B族链球菌血流感染婴儿的临床特征与耐药性研究
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摘要
目的探讨B族链球菌(GBS)血流感染婴儿的临床特征与耐药性。方法选取2016年9月-2017年9月于医院分娩的婴儿4 316例,其中确诊为GBS血流感染婴儿41例。由专门医生收集GBS血流感染患儿临床资料,包括性别、年龄、孕周、生产史(生产方式、羊水是否污染)、合并症、白细胞计数(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)、头颅影像学表现、脑脊液检查结果、是否抗菌药物治疗。结果 4 316例婴儿中确诊为GBS血流感染婴儿41例,感染率为0.95%;GBS血流感染婴儿以男婴为主,占60.98%,新生婴儿占68.29%,晚发型感染占90.24%,生产方式以顺产为主,占87.80%;41例GBS血流感染婴儿CRP上升者占73.17%,WBC上升者占63.41%,PCT上升者占87.80%。GBS对万古霉素、美罗培南、亚胺培南、利奈唑胺、氨苄西林和青霉素G耐药率均为0,对四环素、克林霉素、红霉素和庆大霉素耐药率较高,分别为92.68%、73.17%、63.41%和53.66%。结论本地区婴儿GBS血流感染处于较低的水平,但具有病情严重,并发症发生率高的特点,且对部分抗菌药物耐药情况严重。
OBJECTIVE To investigate the clinical characteristics and drug resistance of group B Streptococcus(GBS)in infants with bloodstream infection.METHODS 4316 infants delivered in the hospital during Sep.2016-Sep.2017 were enrolled.Among them,41 were diagnosed with GBS-associated bloodstream infection.The clinical data of GBS-infected infants were collected by specialists including gender,age,gestational age,delivery history(mode of delivery,amniotic fluid contamination),comorbidities,WBC,PCT,C reactive protein(CRP),skull imaging features,cerebrospinal fluid test results,and antibiotic treatment.RESULTS Among the 4316 infants,41 were diagnosed with GBS-associated bloodstream infection.The infection rate was 0.95%.Most GBS-infected infants were males,accounting for 60.98%.Newborn infants accounted for 68.29%,and late-onset infantile infection accounted for 90.24%.The mode of delivery was dominated by natural labour,accounting for 87.80%.In the41 infants with GBS bloodstream infection,73.17% had increased CRP,63.41% had increased WBC,and 87.80%had increased PCT.The resistance rates of GBS to vancomycin,meropenem,imipenem,linezolid,ampicillin and penicillin G were all 0%,and the resistance rates to tetracycline,clindamycin,erythromycin and gentamycin were relatively high,which were 92.68%,73.17%,63.41%and 53.66%respectively.CONCLUSIONThe prevalence of GBS infection in infants in this area is still at a low level,but it has the characteristics of serious illness and high incidence of complications.The antibiotic resistance to some antibiotics is high and the antibiotics should be used with caution.
OBJECTIVE To investigate the clinical characteristics and drug resistance of group B Streptococcus(GBS)in infants with bloodstream infection.METHODS 4316 infants delivered in the hospital during Sep.2016-Sep.2017 were enrolled.Among them,41 were diagnosed with GBS-associated bloodstream infection.The clinical data of GBS-infected infants were collected by specialists including gender,age,gestational age,delivery history(mode of delivery,amniotic fluid contamination),comorbidities,WBC,PCT,C reactive protein(CRP),skull imaging features,cerebrospinal fluid test results,and antibiotic treatment.RESULTS Among the 4316 infants,41 were diagnosed with GBS-associated bloodstream infection.The infection rate was 0.95%.Most GBS-infected infants were males,accounting for 60.98%.Newborn infants accounted for 68.29%,and late-onset infantile infection accounted for 90.24%.The mode of delivery was dominated by natural labour,accounting for 87.80%.In the41 infants with GBS bloodstream infection,73.17% had increased CRP,63.41% had increased WBC,and 87.80%had increased PCT.The resistance rates of GBS to vancomycin,meropenem,imipenem,linezolid,ampicillin and penicillin G were all 0%,and the resistance rates to tetracycline,clindamycin,erythromycin and gentamycin were relatively high,which were 92.68%,73.17%,63.41%and 53.66%respectively.CONCLUSIONThe prevalence of GBS infection in infants in this area is still at a low level,but it has the characteristics of serious illness and high incidence of complications.The antibiotic resistance to some antibiotics is high and the antibiotics should be used with caution.
引文
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[18]Mwananyanda L,Pierre C,Mwansa J,et al.Preventing bloodstream infections and death in Zambian neonates:impact of a low-cost infection control bundle[J].Clin Infect Dis,2018:10.1093/cid/ciy1114.
[19]Zhou B,Zhu J,Mao Z,et al.Roles of procalcitonin and N-terminal pro-B-type natriuretic peptide in predicting catheterrelated bloodstream infection in severe burn injury patients[J].Dis Markers,2018,22:5607932.
[2]Li X,Fang F,Zhao J,et al.Molecular characteristics and virulence gene profiles of Staphylococcus aureus causing bloodstream infection[J].Braz J Infect Dis,2018:S1413-8670(18)30970-X.
[3]鲍苏青,刘小媚,王青.孕妇生殖道B族链球菌感染对母婴预后影响的临床研究[J].中华医院感染学杂志,2015,25(2):430-432.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]Puckett K,Allen-Bridson K,Godfrey D,et al.Health care-associated infections studies project:An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration case study:bloodstream infectionpatient injection into vascular access 2018[J].Am J Infect Control,2018:S0196-6553(18)31076-9.
[6]Saha SK,Ahmed ZB,Modak JK,et al.Group B Streptococcus among pregnant women and newborns in Mirzapur,Bangladesh:colonization,vertical transmission,and serotype distribution[J].J Clin Microbiol,2017,55(8):2406-2412.
[7]Fabbrini M,Rigat F,Rinaudo CD,et al.The protective value of maternal group B streptococcus antibodies:quantitative and functional analysis of naturally acquired responses to capsular polysaccharides and Pilus proteins in European maternal sera[J].Clin Infect Dis,2016,63(6):746-753.
[8]徐一鸣,韩宁,刘琰,等.孕妇生殖道B族链球菌感染对妊娠结局的影响研究[J].中华医院感染学杂志,2016,26(9):2128-2130.
[9]张紫娟,祝莹,马学娟,等.B族链球菌感染与阴道微生态失调对胎膜早破和妊娠结局的影响研究[J].中华医院感染学杂志,2017,27(20):4768-4771.
[10]Six A,Bellais S,Bouaboud A,et al.Srr2,a multifaceted adhesin expressed by ST‐17hypervirulent Group B Streptococcus involved in binding to both fibrinogen and plasminogen[J].Mol Microbiol,2015,97(6):1209-1222.
[11]Yang A-P,Liu J,Yue LH,et al.Neutrophil CD64combined with PCT,CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J].Clin Chem Lab Med,2016,54(2):345-351.
[12]Wang L,Yang B,Yin B,et al.Clinical significance of PCT,CRP,ESR,WBC count as predictors in postoperative early infectious complications with fever after posterior lumbar internal fixation[J].Zhongguo gu shang,2015,28(1):66-70.
[13]Pilecky M,Schildberger A,Orth-Holler D,et al.Pathogen enrichment from human whole blood for the diagnosis of bloodstream infection:prospects and limitations[J].Diagn Microbiol Infect Dis,2018:S0732-8893(18)30375-4.
[14]Russo R1,Mendes ET1,2,Levin AS,et al.Bloodstream infection in hematopoietic stem cell transplantation outpatients:risk factors for hospitalization and death[J].Rev Inst Med Trop Sao Paulo,2018,61:e3.
[15]中华人民共和国卫生部.抗菌药物临床应用管理办法[J].中华临床感染病杂志,2012,5(6):9-13.
[16]赵英英,孔霞,张洋.对《抗菌药物临床应用指导原则(2015年版)》的不同意见[J].中国医药生物技术,2016,11(6):567-568.
[17]Teatero S,Ferrieri P,Martin I,et al.Serotype distribution,population structure,and antimicrobial resistance of group BStreptococcus strains recovered from colonized pregnant women[J].J Clin Microbiol,2017,55(2):412-422.
[18]Mwananyanda L,Pierre C,Mwansa J,et al.Preventing bloodstream infections and death in Zambian neonates:impact of a low-cost infection control bundle[J].Clin Infect Dis,2018:10.1093/cid/ciy1114.
[19]Zhou B,Zhu J,Mao Z,et al.Roles of procalcitonin and N-terminal pro-B-type natriuretic peptide in predicting catheterrelated bloodstream infection in severe burn injury patients[J].Dis Markers,2018,22:5607932.