B族链球菌感染孕产妇凝血功能变化、耐药情况及不同血清型的毒力基因分布

Changes in coagulation,drug resistance,and virulence gene distribution among different serotypes in pregnant and postpartum women with a group B streptococcus infection

目的检测和分析B族链球菌(GBS)感染孕产妇凝血功能变化、耐药情况及不同血清型的毒力基因分布。方法选择2017年1月—2019年6月本院产检确诊GBS感染的孕产妇45例,纳为观察组;另选择同期产检未发生GBS感染的孕产妇50例纳入对照组。对比检测两组孕产妇凝血功能指标变化,K-B纸片扩散法、E-test法测定GBS的耐药性;PCR检测GBS毒力基因,分析GBS不同血清型的毒力基因分布。结果观察组孕产妇PT、INR、APTT均较对照组缩短(P<0.05),Fbg较对照组升高(P<0.05)。45株GBS对青霉素、万古霉素均敏感,耐药率为0;对四环素、红霉素的耐药率分别为86.67%和71.11%;对克林霉素、左氧氟沙星的耐药率分别为40.00%和35.56%。孕产妇感染GBS的血清型以Ⅰb(35.56%)、Ⅰa(26.67%)、Ⅲ(20.00%)为主,毒力基因以hylB(100%)、scpB(68.89%)、lmb(75.56%)为主。结论GBS感染孕产妇存在高凝低纤溶现象,感染的GBS血清型具有多样性,治疗应选用青霉素、万古霉素等敏感性较高的抗菌药物,以控制感染的发展,改善母婴预后。

Objective To detect and analyze changes in coagulation,drug resistance and virulence gene distribution among different serotypes in pregnant women infected with group B streptococcus(GBS).Methods Forty-five pregnant women diagnosed with a GBS infection at this Hospital from January 2017 to June 2019 served as the observation group.Fifty pregnant women without a GBS infection during the same period served as the control group.Fasting venous blood and vaginal secretions were collected from the two groups.The coagulation indexes of the two groups were determined.The drug resistance of GBS was determined using the K-B disk diffusion method and the E-test method,and the distribution of GBS virulence genes was determined using PCR.Results PT and APTT were shorter and INR was lower in the observation group than those times and that ratio in the control group(P<0.05),and Fbg was higher than that in the control group(P<0.05).Forty-five GBS strains were sensitive to penicillin and vancomycin,with a resistance of 0%.However,their resistance to tetracycline was 86.67%,their resistance to erythromycin was 71.11%,their resistance to clindamycin was 40.00%,and their resistance to levofloxacin was 35.56%.The main serotypes of GBS infection were Ib(35.56%),Ia(26.67%),and III(20.00%).The virulence genes detected were mainly hylB(100%),scpB(68.89%),and lmb(75.56%).Conclusion A phenomenon in the form of a high level of coagulation and low level of fibrinolysis was evident in pregnant and postpartum women infected with GBS.In order to control GBS infections and improve the prognosis for mothers and infants,antibiotics to which GBS is sensitive,such as penicillin and vancomycin,should be given to prevent and treat GBS infections in pregnant and postpartum women.