妊娠晚期B族链球菌的感染现状和耐药情况及阴道微生态情况分析

Analysis of Infection Status,Antibiotic Resistance Status and Vaginal Microecology of Late Pregnant Women with Group B Streptococcus Infection

目的:探讨妊娠晚期孕妇B族链球菌(GBS)的感染现状、耐药情况及GBS感染阴道微生态情况。方法:回顾性分析2020年1月至2022年12月在唐山市妇幼保健院接受产检的37175例妊娠晚期孕妇病例资料,统计GBS培养和药敏试验结果,分析连续3年内不同年龄段孕妇GBS的感染情况、变化趋势及耐药率变迁。同时对2022年1月至2022年12月就诊的849例妊娠晚期孕妇的生殖道标本进行细菌培养及形态学检测(分为GBS阳性组499例和GBS阴性组350例),观察并比较两组的清洁度和微生态指标的特点。结果:2020年1月至2022年12月连续3年,GBS阳性率分别为4.30%、4.79%、5.14%,且逐年增高(P<0.01);不同年龄组GBS检出阳性率的差异无统计学意义(P>0.05);连续3年GBS对青霉素、氨苄西林、阿莫西林/克拉维酸、头孢曲松钠、头孢噻肟、头孢吡肟、美罗培南、利奈唑胺、万古霉素均未发现耐药菌株,对左氧氟沙星、红霉素、克林霉素耐药率较高(均>50%),但耐药率呈下降趋势。对四环素的耐药率较高且耐药率呈上升趋势;在阴道微生态方面,GBS阳性组和GBS阴性组阴道微生态失衡率分别为73.35%和29.71%,其清洁度在Ⅲ~Ⅳ级分别占72.95%和28.86%;GBS阳性组伴有白细胞显著增多的占11.62%;pH>4.5占72.95%,与GBS阴性组比较差异有统计学意义(P<0.01)。清洁度、白细胞、菌群密度与多样性GBS阳性组与阴性组比较,差异均有统计学意义(P<0.01)。结论:妊娠晚期GBS阳性率逐年增高,年龄不是引起GBS感染的因素,青霉素依然可作为产时首选预防药物。对于青霉素过敏者,应根据药敏试验结果科学合理选择抗生素。妊娠晚期GBS感染后具有较高的阴道微生态失衡率,但并非所有GBS感染者阴道微生态均失衡。

Objective:To evaluate the current infection level and antibiotic resistance status of group B streptococcus(GBS)in late pregnant women in the third trimester of pregancy and the vaginal microecology of GBS infected pregnant women.Methods:The data of 37175 women in the third trimester of pregnancy who received prenatal examination in Tangshan Maternal and Child Health Hospital from January 2020 to December 2022 were retrospectively analyzed.We explored the infection status,trends of infection and antibiotic resistance of pregant women of different age groups for three consecutive years using resultss of GBS cultures and drug sensitivity tests.849 women in the third trimester of pregnancy who visited the hospital from January 2022 to December 2022 were specially selected(including 499 GBS positive women and 350 GBS negative women)to conduct both morphological tests and bacterial cultures to genital tract specimen,for the purpose of comparing cleanliness degree and microecology indicators between these two groups.Results:From January 2020 to December 2022,the positive rates of GBS were 4.30%,4.79%and 5.14%,respectively,which increased year by year(P<0.01).There was no statistical difference in infection rate between different age groups(P>0.05);For three consecutive years,no GBS strains resistant to penicillin,ampicillin,amoxicillin/clavulanate,ceftriaxone,cefotaxime,cefepime,meropenem,linezolid and vancomycin were found.The resistance rates to levofloxacin,erythromycin and clindamycin were high(all>50%),however showing a downward trend.The resistance rate to tetracycline was rather high and climbing year by year.In terms of vaginal microecology,the microbiota imbalance rates were 73.35%and 29.71%in GBS positive and negative groups respectively.The gradeⅢ-Ⅳcleanliness were 72.95%and 28.86%,respectively.In the GBS-positive group,11.62%exhibited a significant increase in leukocytes;72.95%had a pH>4.5.These findings showed a statistically significant difference when compared to the GBS-negative group(P<0.01).The differences in cleanliness,leukocyte count,bacterial density and diversity between GBS-positive and GBS-negative groups were all statistically significant(P<0.01).Conclusions:The positive rate of GBS increases year by year.Age is not a factor causing GBS infection.Penicillin can still be used as the first line prophylactic antibiotic during cildbirth in GBS positive pregant women.For those allergic to penicillin,antibiotics should be selected scientifically and reasonably according to the results of drug sensitivity test.Pregnant women had a higher vaginal microecological imbalance rate,but not all GBS infected women had vaginal microecological imbalance.