孕晚期孕妇B族链球菌感染情况及不良妊娠结局分析

Analysis of Group B Streptococcus infection and adverse pregnancy outcomes in late pregnant women

目的研究孕晚期孕妇B族链球菌(GBS)病原学特点和对妊娠结局的影响。方法收集400例于本院就诊并携带GBS孕晚期孕妇资料作为研究对象,并收集400例健康孕晚期孕妇对照组。收集标本并采用触媒试验和微生物鉴定仪进行菌株鉴定。采用K-B纸片法测试GBS耐药情况。回顾性分析孕晚期孕妇GBS易感因素和不良妊娠结局。结果GBS对红霉素、克林霉素、四环素、阿奇霉素、诺氟沙星和环丙沙星耐药率分别为84.95%、78.76%、71.24%、82.53%、58.06%和51.88%。GBS感染组年龄27.12±3.61岁,对照组27.37±3.93岁。GBS感染组BMI 27.67±2.51 kg/m^(2),对照组26.91±2.18 kg/m^(2)。GBS感染组有患有贫血、高血压和糖尿病,以及职业不稳定人员和有流产史构成比分别为17.75%、4.50%、15.50%、49.25%和9.00%;对照组分别为12.50%、4.00%、10.75%、42.25%和2.50%。GBS感染组阴道pH值<4.4,患有滴虫、真菌、线索细胞感染和阴道与宫颈炎症构成比分别为24.00%、2.75%、14.50%、12.75%和11.50%;对照组分别为54.25%、0.75%、8.75%、8.00%和3.00%。GBS感染组和对照组年龄和是否患有高血压差异无统计学意义(P>0.05),而两组患者BMI、患有贫血、糖尿病、滴虫、真菌、线索细胞感染和阴道与宫颈炎症,以及职业不稳定人员和有流产史的构成比差异有统计学意义(P<0.05)。GBS感染组的胎膜早破、羊膜炎、胎儿窘迫、产后出血和产后感染发生率分别为20.75%、9.25%、10.50%、8.75%和16.00%,对照组分别为2.75%、1.25%、4.00%、2.25%和0.75%。两组患者胎膜早破、羊膜炎、胎儿窘迫、产后出血和产后感染发生率据差异有统计学意义(P<0.05)。GBS感染组的新生儿肺炎、病理性黄疸、新生儿脓血症和新生儿窒息的发生率分别为20.75%、9.25%、10.50%、8.75%和16.00%,对照组分别为3.75%、0.00%、0.00%和0.00%。两组患者新生儿肺炎、病理性黄疸和新生儿脓血症发生率差异有统计学意义(P<0.05),而新生儿窒息发生率差异无统计学意义(P>0.05)。结论GBS对大环内酯类、喹诺酮类抗生素产生了一定的耐受性,对青霉素等抗生素仍敏感。肥胖、糖尿病、贫血、有流产史、工作不稳定和阴道微生态差的患者易患GBS感染,发生GBS感染的孕妇易发生不良妊娠结局。

Objective To study the pathogenic characteristics of Group B Streptococcus(GBS)in late pregnancy and its impact on pregnancy outcomes.Methods The data were collected from 400pregnant women who visited our hospital and carried GBS for late pregnancy as research subjects,and collect 400healthy late pregnancy pregnant women as a control group.The specimens were collected and strains were identified by catalyst tests and microbial identification instruments.The resistance of GBS were tested by K-B paper method.The GBS susceptibility factors and adverse pregnancy outcomes in late pregnancy women were analyzed.Results The resistance rates of GBS to erythromycin,clindamycin,tetracycline,azithromycin,norfloxacin,and ciprofloxacin were 84.95%,78.76%,71.24%,82.53%,58.06%,and 51.88%,respectively.The age of GBS infection group was 27.12±3.61years old,while the control group was 27.37±3.93years old.The BMI of the GBS infection group was 27.67±2.51kg/m^(2),while the control group was 26.91±2.18kg/m^(2).The proportions of people with anemia,hypertension,diabetes,occupational instability and abortion history in the GBS infection group were 17.75%,4.50%,15.50%,49.25%and 9.00%,respectively;The control groups were 12.50%,4.00%,10.75%,42.25%,and 2.50%,respectively.The proportions of the vaginal pH value less than 4.4,trichomonads,fungi,clue cells,and vaginal and cervical inflammationin the GBS infection group were 24.00%,2.75%,14.50%,12.75%,and 11.50%,respectively.The control groups were 54.25%,0.75%,8.75%,8.00%,and 3.00%,respectively.The age and hypertension of GBS infection group and control group were not statistically significant(P>0.05),while the data of BMI,anemia,diabetes,trichomonas,fungi,clue cell infection,vaginitis and cervicitis,occupational instability and abortion history of the two groups were statistically significant(P<0.05).The incidences of premature rupture of membranes,amniotic,fetal distress,postpartum hemorrhage,and postpartum infection in the GBS infection group were 20.75%,9.25%,10.50%,8.75%,and 16.00%,respectively,while those in the control group were 2.75%,1.25%,4.00%,2.25%,and 0.75%,respectively.There were statistically significant differences in the incidences of premature rupture of membranes,amniotic,fetal distress,postpartum hemorrhage,and postpartum infection between the two groups of patients(P<0.05).The incidences of neonatal pneumonia,pathological jaundice,neonatal sepsis,and neonatal asphyxia in the GBS infection group were 20.75%,9.25%,10.50%,8.75%,and 16.00%,respectively,while those in the control group were 3.75%,0.00%,0.00%,and 0.00%,respectively.There were statistically significant differences in the incidence of neonatal pneumonia,pathological jaundice,and neonatal sepsis between the two groups of patients(P<0.05),while the incidence of neonatal asphyxia was not statistically significant(P>0.05).Conclusion GBS had a certain degree of tolerance to macrolides and quinolones,but remains sensitive to penicillins and other antibiotics.Patients with obesity,diabetes,anemia,history of abortion,unstable work and poor vaginal microflora were prone to GBS infection.Pregnant women with GBS infection were prone to adverse pregnancy outcomes.