遵义地区孕晚期女性生殖道无乳链球菌的筛查及耐药性分析

Screening and drug resistance analysis of Streptococcus agalactiae in fem ale reproductive tract during late pregnancy in Zunyi area

目的:了解遵义地区孕晚期女性阴道及肛周分泌物中无乳链球菌的检出情况及该病原菌对抗菌药物的耐药、敏感情况,为临床妊娠期无乳链球菌感染的合理用药提供科学依据。方法:以2021年1月至2022年4月就诊于遵义市妇幼保健院、正安县妇幼保健院和湄潭县妇幼保健院三家医院产科门诊的961例孕35~37周的孕妇为研究对象。利用无乳链球菌专用转运拭子采集孕妇阴道及肛周分泌物并进行细菌培养分离,利用VITEK 2细菌鉴定系统对疑似菌株进行鉴定,并利用纸片扩散法(K-B法)对分离鉴定的无乳链球菌开展药物敏感性试验(药敏试验),最后利用WHONET 5.6软件统计分析药敏试验结果。结果:共收集孕妇的阴道及肛周分泌物标本961份,从其中58份标本中分离出58株无乳链球菌,检出率为6.0%。药敏试验结果显示,分离出的无乳链球菌对青霉素、氨苄西林、头孢曲松、利奈唑胺及万古霉素100%敏感,对四环素的耐药率最高(达77.6%),其次是克林霉素(达67.2%),其对红霉素和左氧氟沙星的耐药率均超过50%。在58株无乳链球菌中,共检出红霉素耐药而克林霉素敏感或中介的无乳链球菌33株,其中D-试验(即诱导克林霉素耐药试验)阳性菌株13株,阳性率为39.4%。结论:遵义地区孕晚期女性无乳链球菌的感染率较高,青霉素可作为该地区治疗孕晚期女性无乳链球菌感染的首选药物。临床上应加强对孕晚期女性无乳链球菌的筛查,并根据药敏试验结果合理选择抗生素进行治疗。

Objective:To investigate the detection of Streptococcus agalactiae in vaginal and perianal secretions of women in late pregnancy in Zunyi area,as well as the resistance and sensitivity of the pathogenic bacteria to antibiotics,so as to provide scientific basis for rational drug use of Streptococcus agalactiae infection in clinical pregnancy.Methods:From January 2021 to April 2022,a total of 961 pregnant women with 35 to 37 weeks of gestation were enrolled in the obstetric clinics of three hospitals:Zunyi Maternal and Child Health Care Hospital,Zheng‘an County Maternal and Child Health Care Hospital and Meitan County Maternal and Child Health Care Hospital.The vaginal and perianal secretions of pregnant women were collected using a special transport swab for Streptococcus agalactiae and cultured for bacterial isolation.The suspected strains were identified using the VITEK 2 bacterial identification system.The disk diffusion method(K-B method)was used to carry out drug sensitivity test(drug sensitivity test)for the isolated and identified Streptococcus agalactiae.Finally,WHONET 5.6 software was used to analyze the drug sensitivity test results.Results:A total of 961 vaginal and perianal secretions of pregnant women were collected,58 strains of Streptococcus agalactiae were isolated from 58 specimens,the detection rate was 6.0%.The results of drug sensitivity test showed that Streptococcus agalactiae isolated were 100%sensitive to penicillin,ampicillin,ceftriaxone,Linezolid and vancomycin.The resistance rate to tetracycline was the highest(77.6%),followed by clindamycin(67.2%),and the resistance rate to erythromycin and levofloxacin were both over 50%.Among 58 Streptococcus agalactis strains,33 Streptococcus agalactis strains were found to be resistant to erythromycin but sensitive or intermediate to clindamycin,among which 13 strains were positive for D-test(inducing clindamycin resistance test),with a positive rate of 39.4%.Conclusion:The infection rate of Streptococcus agalactiae among women in late pregnancy is high in Zunyi area,and penicillin can be used as the first choice for the treatment of Streptococcus agalactiae infection in women in late pregnancy in Zunyi area.Clinical screening of Streptococcus agalactiae should be strengthened and antibiotics should be reasonably selected for treatment according to the results of drug sensiti vity test.