B族链球菌感染影响因素及耐药性分析

The Influence Factors of Perinatal Group B Streptococcus Infection and Related Drug Resistance Analysis

目的调查北京朝阳区孕产妇B族链球菌的感染及耐药情况,分析合并有妊娠糖尿病、阴道炎疾病的孕妇B族链球菌检测阳性与妊娠结局的关系,为临床合理使用抗菌药物及孕妇孕产期保健提供临床依据。方法收集近2年期间在本院就诊住院的30~42周孕产妇阴道及直肠拭子、新生儿血液及分泌物标本。进行B族链球菌培养、鉴定及药物敏感性测定。结果近2年孕产妇中B族链球阳性率为6.91%(329/4762);新生儿B族链球菌阳性率0.43‰(2/4700)。阴道与直肠拭子联合检测GBS阳性率为6.91%,显著高于阴道拭子(5.45%)和直肠拭子阳性率(6.01%)。B族链球菌对四环素耐药率最高(63.2%),其次为克林霉素(62.1%)和环丙沙星(52.9%),未发现对青霉素、氨苄西林、利奈唑胺、万古霉素、替加环素的耐药菌株。合并有妊娠糖尿病和阴道炎的孕产妇B族链球菌阳性率显著高于阴性孕产妇(P<0.05)。结论北京朝阳北苑地区的孕产妇可以继续将青霉素、氨苄西林、利奈唑胺、万古霉素、替加环素作为首选药物。而对四环素、克林霉素和环丙沙星出现较高的耐药性。孕产妇合并妊娠糖尿病、阴道炎疾病均为孕产妇B族链球菌高感染率的危险因素,临床应积极进行及早干预,降低孕妇孕晚期的B族链球菌感染率。

Objective To investigate the infection status and drug resistance of group B Streptococcus in pregnant women in Chaoyang District,Beijing,and to analyze the relationship between positive detection of group B streptococci and pregnancy outcome in pregnant women with gestational diabetes mellitus and vaginitis.Methods The vaginal and rectal swabs of pregnant women and newborns,blood and secretion samples of 30-42 weeks hospitalized in our hospital in past 2 years were collected for the study.In cultured samples,identification and drug sensitivity of group B Streptococcus were determined.Results The positive rate of group B hammer in pregnant women in past 2 years was 6.91%(329/4762);The positive rate of group B streptococcus in newborns was 0.43‰(2/4700).The positive rate of GBS in vaginal and rectal swabs was 6.91%,which was significantly higher than that in vaginal swabs(5.45%)and rectal swabs(6.01%).The resistance rate of group B streptococcus to tetracycline was the highest(63.2%),followed by clindamycin(62.1%)and ciprofloxacin(52.9%),and no drug-resistant strains to penicillin,ampicillin,linezolid,vancomycin and tegacyclin were found.The positive rate of group B streptococci in pregnant women with gestational diabetes and vaginitis was significantly higher than that in negative pregnant women(P<0.05).Conclusion Our study suggests that penicillin,ampicillin,linezolid,vancomycin and tegacyclin can continue to be the first choice for pregnant women in Beiyuan area,Chaoyang,Beijing.The drug resistance to tetracycline,clindamycin and ciprofloxacin is relatively higher.Pregnant women with gestational diabetes and vaginitis are all risk factors for the high prevalence of group B streptococci in pregnant women.Clinical intervention should be carried out actively to reduce the infection rate of group B Streptococcus in the third trimester of pregnancy.