南昌市围生期孕妇B族链球菌感染情况及耐药分析

Infection Status and Drug Resistance Analysis of Group B Streptococcus in Pregnant Women During Perinatal Period in Nanchang

目的分析南昌市围生期孕妇B族链球(GBS)的菌感染情况及耐药性。方法选取2018年9月~2019年9月江西省妇幼保健院产检的800例围生期孕妇为研究对象,采集肛周及阴道分泌物进行GBS检测,统计其检出率;应用K-B纸片扩散法与D试验检测GBS阳性分离菌株的药物敏感性,分析耐药表型;应用PCR法检测耐药菌株的耐药基因,分析耐药表型与耐药基因情况。结果800例孕妇共检出GBS阳性43例,检出率为5.38%(43/800);GBS对万古霉素、头孢哌酮/舒巴坦、头孢吡肟、青霉素、头孢曲松及左氧氟沙星的敏感率较高,分别占100.00%、100.00%、100.00%、95.34%、95.34%、93.02%;对四环素、红霉素、克林霉素和氯霉素敏感率低,分别占23.26%、25.58%、41.86%、65.12%。D试验中,耐药表型以cMLS表型为主,占48.84%(21/43),其次为M型、S型、L型,且未检出iMLS型;耐药基因以erm为主,其中ermB 18株,ermTR 8株,其次为mef和linB。结论围生期孕妇GBS检出率较高,临床应重视围生期孕妇GBS感染的筛查。GBS分离菌株对红霉素、克林霉素的敏感性较低,对万古霉素、头孢哌酮/舒巴坦的敏感性相对较高。临床应根据药敏实验结果及D试验结果,合理选用抗菌药物,提高治疗的有效性和安全性,有效改善孕妇妊娠结局。

Objective To analyze the bacterial infection and drug resistance analysis of pregnant women with group B streptococcus(GBS)in perinatal period in Nanchang.Methods From September 2018 to September 2019,800 perinatal pregnant women were examined in the Jiangxi Maternal and Child Health Hospital.The perianal and vaginal secretions were collected for GBS testing,and the detection rate was counted.K-B paper was used for diffusion method D test were used to detect the drug sensitivity of GBS-positive isolates and analyze the drug-resistant phenotype;PCR method was used to detect the drug-resistant genes of drug-resistant strains,and the drug-resistant phenotype and drug-resistant genes were analyzed.Results A total of 43 pregnant women were positive for GBS in 800 cases,the detection rate was 5.38%(43/800);GBS was sensitive to vancomycin,cefoperazone/sulbactam,cefepime,penicillin,ceftriaxone and levofloxacin The rate is higher,accounting for 100.00%,100.00%,100.00%,95.34%,95.34%,93.02%respectively;the sensitivity to tetracycline,erythromycin,clindamycin and chloramphenicol is low,accounting for 23.26%,25.58%,41.86%,65.12%.In the D test,the resistance phenotype was mainly cMLS phenotype,accounting for 48.84%(21/43),followed by M type,S type,L type,and iMLS type was not detected;drug resistance genes were mainly erm among them,18 ermB strains and 8 ermTR strains,followed by mef and linB.Conclusion The detection rate of GBS in perinatal pregnant women is relatively high,and clinical attention should be paid to the screening of GBS infection in perinatal pregnant women.GBS isolates have low sensitivity to erythromycin and clindamycin,and relatively good sensitivity to vancomycin and cefoperazone/sulbactam.According to the results of the drug sensitivity test and the D test,the clinical selection of rational antibacterial drugs should improve the effectiveness and safety of treatment and effectively improve the pregnancy outcome of pregnant women.