妊娠晚期孕妇无乳链球菌感染与耐药性变迁分析

Analysis of Streptococcus agalactiae infection and drug resistance tendency in pregnant women in late pregnancy

目的对妊娠晚期孕妇生殖道分离的无乳链球菌常用抗菌药物耐药趋势做回顾性分析,为临床预防和治疗感染提供依据。方法 2011年1月-2016年11月待产孕妇生殖道标本分离出的细菌用VITEK 2 Compact分析仪进行鉴定和药敏试验,对红霉素耐药、克林霉素敏感或中介的菌株做D试验。结果检出586株无乳链球菌,无万古霉素、头孢曲松、利奈唑胺和替加环素耐药菌株;对青霉素、氨苄西林和奎奴普汀/达福普汀高度敏感;对左氧氟沙星、红霉素、克林霉素及四环素平均耐药率分别为38.6%、75.3%、75.9%及85.5%,红霉素和克林霉素耐药率在2012年开始上升较快以后相对平稳,四环素耐药率呈逐年下降趋势;呋喃妥因敏感性较高,耐药率缓慢上升。D试验阳性率为20.4%。结论青霉素、氨苄西林可作为治疗无乳链球菌感染的首选药物,对青霉素过敏要根据药敏结果选用红霉素和克林霉素,头孢菌素类抗生素可作为二线选择药物,重度感染可选用利奈唑胺、替加环素。

Objective To retrospectively analyze the trend of antimicrobial resistance of Streptococcus agalactia isolated from reproductive tract of pregnant women in late pregnancy, and to provide evidence for clinical prevention and treatment of infection. Methods The bacteria isolated from the maternal genital tract specimens of the pregnant from January 2011 to November 2016 were identified by VITEK 2 Compact analyzer and the drug sensitivity test was performed. D test was performed on el2cthromycin resistant, clindamycin sensitive or intermediate strains. Results There were 586 strains of Streptococcus lactis, no vancomycin, ceflriaxone, linezolid, and cyclosporine resistant strains ; resistant strains to penicillin, ampicillin and quinupristin / Dafoe/leptin is highly sensitive, but resistance to lcvofloxacin, erythromycin, clindamycin, tetracycline and higher rate of the average resistance rate rates were 38.6% , 75.3% , 75.9% and 85.5%. The erythromycin and clindamycin resistance rate in 2012 begins to rise rapidly after steady fluctuation; tetracycline resistance rate decreased year by year; high sensitivity to nitrofurantoin, drug resistance rate increased slowly. The positive rate of D test was 20.4%. Conclusion Penicillin and ampicillin can be treated as preferred drugs to Streptococcus agalactia infection. According to the results of drug sensitivity, penicillin and erythromycin should be selected according to the results of drug sensitivity. Cephalosporins can be selected as second - line drugs, and severe infections can be treated with with optional linezolid, tigecycline.