Brain abscess caused by Streptococcus anginosus group:Three case reports

BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.

Disease burden,antimicrobial resistance and molecular characterization of invasive group B Streptococcus among non-pregnant adults in Malaysia:A protocol study

and pili genes are also investigated.Methods:This multicentre,prospective,observational study is conducted in seven major tertiary hospitals in Malaysia among non-pregnant adults.Simultaneously,a retrospective study is conducted in the selected hospitals with similar approaches.GBS isolates are subjected to phenotyping,serotyping by multiplex PCR,antimicrobial susceptibility testing and PCR-detection of GBS virulence and pilus genes.Seven housekeeping genes are amplified and sequenced for multi-locus sequence typing.Discussion:Findings from the study may contribute to the management of clinical practice to diagnose and prevent GBS related diseases in a timely manner.Prudent use of antibiotics is encouraged by monitoring antimicrobial resistance.

Vaginal Carriage of Group B Streptococcus in Pregnant Women in Rural Areas in Senegal

Vaginal carriage of Group B Streptococcus (GBS) is a maternal and child health issue. Our objective was to determine the prevalence of GBS carriage;identify the factors associated with this carriage and determine the antibiotic sensitivity of the isolated strains. We conducted a cross-sectional and prospective study in rural Senegal (in the health district of Sokone). Socio-demographic, clinical and gynaeco-obstetrical data were collected. Vaginal swabs were taken by the midwives on specific settings in order to test for GBS and other High Risk Vaginal Bacteria (HRVB). Antibiotic susceptibility testing was done according to the recommendations of the CA SFM/EUCAST 2020. In total, 100 pregnant women were targeted and 97 pregnant women were included. Their age ranged from 18 to 40 years with 64.9% (63/97) of participants belonging to the “20 - 30” age group. The overall prevalence of Group B Streptococcus carriage was 15.5% (15/97). However, the proportion of women with at least one high risk infectious bacteria was 29.89% (29/97). No statistically significant differences were found between GBS carriage and the potential factors studied. However, the study also looked for the presence of other high-risk bacteria and coinfections were indeed found between GBS and E. coli and Staphylococcus aureus. Antibiotic susceptibility testing shows that GBS strains were fully susceptible to penicillin G, erythromycin, clindamycin, chloramphenicol, rifampicin and vancomycin. Sensitivities to norfloxacin and gentamycin were 73.3% and 86.7% respectively. In contrast, high resistance to tetracycline (86.7%) was observed. GBS carriage remains a major public health issue because of its consequences for the mother and the newborn. Correct screening and proper monitoring of strain susceptibility remain one of the most effective means of patient management and care.

New modular platform based on multi-adjuvanted amphiphilic chitosan nanoparticles for efficient lipopeptide vaccine delivery against group A streptococcus

An effective vaccine against group A streptococcus(GAS)is highly desirable for definitive control of GAS infections.In the present study,two variants of amphiphilic chitosan nanoparticles-based GAS vaccines were developed.The vaccines were primarily composed of encapsulated KLH protein(a source of T helper cell epitopes)and lipidated M-protein derived B cell peptide epitope(lipoJ14)within the amphiphilic structure of nanoparticles.The only difference between themwas one of the nanoparticles vaccines received additional surface coating with poly(I:C).The formulated vaccines exhibited nanosized particles within the range of 220–240 nm.Cellular uptake study showed that nanoparticles vaccine without additional poly(I:C)coating has greater uptake by dendritic cells and macrophages compared to nanoparticles vaccine that was functionalized with poly(I:C).Both vaccines were found to be safe in mice and showed negligible cytotoxicity against HEK293 cells.Upon immunization in mice,both nanoparticle vaccines produced high antigen-specific antibodies titres that were regulated by a balanced Th1 and Th2 response compared to physical mixture.These antibodies elicited high opsonic activity against the tested GAS strains.Overall,our data demonstrated that amphiphilic chitosan nanoparticles platform induced a potent immune response even without additional inclusion of poly(I:C).

Influence of group B streptococcus and vaginal cleanliness on the vaginal microbiome of pregnant women

BACKGROUND The vaginal microbiome plays a critical role in the health of pregnant women and their newborns.Group B Streptococcus(GBS)and vaginal cleanliness significantly affect the vaginal microecosystem and are closely associated with vaginal diseases.AIM To explore the effects of GBS status and vaginal cleanliness on vaginal microecosystems.METHODS We collected 160 vaginal swabs from pregnant women and divided them into the following four groups based on GBS status and vaginal cleanliness:GBS-positive+vaginal cleanliness I–II degree,GBS-negative+vaginal cleanliness I–II degree,GBS-positive+vaginal cleanliness III–IV degree,and GBS-negative+vaginal cleanliness III–IV degree.Samples were subjected to 16S rRNA gene amplicon sequencing.RESULTS Alpha diversity analysis showed that the Shannon index did not significantly differ between the four groups.We identified significant variation in taxa abundance between the GBS-positive and GBS-negative groups and between the vaginal cleanliness I–II degree and III–IV degree groups.Principal coordinate analysis and non-metric multidimensional scaling analysis further confirmed the microbial diversity of the four groups.Moreover,the linear discriminant analysis demonstrated that Lactobacillus jensenii and Actinobacteria were strongly associated with GBS-positive status,and Lactobacillus iners,Lactobacillaceae,Lactobacillus,Lactobacillales,Bacilli and Firmicutes were closely correlated with GBS-negative status.CONCLUSION GBS status and vaginal cleanliness significantly affect vaginal microbiome differences in pregnant women.Our findings provide instructional information for clinical antibiotic treatment in pregnant women with different GBS statuses and vaginal cleanliness degrees.

Prevalence of Group B Streptococcus among Pregnant Women in Bobo-Dioulasso (Burkina Faso)

Background: Group B Streptococcus (GBS) or Streptococcus agalactiae, which asymptomatically colonizes the female genital tract, is one of the leading causes of septicemia, meningitis and pneumonia in neonates. This study was conducted in Bobo Dioulasso, Burkina Faso to determine the prevalence of GBS colonization among pregnant women. Methods: Six hundred and eleven (611) pregnant women were screened for GBS colonization between July and December 2016. Vaginal swab samples were aseptically collected from the subjects after oral informed consent. Standard microbiological methods were used to isolate and identify GBS isolates. The antibiotic susceptibility profile of GBS isolates was assessed using the Kirby-Bauer disk diffusion method. Results: Colonization prevalence was 6.05%. No risk factors associated with the carriage rate was statistically identified. All isolates were susceptible to Amoxicillin, Ampicillin, Cefotaxime, Levofloxacin, Vancomycin and Nitrofurantoin. Resistance to antibiotics was found for erythromycin (35.14%), lincomycin (16.22%) and penicillin G (10.81%). Conclusion: Although a low carriage (6.05%) rate and isolates were susceptible to many antibiotics found in this study, a policy of systematic screening of pregnant women at least in the third trimester must be promoted.

Protocol for a Diagnostic Accuracy Study of Polymerase Chain Reaction for Detecting Group B <i>Streptococcus</i>Colonisation in Early Labour or with Spontaneous Ruptured Membranes

Background: Group B Streptococcus [GBS] is a bacterium which transiently colonises the genital tract and can be transmitted from mother to baby at birth. Babies colonised with GBS can develop early-onset group B streptococcus disease [EOGBSD] which can lead to extended hospital stay, disability and death. One of the primary methods for determining which women are most likely to be GBS positive at the time of birth is antenatal universal culture-based screening. Recently Polymerase Chain Reaction [PCR] screening has emerged as a point-of-care method for screening women during the intrapartum period. This study will compare the diagnostic accuracy of this new technology and antenatal culture-based screening at 35 to 37 weeks gestational age, with the reference standard of formal culture-based testing in labour. Methods: This prospective observational study will take place in an Australian hospital. Consecutive women with one or more live fetuses, intending to have a vaginal birth will be asked to participate. Planned screening for GBS colonisation using microbiological culture on a self-collected specimen will occur at 35 to 37 completed weeks gestational age as per our usual hospital policy. A PCR GBS test by Xpert GBS (Cepheid) will be performed on admission to labour ward or at the time of rupture of membranes. The reference standard will be a formal GBS culture on a combined lower vaginal and perianal swab. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios will be estimated for both antenatal screening and the intrapartum Xpert GBS (Cepheid) point-of-care test and compared to the reference standard. Results: It is expected that the study will be completed by mid to late 2020. Conclusion: This study has the potential to improve the accuracy of GBS screening of pregnant women and therefore health outcomes for mothers and babies. There is also the potential for a cost savings to the health system.

Risk Factors for Group B <i>Streptococcus</i>Colonization and Drugs Sensitivity Pattern in a Nigerian Obstetric Population

Background: Group B Streptococcus (GBS) is a major cause of bacterial infections in the perinatal period, of which colonization prevalence among Northern-Nigerian pregnant women is scarce. We attempted to determine 1) its prevalence, 2) risk factors for GBS colonization and 3) drugs-susceptibility. Methodology: This cross-sectional study involved 185 pregnant women between 35 - 37 weeks of gestation at tertiary health center of Sokoto, Nigeria. Vaginal/rectal swabs were collected, were cultured for GBS and tested for drug-susceptibilities. The study was conducted between December, 2017 and April, 2018. Results: One hundred and eighty five (185) pregnant women participated in this study. GBS vaginal-colonization-rate was 3.8% (7/185). A significance relationship was observed between GBS-colonization and socio-economic class, as 57.10% (4/7) of the GBS positive women were of low-socio economic class (p 0.035). No associations were observed between GBS-colonization and the followings: maternal age, parity, poor obstetric outcome-history. All the 7 GBS positive cultures were sensitive to Clindamycin. One was sensitive to both Clindamycin and Ceftriaxone. None was sensitive to Penicillin. Conclusion: The prevalence of GBS colonization was low in this area. Maternal socio-economic class is found to be a risk of GBS-colonization.

Vaginal Colonization and Antibiotic Susceptibility Pattern of Group B <i>Streptococcus</i>Isolated from Pregnant Women in Maternitéde l’Hôpital Des Soeurs de Pauvres de Bergame de Kimbanseke, Kinshasa, Democratic Republic of Congo

Group B Streptococcus (GBS) is a Gram-positive bacterium which often colonizes maternal vaginal and rectal epitheliums and can be transmitted to the neonate during delivery. GBS infections may cause significant maternal and neonatal morbidity, including sepsis, pneumonia and meningitis. In Democratic Republic of Congo, few studies have been done on GBS colonization of pregnant women. This study was conducted in Kinshasa, Democratic Republic of Congo in order to determine the prevalence of GBS vaginal colonization among pregnant women at a gestational age of 35 - 37 weeks and the antibiotic susceptibility. Vaginal swabs of 104 pregnant women were inoculated onto Chromatic Strepto B medium. GBS isolates were identified by Gram staining, catalase test, blue-green colonies and confirmed to be GBS by Strepto B latex test kit. Antibiotic susceptibility test was done using the disc diffusion method. The prevalence of GBS vaginal colonization was 23.07%. Of the isolates studied 100%, 75%, 62.5%, 50% were sensitive to vancomycin, clindamycin, cefazolin, and erythromycin respectively. Our findings seem to suggest that maternal GBS colonization rate in this study was higher compared to a previous report from Bukavu in Democratic Republic of Congo. All isolates were found to be sensitive to vancomycin which was the most effective antibiotic for the treatment of GBS infections.

Streptococcus agalactiae:Sensitivity profile in pregnant women attending health units in northeastern Brazil

BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early-onset disease. The risk of infectionincreases to 15.2% in premature neonates, to 10.7% when the parturient haschorioamnionitis or premature rupture of membranes for more than 24 h and to9.7% if the mother has postpartum bacteremia. In addition to causing perinatal,neonatal and postnatal deaths, neonatal hospital infection is associated with highcosts, as hospitalization is three times longer than in uninfected children. Theidentification of pregnant women colonized by GBS, through universal screening,associated with the adoption of appropriate antibiotics at the time of delivery arethe most successful preventive measures.AIMTo evaluate the sensitivity profile of GBS isolated from pregnant womenattending Vitória da Conquista-BA.METHODS This is a cross-sectional study with a quantitative approach carried out in themunicipality of Vitória da Conquista-Bahia between February 2017 and March2018. The study population was composed of 210 pregnant women, with agestational age of 32 to 40 wk, who were aged 18 years or older living in the urbanarea of the municipality of Vitória da Conquista. After a brief explanation aboutthe research and obtaining a signed an informed consent form, data andvaginorectal swabs were collected from the women for GBS research. Examinationof the samples in order to identify the presence of GBS was by culture on sheep blood agar and chromogenic agar for GBS and then, seeded on plates containingstreptococcal culture medium and incubated for 18 h to 24 h at 35°C. Theantimicrobial sensitivity profile of positive GBS samples was determined by thedisk diffusion technique, according to the Clinical and Laboratory StandardsInstitute manual (2017). The data obtained were stored in a database usingMicrosoft Office Excel spreadsheets and a descriptive analysis was performedwith the aid of the EPI-INFO statistical package (version 3.5.2).RESULTSAmong the 210 pregnant women participating in the study, 38 (18.1%) had apositive GBS culture. All strains isolated from GBS were sensitive to 10 Upenicillin, 10 μg ampicillin, 30 μg cefotaxime and 30 μg vancomycin. Seven strains(18.4%) resistant to clindamycin 2 μg and eight (21.1%) resistant to erythromycin15 μg were found. Of these, six were concomitantly resistant to erythromycin andclindamycin, two resistant only to erythromycin and one resistant only toclindamycin. All nine GBS isolates that showed resistance to erythromycin and/orclindamycin showed negative results on the D-test. Two thirds of the isolatesshowed cMLSB phenotype and resistance only to erythromycin in specimens inthis study (02), refers to strains with phenotype M and resistance to clindamycin(01) only with phenotype L.CONCLUSIONChemoprophylaxis for GBS in pregnant women, especially for those allergic topenicillin, should be guided by an antimicrobial susceptibility test as resistantGBS strains were reported in this study.

孕晚期产前抗生素治疗B族链球菌感染对新生儿结局、血清炎症因子及B族链球菌药物敏感试验结果的影响

目的探究孕晚期产前抗生素治疗B族链球菌(GBS)感染对新生儿结局、血清炎症因子及GBS药物敏感试验结果的影响。方法选取2020年1月至2022年12月期间成都市新都区人民医院收治的60例GBS阳性孕妇所生的新生儿作为研究对象,依据孕母产前是否采用抗生素治疗分为对照组(n=29)和观察组(n=31)。对照组未给予预防性抗生素治疗,观察组根据药物敏感试验结果给予抗生素治疗。比较两组孕妇妊娠结局、新生儿结局以及新生儿出生6、24 h血清白细胞介素-6(IL-6)、降钙素原、C反应蛋白(CRP)水平,并分析新生儿GBS药物敏感试验结果。结果31例孕妇经药物敏感试验检查,对青霉素敏感度最高,故选择27例GBS感染孕妇进行青霉素治疗;对于青霉素过敏者有3例,2例应用克林霉素,1例应用头孢唑林。观察组孕妇不良妊娠结局总发生率为9.66%,低于对照组(31.03%),差异有统计学意义(P<0.05)。观察组新生儿不良结局总发生率、早发型GBS疾病(EOGBS)发生率分别为6.45%、6.45%,均低于对照组(27.59%、24.14%),差异均有统计学意义(P<0.05)。观察组新生儿出生后6 h血清IL-6、降钙素原、CRP水平分别为(76.21±7.96)pg/mL、(0.82±0.12)μg/L、(5.36±0.85)mg/L,24 h血清IL-6、降钙素原、CRP水平分别为(62.35±6.47)pg/mL、(0.61±0.09)μg/L、(3.15±0.64)mg/L,均低于对照组[6 h:(88.25±9.15)pg/mL、(0.92±0.15)μg/L、(8.25±1.63)mg/L;24 h:(66.21±7.11)pg/mL、(0.72±0.11)μg/L、(4.22±0.71)mg/L],差异均有统计学意义(P<0.05)。60例新生儿经药物敏感试验检查,对青霉素敏感度均大于90%。结论孕晚期产前抗生素治疗GBS感染,不仅可改善产妇妊娠结局,还可改善新生儿结局,降低EOGBS发生率,缓解炎症反应状态,且不影响新生儿药物敏感试验结果。

B群链球菌暴露后蜕膜间质细胞死亡和炎症信号的相关性研究

目的探究B群链球菌暴露后蜕膜间质细胞死亡和炎症信号的相关性。方法选取2017年10月至2019年10月于保定市第二中心医院妇产科分娩的孕妇100例,分为早产组27例和足月顺产组73例,取孕妇阴道拭子和蜕膜间质组织,检测B群链球菌阳性率、蜕膜间质细胞凋亡情况、血清炎性因子水平、NLRP3、Caspase-1、OX40、OX40L、PD-1和PD-L1 mRNA表达,分析B群链球菌暴露后蜕膜间质细胞死亡和炎症信号的相关性。结果2组孕妇B群链球菌阳性率、蜕膜间质细胞凋亡情况、血清炎性因子水平、NLRP3、Caspase-1、OX40、OX40L、PD-1和PD-L1 mRNA表达比较,差异均有统计学意义(P<0.05)。早产组孕妇的GBS阳性率和蜕膜组织细胞凋亡值分别为37.04%和(46.73±4.92),足月顺产组的GBS阳性率和蜕膜组织细胞凋亡值仅为9.59%和(6.03±2.04);早产组孕妇的血清炎性因子水平高于足月顺产组,蜕膜间质细胞凋亡的孕妇血清炎性因子水平高于未凋亡的孕妇,差异有统计学意义(P<0.05)。结论B群链球菌暴露后蜕膜间质细胞死亡和炎症信号存在相关性,蜕膜间质细胞死亡会引发炎性因子水平升高。

分娩期抗生素预防性治疗对生殖道B族链球菌定植病人妊娠结局及阴道菌群微生态的影响

目的:分析分娩期抗生素预防性治疗对生殖道B族链球菌(GBS)定植孕妇妊娠结局及阴道菌群微生态的影响。方法:选择产检且分娩的孕妇160例为研究对象,GBS检查均为阳性,依随机分组法分为对照组和观察组,每组80例。对观察组分娩前至少4 h给予抗生素预防治疗,对照组分娩前给予甲硝唑栓治疗,并记录观察组和对照组母婴结局以及阴道菌群微生态情况。结果:观察组不良结局总发生率低于对照组(P<0.05)。治疗后观察组GBS、白细胞酯酶、唾液酸酶、乙酰氨基葡萄糖苷酶、过氧化氢酶检出率较对照组低,阴道菌群密集Ⅱ~Ⅲ度、乳杆菌和清洁度Ⅰ~Ⅱ级检出率较对照组高(P<0.05~P<0.01)。观察组孕妇的治疗总有效率为98.75%,高于对照组总有效率83.75%(P<0.01)。结论:分娩期抗生素预防性治疗对GBS定植孕妇妊娠结局有良好的改善作用,可以改善阴道菌群微生态环境。

新生儿GBS感染所致化脓性脑膜炎中血清维生素D和炎性细胞因子的表达及意义

目的检测新生儿B族链球菌(group B streptococcus,GBS)感染所致化脓性脑膜炎(purulent meningitis,PM)血清中维生素D、白细胞介素(interleukin,IL)-6、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(c-reactive protein,CRP)的表达水平,并探讨其临床价值。方法选取2017年5月至2020年5月在秦皇岛市第一医院出生的59例GBS感染的PM新生儿纳入观察组,同期59例非GBS感染的PM新生儿(晚发败血症)纳入对照组。检测所有受试者血清维生素D、CRP、IL-6、IL-10和TNF-α水平,并进行Pearson相关性分析;利用受试者操作特征(receiver operating characteristic,ROC)曲线分析血清维生素D和炎性细胞因子对新生儿GBS感染所致PM的诊断价值。统计学方法采用t检验、χ^(2)检验和Pearson相关性分析。结果观察组与对照组孕产妇胎膜早破[47.5%(28/59)与5.1%(3/59),χ^(2)=27.345]、产时窒息[52.5%(31/59)与18.6%(11/59),χ^(2)=14.787]和产褥感染[(44.1%(26/59)与(22.0%(13/59)),χ^(2)=6.473]的发生率比较,观察组明显高于对照组(P<0.05)。观察组血清维生素D水平显著低于对照组[(13.3±2.1)μg/L与(21.1±5.0)μg/L,t=11.345],IL-6[(87.1±14.5)μg/L与(63.9±11.9)μg/L,t=9.507]、IL-10[(49.6±15.2)μg/L与(29.3±10.0)μg/L,t=8.596]、TNF-α[(76.8±19.0)μg/L与(50.0±10.8)μg/L,t=9.410]和CRP[(21.5±5.0)μg/L与(13.7±3.7)μg/L,t=9.702]水平显著高于对照组(P值均<0.05)。Pearson相关性分析结果显示,观察组血清维生素D水平分别与IL-6、IL-10、TNF-α和CRP水平呈负相关(r=-0.662、-0.644、-0.564、-0.643,P<0.05);血清维生素D、IL-6、IL-10、TNF-α和CRP单独诊断GBS感染新生儿PM的曲线下面积(area under the curve,AUC)分别为0.831(95%CI:0.757~0.904)、0.887(95%CI:0.830~0.944)、0.859(95%CI:0.793~0.925)、0.888(95%CI:0.821~0.955)、0.879(95%CI:0.820~0.938),5项联合检测的AUC为0.991(95%CI:0.978~1.000)。结论GBS感染所致的PM新生儿血清中维生素D水平降低,炎性细胞因子水平增加,对于GBS感染所致的PM具有一定的辅助诊断价值。

妊娠晚期感染B族链球菌孕妇早产的危险因素及其pbp2x基因突变分析

目的 分析某院感染B族链球菌(GBS)孕妇发生早产的危险因素及观察早产孕妇感染GBS的pbp2x基因突变情况。方法 选取2022年1月至2023年5月在该院分娩且感染GBS的孕妇199例,根据早产与否分为观察组(41例)和对照组(158例)。采用二分类logistic回归模型和受试者操作特征(ROC)曲线分析感染GBS的孕妇发生早产的危险因素;对早产孕妇的GBS样本进行pbp2x基因一代测序分析。结果 199例感染GBS孕妇中发生早产41例,发生率为20.6%。Logistic回归分析显示,年龄[比值比(OR)=1.151,P=0.004)]和口服葡萄糖耐量试验(OGTT)异常项数(OR=2.995,P<0.001)是感染GBS孕妇发生早产的独立危险因素。两危险因素联合预测早产的曲线下面积(AUC)为0.783,最佳敏感度为75.6%,特异度为69.0%,较单项危险因素预测价值高。pbp2x基因测序发现3个错义突变(1129G>A、1148T>G、1528A>G),未发现影响GBS对青霉素敏感性的基因突变。结论 年龄和OGTT异常项数是感染GBS孕妇发生早产的危险因素,两者联合预测的效能优于单项,早产孕妇感染的GBS中尚未发现影响青霉素敏感性的pbp2x基因突变。

中段尿培养检出B群链球菌的临床意义

目的 探讨中段尿培养中分离出B群链球菌(GBS)的临床意义和耐药性,旨在为临床尿路感染诊治提供依据。方法 通过实验室信息系统搜索2020年2月—2022年12月南京某医院住院和门诊患者中段尿培养分离出GBS的菌株信息,筛选资料完整者,查阅病例资料、尿常规及药敏试验结果。结果 中段尿培养标本共检出非重复细菌9 081株,其中GBS 425株,占比4.7%,位列第6。剔除资料不完整者,共纳入365例患者进行研究。其中男性169例(46.3%),女性196例(53.7%),平均年龄(55.4±15.2)岁。365例检出GBS的患者来源于17个科室,泌尿外科(237例,64.9%)占比最高。患者基础疾病主要包括高血压病136例,糖尿病95例,泌尿系统结石120例,泌尿系统肿瘤98例;211例患者接受了泌尿系统手术,术前均使用了抗菌药物,205例在术后留置导尿管;9例在妊娠中晚期尿液中检出GBS。GBS菌落计数≤10^(4)CFU/mL占36.4%(133例),10^(4)~10^(5)CFU/mL占38.9%(142例),≥10^(5)CFU/mL占24.7%(90例)。有尿路感染症状的患者占24.9%(91例),无症状性菌尿患者占75.1%(274例)。男性中有尿路感染症状者低于女性(19.5%VS 29.6%,P<0.05)。随着尿培养GBS菌落计数增加,有尿路感染症状的患者比例呈升高趋势(P<0.05)。尿培养送检当日尿常规白细胞、白细胞酯酶、亚硝酸盐阳性比率分别为53.2%、50.1%、3.8%。有症状尿路感染患者中尿潜血、白细胞酯酶、白细胞、尿蛋白的阳性率均高于无症状性菌尿患者(均P<0.05)。未发现GBS对青霉素、氨苄西林、万古霉素、利奈唑胺、替加环素耐药,对左氧氟沙星、莫西沙星耐药率在40%左右,对四环素、克林霉素耐药率>60%。结论 尿液中分离出GBS在非妊娠成人中比较常见,有尿路感染症状者仅占少数。尿培养、尿常规结果应结合患者临床症状、体征综合判断。尿液中GBS对多种抗菌药物敏感,临床应根据药敏结果合理用药。

孕妇阴道B族链球菌检测联合胎儿脐带血中性粒细胞CD64指数预测胎膜早破新生儿感染的价值

目的 探讨孕妇阴道B族链球菌(GBS)检测联合胎儿脐带血中性粒细胞CD64指数对胎膜早破(PROM)新生儿感染的预测价值,并分析其影响因素。方法 选取2022年3—12月湖南省妇幼保健院170例足月分娩PROM新生儿作为观察组,根据新生儿感染情况分为感染组(48例)和未感染组(122例)。比较新生儿一般资料,分析PROM新生儿感染与临床特征的关系。采用多因素Logistic回归分析评价PROM新生儿感染的影响因素;构建列线图模型,并进行验证。采用受试者工作特征(ROC)曲线评价GBS阳性、CD64指数判断新生儿感染的效能。结果 感染组和未感染组PROM到分娩时间、绒毛膜羊膜炎、GBS阳性、阴道指检次数、产前使用抗菌药物、5 min Apgar评分<7分、羊水污染、CD64指数差异均有统计学意义(P<0.05)。PROM到分娩时间、绒毛膜羊膜炎、GBS阳性、阴道指检次数、CD64指数是PROM新生儿感染的危险因素(P<0.05),这5项指标在列线图预测模型中的总分为294分,对应的感染风险为73.15%。交互作用分析结果显示,CD64指数、GBS阳性对感染组和未感染组具有正相加交互作用(P<0.001)。ROC曲线分析结果显示,CD64指数和GBS阳性单项检测和联合检测判断PROM新生儿感染的曲线下面积分别为0.763、0.807和0.847。结论 孕妇阴道GBS检测联合胎儿脐带血中性粒细胞CD64指数对PROM新生儿感染具有较高的预测价值。PROM到分娩时间、绒毛膜羊膜炎、阴道检查次数是导致PROM新生儿感染的危险因素,临床应重点关注,以降低感染风险。

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

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。

GBS、衣原体联合解脲支原体检测对胎膜早破患者妊娠结局的预测作用

目的 研究B族链球菌(GBS)、衣原体联合解脲支原体(UU)检测对胎膜早破患者妊娠结局的预测作用。方法 选取上海交通大学医学院附属新华医院2021年2月至2023年1月收治的胎膜早破产妇168例为观察组,另选取同期进行孕检且结果正常的165名孕妇为对照组。对比两组GBS、衣原体、UU阳性率;分析GBS、衣原体、UU单一检测对观察组不良妊娠结局的预测结果;分析GBS、衣原体、UU三者联合对观察组孕妇不良妊娠结局的预测结果。结果 观察组GBS阳性率、衣原体阳性率、UU阳性率均比对照组高,差异均有统计学意义(P<0.05)。GBS阴性122例,GBS阳性46例,GBS阳性胎膜早破孕妇不良妊娠结局发生率比对照组高,差异有统计学意义(P<0.05)。衣原体阴性128例,衣原体阳性40例,衣原体阳性胎膜早破孕妇不良妊娠结局发生率比对照组高,差异有统计学意义(P<0.05)。UU阴性117例,UU阳性51例,UU阳性胎膜早破孕妇不良妊娠结局发生率比对照组高,差异有统计学意义(P<0.05)。168例胎膜早破孕妇中,GBS、衣原体和UU均为阴性117例,GBS、衣原体和UU为单一一个或两个为阳性11例,GBS、衣原体和UU均为阳性40例;GBS、衣原体和UU均为阳性胎膜早破孕妇不良妊娠结局发生率均比单一或两个感染及阴性胎膜早破孕妇高,差异有统计学意义(P<0.05)。结论 胎膜早破孕妇的GBS、衣原体和UU阳性率均高于正常妊娠孕妇,且GBS、衣原体和UU联合检测可更准确地预测母体和胎儿不良结局。

A族链球菌咽炎的临床诊断及评分制的应用进展

咽炎可由病毒、细菌等多种病原感染引起,其中A族链球菌(group A streptococcus,GAS)是咽炎最常见的细菌性病原。基于症状和体征的临床诊断很难将GAS咽炎与其他原因咽炎截然分开,经验性治疗势必会导致抗菌药物的过度使用。随着国内抗菌药物管理工作和医保支付改革措施的深入,减少不必要的检测和抗菌药物处方势在必行。为促进GAS咽炎规范化诊治,该文梳理了国外不同指南中关于GAS咽炎临床诊断和鉴别诊断,尤其是指导GAS咽炎实验室检测和抗菌治疗决策的临床评分制及其应用建议,供国内同道开展研究和临床实践时参考。