孕晚期女性B群链球菌感染相关高危因素及其耐药性分析  

The Group B Streptococus infection risk factors and drug resistance in third trimester of pregnancy in women

作　　者：贺锐[1] 张丽秀[1] 李永欢 韩璐 HE Rui;ZHANG Li-xiu;LI Yong-huan;HAN Lu(Department of Clinical Laboratory,Provincial Maternity and Child-Care Hosipital of Gansu,Lanzhou,Gansu 730050,China)

机构地区：[1]甘肃省妇幼保健院临床检验中心,甘肃兰州730050

出　　处：《中国微生态学杂志》2023年第1期84-87,96,共5页Chinese Journal of Microecology

基　　金：兰州市人才创新创业项目(2018-RC-23)。

摘　　要：目的分析孕晚期女性B群链球菌(GBS)感染与孕产妇基础状态及伴随疾病之间的关系,探讨女性围产期GBS感染相关因素,分析GBS体外药物敏感性,指导GBS感染人群预防性抗菌药物的合理使用。方法对2019年7月至2020年6月9945名妊娠35~37周女性的阴道和肛周拭子进行GBS培养及分离鉴定,根据GBS检出情况分为GBS(+)组和GBS(-)组,对两组对象的年龄、生产史、流产史及疾病伴随情况进行单因素分析,采用二元Logistic回归分析GBS感染高危因素;对所有GBS(+)者行抗菌药物敏感性试验,分析GBS药物敏感情况。结果兰州地区孕晚期女性生殖道GBS定植率为4.48%(446/9945)。危险因素分析显示,年龄、生产史、流产史及妊娠合并糖尿病为GBS感染的高危因素(均P<0.05)。多因素二元logistic回归分析显示,年龄、生产史、流产史及妊娠合并糖尿病为影响GBS感染发生的独立危险因素(均P<0.05)。GBS体外药敏试验显示,GBS对氨苄西林、利奈唑胺、苄青霉素、奎奴普丁/达福普汀、万古霉素、替加环素、头孢噻肟及美罗培南均未出现耐药情况;对左氧氟沙星耐药率为67.71%,莫西沙星耐药率为62.56%,红霉素耐药率为78.70%,克林霉素耐药率为84.53%。结论生产史、流产史、妊娠年龄以及是否合并糖尿病是孕晚期女性GBS感染的高危因素。青霉素是治疗GBS感染的首选药物,克林霉素及红霉素用于治疗青霉素过敏的患者时,需进行体外药敏试验判断其敏感性。Objective To analyze the relationship between group B Streptococus(GBS)infection and the basic status or accompanying diseases of pregnant women in third trimester of pregnancy,explore the risk factors of GBS infection in pregnant women and the pathogen drug resistance,and provide guidance for rational use of antimicrobials for prevention of GBS infection.Methods A total of 9,945 pregnant women from July 2019 to June 2020 at 35-37 weeks of pregnancy were detected by using vaginal and perirectal swab culturing.According to the results,they were divided into GBS(+)group and GBS(-)group.Maternal age,history of parity and/or abortion,and concomitant chronic pathologies were compared between groups with Univariate analysis.High-risk factors of GBS infection were analyzed using binary Logistic regression.Antimicrobial susceptibility testing was done for all GBS(+)patients to analyze the GBS drug resistance.Results The colonization rate of GBS in the third trimester of pregnancy in Lanzhou was 4.48%(446/9945).Age,birth history,history of abortion and pregnancy complicated by diabetes were high risk factors for GBS infection(all P<0.05).Multivariate binary logistic regression analysis showed that age,birth history,history of abortion and pregnancy complicated by diabetes were independent risk factors affecting GBS infection(all P<0.05).Antimicrobial susceptibility testing showed that GBS was susceptible to Ampicillin,Linezolid,Benzylpenicillin,Quinupridine/Dalfopristin,Vancomycin,Tigecycline,Cefotaxime and Meropenem;the resistance rate to Levofloxacin was 67.71%,that to Moxifloxacin was 62.56%,that to Erythromycin was 78.70%,and that to Clindamycin was 84.53%.Conclusion Age,birth history,history of abortion and pregnancy complicated by diabetes are high risk factors for GBS infection in the third trimester of pregnancy.Penicillin is still the first choice for GBS infection;Clindamycin and Erythromycin should be tested for antimicrobial susceptibility before used for treating GBS infection in the case of Penicillin allerg

关 键 词：孕晚期 B群链球菌 高危因素 抗菌药物 耐药性 

分 类 号：R446.5[医药卫生—诊断学]