妊娠期B族链球菌感染现状及对母儿结局的影响
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摘要
目的:探讨孕妇孕晚期B族链球菌(GBS)的定植率、基因分型、感染高危因素、母儿围产结局及药敏情况,以期为临床诊疗提供参考。方法:2016年6月至2017年6月在上海交通大学医学院附属新华医院产科进行产前检查、孕35～37周行GBS筛查的孕妇3475例,采用细菌培养和PCR两种方法筛查。GBS显色培养平板结果为阳性的154例为感染组,阴性995例为对照组,感染组临产后应用抗生素预防感染。回顾分析两组的临床资料及围产结局。对154株GBS菌株进行多位点序列分型(MLST)和药敏实验。结果:孕妇的GBS总体定植率为11.7%(406/3475),GBS显色培养平板阳性率高于PCR(12.3%vs 9.9%)。MLST分型主要为ST-366、687、15、32、19、12、24和27。年龄大、文化程度低、有流产史的孕妇感染GBS的机率大;GBS感染组和对照组孕妇的围产结局,如胎膜早破、羊水粪染、胎儿窘迫、产后出血、Apgar评分等比较,差异均无统计学意义(P>0.05);感染GBS的孕妇发生早产、低出生体重儿及剖宫产的概率增加(48.1%vs 56.7%、1.3%vs 5.7%、5.2%vs 6.5%,P均<0.05)。GBS对氨苄西林、万古霉素、青霉素、头孢曲松完全敏感;而对喹诺酮类、大环内酯类、四环素类抗生素有一定的耐药性。结论:孕晚期常规GBS筛查及分娩期预防性使用抗生素治疗能减少母儿不良围产期结局的发生,推荐GBS显色培养基为首选检测方法,头孢类抗生素可作为预防及治疗GBS感染的首选药物。
Objective:To investigate the colonization rate,genotyping,high risk factors of group B streptococcus(GBS) infection,maternal-neonatal outcomes and drug susceptibility of GBS in pregnant women.Methods:A total of 3475 pregnant women were screened for GBS at 35～37 weeks from June 2016 to June 2017 in Xinhua Hospital of Shanghai Jiaotong University School of Medicine.All samples were assayed by the chromogenic plate of GBS culture and PCR methods.154 cases of pregnant women with positive GBS screening were assigned to infection group,and 995 cases of pregnant women with negative GBS screening in same hospital at same period as control group.Antibiotics were given to prevent infection for GBS positive group during labor.High risk factors of GBS infection during pregnancy were analyzed and the perinatal outcomes of the two group were compared.The multilocus sequence typing of 154 GBS strains was analyzed.Results:The total colonization rate of GBS in pregnant women was 11.7%(406/3475).The detection rate of GBS display color plate was 12.3%,which were superior to PCR 9.9%.The MLST classification was mainly ST-366,687,15,32,19,12,24 and 27.Older age,history of abortion and lower level of education were risk factors for GBS infection during pregnancy.There were no significant differences in perinatal outcomes such as premature rupture,meconium-stained amniotic fluid,fetal distress,postpartum hemorrhage,Apgar score,between GBS-positive group and control group.Incidences of preterm labor,low birth weight infants,and cesarean section in the infection group were significantly higher than those in control group(10.4% vs 4.6%、9.1% vs 4.2%、48.1% vs 38.5%,all P<0.05).GBS isolates were all(100%) sensitive to ampicillin,vancomycin,penicillin and ceftriaxone;but it was resistant to quinolones,macrolides and tetracyclines.Conclusion:GBS screening during pregnancy and intrapartum antibiotic prophylaxis can reduce the incidence of poor maternal-neonatal outcomes.The chromogenic plate of GBS is recommended as the preferred method of detection.Cephalosporins can be used as an appropriate first-line antibiotic choice for intrapartum GBS.
Objective:To investigate the colonization rate,genotyping,high risk factors of group B streptococcus(GBS) infection,maternal-neonatal outcomes and drug susceptibility of GBS in pregnant women.Methods:A total of 3475 pregnant women were screened for GBS at 35～37 weeks from June 2016 to June 2017 in Xinhua Hospital of Shanghai Jiaotong University School of Medicine.All samples were assayed by the chromogenic plate of GBS culture and PCR methods.154 cases of pregnant women with positive GBS screening were assigned to infection group,and 995 cases of pregnant women with negative GBS screening in same hospital at same period as control group.Antibiotics were given to prevent infection for GBS positive group during labor.High risk factors of GBS infection during pregnancy were analyzed and the perinatal outcomes of the two group were compared.The multilocus sequence typing of 154 GBS strains was analyzed.Results:The total colonization rate of GBS in pregnant women was 11.7%(406/3475).The detection rate of GBS display color plate was 12.3%,which were superior to PCR 9.9%.The MLST classification was mainly ST-366,687,15,32,19,12,24 and 27.Older age,history of abortion and lower level of education were risk factors for GBS infection during pregnancy.There were no significant differences in perinatal outcomes such as premature rupture,meconium-stained amniotic fluid,fetal distress,postpartum hemorrhage,Apgar score,between GBS-positive group and control group.Incidences of preterm labor,low birth weight infants,and cesarean section in the infection group were significantly higher than those in control group(10.4% vs 4.6%、9.1% vs 4.2%、48.1% vs 38.5%,all P<0.05).GBS isolates were all(100%) sensitive to ampicillin,vancomycin,penicillin and ceftriaxone;but it was resistant to quinolones,macrolides and tetracyclines.Conclusion:GBS screening during pregnancy and intrapartum antibiotic prophylaxis can reduce the incidence of poor maternal-neonatal outcomes.The chromogenic plate of GBS is recommended as the preferred method of detection.Cephalosporins can be used as an appropriate first-line antibiotic choice for intrapartum GBS.
引文
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[15] Teatero S,Ferrieri P,Martin I,et al.Serotype distribution,population structure,and antimicrobial resistance of group B streptococcus strains recovered from colonized pregnant women[J].J Clin Microbiol,2017,55(2):412-422
[16] Manning SD,Springman AC,Lehotzky E,et al.Multilocus sequence types associated with neonatal group B streptococcal sepsis and meningitis in Canada[J].J Clin Microbiol,2009,47(4):1143-1148
[17] Lartigue MF,Kostrzewa M,Salloum M,et al.Rapid detection of "highly virulent" Group B Streptococcus ST-17 and emerging ST-1 clones by MALDI-TOF mass spectrometry[J].J Microbiol Methods,2011,86(2):262-265
[18] 张兰,朱樱梅,李敏许.妊娠期B族链球菌感染的高危因素及其对新生儿预后影响分析[J].中国妇幼健康研究,2017,28(6):731-733
[19] Money D,Allen VM.The prevention of early-onset neonatal group B streptococcal disease[J].J Obstet Gynaecol Can,2013,35(10):939-948
[20] 陈红波,孟祥莲,王谢桐.围生期B族链球菌感染的研究现状[J].现代妇产科进展,2015,24(2):149-151
[21] 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
[2] Verani JR,McGee L,Schrag SJ.Prevention of perinatal group B streptococcal disease--revised guidelines from CDC,2010[J].MMWR,2010,59(Rr-10):1-36
[3] Baker CJ.The spectrum of perinatal group B streptococcal disease[J].Vaccine,2013,31(Suppl 4):D3-6
[4] State C.Prevention of perinatal group B streptococcal disease:a public health perspective.Centers for Disease Control and Prevention[J].MMWR,1996,45(Rr-7):1-24
[5] Schrag S,Gorwitz R,Fultz-Butts K,et al.Prevention of perinatal group B streptococcal disease.Revised guidelines from CDC[J].MMWR,2002,51(Rr-11):1-22
[6] Le Doare K,O'Driscoll M,Turner K,et al.Intrapartum antibiotic chemoprophylaxis policies for the prevention of group b streptococcal disease worldwide:systematic review[J].Clin Infect Dis,2017,65(suppl_2):S143-S151
[7] Tien N,Ho CM,Lin HJ,et al.Multilocus sequence typing of invasive group B Streptococcus in central area of Taiwan[J].J Microbiol Immunol Infect,2011,44(6):0-434
[8] Madrid L,Seale AC,Kohli-Lynch M,et al.Infant group B streptococcal disease incidence and serotypes worldwide:systematic review and meta-analyses[J].Clin Infect Dis,2017,65(suppl_2):S160-S172
[9] Wollheim C,Sperhacke RD,Fontana SKR,et al.Group B Streptococcus detection in pregnant women via culture and PCR methods[J].Rev Soc Bras Med Trop,2017,50(2):179-183
[10] 普筱敏,张力,旷凌寒,等.成都地区妊娠晚期B群链球菌定植情况调查及围产结局分析[J].现代妇产科进展,2018,27(1):33-36
[11] Abdelazim IA.Intrapartum polymerase chain reaction for detection of group B streptococcus colonisation[J].Aust N Z J Obstet Gynaecol,2013,53(3):236-242
[12] Bourgeois-Nicolaos N,Cordier AG,Guillet-Caruba C,et al.Evaluation of the Cepheid Xpert GBS assay for rapid detection of group B Streptococci in amniotic fluids from pregnant women with premature rupture of membranes[J].J Clin Microbiol,2013,51(4):1305-1306
[13] Helmig RB,Gertsen JB.Diagnostic accuracy of polymerase chain reaction for intrapartum detection of group B streptococcus colonization[J].Acta Obstet Gynecol Scand,2017,96(9):1070-1074
[14] Jones N,Bohnsack JF,Takahashi S,et al.Multilocus sequence typing system for group B streptococcus[J].J Clin Microbiol,2003,41(6):2530-2536
[15] Teatero S,Ferrieri P,Martin I,et al.Serotype distribution,population structure,and antimicrobial resistance of group B streptococcus strains recovered from colonized pregnant women[J].J Clin Microbiol,2017,55(2):412-422
[16] Manning SD,Springman AC,Lehotzky E,et al.Multilocus sequence types associated with neonatal group B streptococcal sepsis and meningitis in Canada[J].J Clin Microbiol,2009,47(4):1143-1148
[17] Lartigue MF,Kostrzewa M,Salloum M,et al.Rapid detection of "highly virulent" Group B Streptococcus ST-17 and emerging ST-1 clones by MALDI-TOF mass spectrometry[J].J Microbiol Methods,2011,86(2):262-265
[18] 张兰,朱樱梅,李敏许.妊娠期B族链球菌感染的高危因素及其对新生儿预后影响分析[J].中国妇幼健康研究,2017,28(6):731-733
[19] Money D,Allen VM.The prevention of early-onset neonatal group B streptococcal disease[J].J Obstet Gynaecol Can,2013,35(10):939-948
[20] 陈红波,孟祥莲,王谢桐.围生期B族链球菌感染的研究现状[J].现代妇产科进展,2015,24(2):149-151
[21] 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