed in late pregnancy. GBS is sensitive to penicillin and cephalosporins, and has a high resistance rate to macrolides and quinolones. Penicillin and cephalosporin should be preferred for GBS infection.
Objective To explore the prevalence of group B streptococcus(GBS) in the reproductive tract of women in late pregnancy. To investigate the effect of GBS infection on pregnancy outcomes,and to analyze the drug resistance of GBS. Methods From March 2016 to June 2017, 3 674 pregnant women who delivered in 3201 Hospital Affiliated of Xi'an Jiaotong University Medicine Center were selected to perform vaginal secretion GBS bacterial culture at the time of admission. The GBS-positive pregnant women were set as the observation group and the GBS-negative pregnant women were set as the control group. The pregnancy outcomes of the two groups were compared and the GBS resistance was analyzed. Results The rate of GBS infection in the reproductive tract of women in late pregnancy was 1.71 %. There was no significant difference in the rates of preterm delivery and neonatal asphyxia between the observation group and the control group(P>0.05). The premature rupture rate(36.5 %), puer infection rate(7.9 %), and neonatal infection rate(6.3 %) were higher in the observation group than those in the control group(15.6 %, 0.3 %, 1.3 %). The differences were statistically significant(P<0.05).Drug susceptibility tests for isolated and cultured GBS: sensitivity to penicillin, cephalosporin, meropenem, linezolid, vancomycin were 100 %;amoxicillin sensitivity was 98.4 %;the sensitivity rates to erythromycin, levofloxacin, clindamycin and azithromycin were 11.1 %, 39.7 %, 14.8 % and 12.5 %. Conclusions GBS infection in the reproductive tract of women during the third trimester increases the incidence of adverse pregnancy outcomes. GBS screening may be routinely performed in late pregnancy. GBS is sensitive to penicillin and cephalosporins, and has a high resistance rate to macrolides and quinolones. Penicillin and cephalosporin should be preferred for GBS infection.
引文
[1] Pettersson K.Perinatal infection with Group B streptococci[J].Semin Fetal & Neonatal Med, 2007,12(3): 193-197.
[2] Barcaite E, Bartusevicius A,Tameliene R,et al.Prevalence of maternal group B streptococcal colonisation in European countries[J].Acta Obstet Gynecol Scand, 2008.87(3): 260-271.
[3] 刘泽滨,聂署萍,陆学东,等.某院妇产科住院患者的无乳链球菌感染情况及耐药性研究 [J].检验医学与临床, 2016,13(21): 3049-3051.
[4] 朱燕飞,施美华,王萍.妊娠晚期生殖道B族链球菌感染对母婴预后的影响 [J].中华医院感染学杂志, 2016,26(22): 5202-5203,5267.
[5] 雷蜜,倪维.不同方法检测B群链球菌效果评价 [J].检验医学与临床, 2016,13(20): 2847-2849.
[6] Park J S, Cho D H,Yang J H,et al.Usefulness of a rapid real-time PCR assay in prenatal screening for group B streptococcus colonization [J].Ann Lab Med, 2013,33(1): 39-44.
[7] 黄晓玲,林云霞,梁敏洪,等.妊娠晚期妇女B族链球菌带菌情况与母婴预后的关系 [J].中国计划生育和妇产科, 2015,7(10): 45-47.
[8] 张莹,孙晖,王英,等.抗感染干预对孕妇生殖道B族链球菌感染胎膜早破的影响[J].中华医院感染学杂志, 2017,27(1): 179-181,211.
[9] 何建维,张燕,陈敏,等.重庆地区不同育龄围产期女性B族溶血性链球菌的研究[J].国际检验医学杂志, 2016,37(19): 2784-2786.
[10] Russell N J,Seale A C,O'Sullivan C,et al.Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide: systematic review and meta-analyses[J].Clin Infect Dis, 2017, 65(suppl_2): S 152-S 159.
[11] Vornhagen J,Quach P,Santana-Ufret V,et al.Human cervical mucus plugs exhibit insufficiencies in antimicrobial activity towards group B streptococcus [J].Infect Dis, 2018,217(10): 1626-1636.
[12] Lin H C, Lu J J,Ho C M,et al.Identification of a proteomic biomarker associated with invasive ST1, serotype VI Group B Streptococcus by MALDI-TOF MS [J].Microbiol Immunol Infect, 2019,52(1):81-89.
[13] Jefferies A L.Management of term infants at increased risk for early-onset bacterial sepsis [J].Paediatr Child Health, 2017,22(4): 223-228.
[14] 张永,张秦,吴元赭,等.妊娠晚期孕妇B族溶血性链球菌感染对母儿的影响 [J].医学研究生学报, 2013,26(8): 833-835.
[15] Li S,Wen G,Cao X,et al.Molecular characteristics of Streptococcus agalactiae in a mother-baby prospective cohort study: Implication for vaccine development and insights into vertical transmission [J].Vaccine, 2018,36(15): 1941-1948.
[16] 王茜, 马良坤,宋英娜,等.妊娠晚期B族链球菌感染的筛查方法及妊娠结局分析 [J].中华医学杂志, 2016,96(15): 1188-1191.
[17] 李亚梅,张利侠,秦利,等.围产期孕妇B族链球菌的感染和耐药性检测及对妊娠结局的影响 [J].现代检验医学杂志, 2013,28(1): 87-89.
[18] Ahmadzia, H K,R P Heine.Diagnosis and management of group B streptococcus in pregnancy [J].Obstet Gynecol Clin North Am, 2014, 41(4): 629-647.
[2] Barcaite E, Bartusevicius A,Tameliene R,et al.Prevalence of maternal group B streptococcal colonisation in European countries[J].Acta Obstet Gynecol Scand, 2008.87(3): 260-271.
[3] 刘泽滨,聂署萍,陆学东,等.某院妇产科住院患者的无乳链球菌感染情况及耐药性研究 [J].检验医学与临床, 2016,13(21): 3049-3051.
[4] 朱燕飞,施美华,王萍.妊娠晚期生殖道B族链球菌感染对母婴预后的影响 [J].中华医院感染学杂志, 2016,26(22): 5202-5203,5267.
[5] 雷蜜,倪维.不同方法检测B群链球菌效果评价 [J].检验医学与临床, 2016,13(20): 2847-2849.
[6] Park J S, Cho D H,Yang J H,et al.Usefulness of a rapid real-time PCR assay in prenatal screening for group B streptococcus colonization [J].Ann Lab Med, 2013,33(1): 39-44.
[7] 黄晓玲,林云霞,梁敏洪,等.妊娠晚期妇女B族链球菌带菌情况与母婴预后的关系 [J].中国计划生育和妇产科, 2015,7(10): 45-47.
[8] 张莹,孙晖,王英,等.抗感染干预对孕妇生殖道B族链球菌感染胎膜早破的影响[J].中华医院感染学杂志, 2017,27(1): 179-181,211.
[9] 何建维,张燕,陈敏,等.重庆地区不同育龄围产期女性B族溶血性链球菌的研究[J].国际检验医学杂志, 2016,37(19): 2784-2786.
[10] Russell N J,Seale A C,O'Sullivan C,et al.Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide: systematic review and meta-analyses[J].Clin Infect Dis, 2017, 65(suppl_2): S 152-S 159.
[11] Vornhagen J,Quach P,Santana-Ufret V,et al.Human cervical mucus plugs exhibit insufficiencies in antimicrobial activity towards group B streptococcus [J].Infect Dis, 2018,217(10): 1626-1636.
[12] Lin H C, Lu J J,Ho C M,et al.Identification of a proteomic biomarker associated with invasive ST1, serotype VI Group B Streptococcus by MALDI-TOF MS [J].Microbiol Immunol Infect, 2019,52(1):81-89.
[13] Jefferies A L.Management of term infants at increased risk for early-onset bacterial sepsis [J].Paediatr Child Health, 2017,22(4): 223-228.
[14] 张永,张秦,吴元赭,等.妊娠晚期孕妇B族溶血性链球菌感染对母儿的影响 [J].医学研究生学报, 2013,26(8): 833-835.
[15] Li S,Wen G,Cao X,et al.Molecular characteristics of Streptococcus agalactiae in a mother-baby prospective cohort study: Implication for vaccine development and insights into vertical transmission [J].Vaccine, 2018,36(15): 1941-1948.
[16] 王茜, 马良坤,宋英娜,等.妊娠晚期B族链球菌感染的筛查方法及妊娠结局分析 [J].中华医学杂志, 2016,96(15): 1188-1191.
[17] 李亚梅,张利侠,秦利,等.围产期孕妇B族链球菌的感染和耐药性检测及对妊娠结局的影响 [J].现代检验医学杂志, 2013,28(1): 87-89.
[18] Ahmadzia, H K,R P Heine.Diagnosis and management of group B streptococcus in pregnancy [J].Obstet Gynecol Clin North Am, 2014, 41(4): 629-647.