妊娠期宫内感染病原菌及B族链球菌感染对分娩的影响

Effect of pathogenic microorganisms and group B Streptococcus infection delivery in patients with intrauterine infection during pregnancy

目的 研究妊娠期宫内感染患者病原微生物分布特点,以及主要致病菌B族链球菌对分娩情况的影响。方法 选取2019年2月-2022年1月于新余市人民医院产科检查的妊娠期宫内感染患者98例,进行宫腔细菌培养、鉴定,分析病原微生物的分布特点、宫内感染孕妇的临床症状,采用比值比(OR)分析B族链球菌带菌对孕妇妊娠结局及新生儿的影响。结果 98份宫颈分泌物中检出病原菌138株,其中革兰阴性菌72株,革兰阳性菌48株,真菌18株;主要感染病原菌为大肠埃希菌、B族链球菌、铜绿假单胞菌;B族链球菌对万古霉素、头孢呋辛、头孢吡肟完全敏感,对青霉素、环丙沙星、莫西沙星、头孢西丁、苯唑西林、头孢唑林的敏感率均>90%,对红霉素、克林霉素的敏感度较低;临床症状主要为发热(85.71%)、白带异味(61.22%);B族链球菌感染组的宫内窘迫和胎膜早破发生率均高于非B族链球菌感染组(P<0.05),B族链球菌感染组孕妇发生宫内窘迫和胎膜早破的风险分别是非B族链球菌感染组孕妇的3.569倍和3.170倍,B族链球菌感染组新生儿肺炎、上呼吸道感染以及B族链球菌阳性发生率均高于非B族链球菌感染组(P<0.05),感染组孕妇发生新生儿肺炎、上呼吸道感染以及B族链球菌阳性的风险是非B族链球菌感染组孕妇的3.526倍、4.295倍、3.160倍。结论 B族链球菌是引起妊娠期宫内感染的重要致病菌,可增加不良妊娠结局风险,影响新生儿健康,临床上需重点关注孕妇宫内B族链球菌的感染情况,并根据药敏试验选用敏感抗菌药物治疗。

OBJECTIVE To study the distribution characteristics of pathogenic microorganisms in patients with intrauterine infection during pregnancy,and the effect of the main pathogenic bacteria group B Streptococcus on delivery.METHODS A total of 98 patients with intrauterine infection during pregnancy who were examined in obstetrics department of Xinyu People's Hospital from Feb 2019 to Jan 2022 were recruited.The uterine cavity bacteria were cultured and identified;the distribution characteristics of pathogenic microorganisms and the clinical symptoms of pregnant women with intrauterine infection were analyzed.The odds ratio(OR)was used to analyze the effect of group B Streptococcus on pregnancy outcomes and neonatal outcomes of pregnant women.RESULTS 138 strains of pathogenic bacteria were detected from 98 cervical secretions,including 72 strains of gram-negative bacteria,48 strains of gram-positive bacteria and 18 strains of fungi.The main infectious pathogens were Escherichia coli,group B Streptococcus,and Pseudomonas aeruginosa.Group B Streptococcus was completely sensitive to vancomycin,cefuroxime and cefepime;the drug sensitivity rates to penicillin,ciprofloxacin,moxifloxacin,cefoxitin,oxacillin and cefazolin were>90%while the drug sensitivity to erythromycin and clindamycin was low.The main clinical symptoms were fever(85.71%)and leucorrhea odor(61.22%).The incidence of intrauterine distress and premature rupture of membranes in the group B Streptococcus infection group was higher than that in the nongroup B Streptococcus infection group(P<0.05).The risk of intrauterine distress and premature rupture of membranes in the group B Streptococcus infection group was 3.569 times and 3.170 times higher than that in the nongroup B Streptococcus infection group,respectively.The incidence of upper respiratory tract infection and neonatal pneumonia in the group B Streptococcus infection group positivity was higher than that in the non-group B Streptococcus infection group(P<o.05).The risk of neonatal pneumonia,upper respiratory tract infection and group B Streptococcus infection in the group B Streptococcus infection group was 3.526 times,4.295 times,and 3.160 times higher than those in the non-group B Streptococcus infection group.CONCLUSION Group B Streptococcus is an important pathogen causing intrauterine infection during pregnancy,which can increase the risk for adverse pregnancy outcomes and affect the health of newborns.In clinical practice,attention should be paid to the intrauterine infection of group B Streptococcus in pregnant women,and sensitive antibiotics should be selected according to drug sensitivity test.