454例妊娠期妇女B族链球菌定植状况对妊娠结局的影响

Effect of Group B Streptococcus colonization on pregnancy outcome in 454 pregnant women

摘要:

目的：对重庆市妊娠期妇女B族链球菌（Group B Streptococcus，GBS）定植状况进行调查，并分析其对妊娠结局的影响。方法：选取454例在重庆市永川区妇幼保健院建卡并完成孕检、分娩的孕妇为研究对象，分别取阴拭子和肛拭子送检，进行GBS检测及药敏试验。统计分析GBS定植对妊娠结局及新生儿结局的影响。结果：①454例孕妇中，肛拭子阳性者33例，阴拭子阳性者28例，二者均阳性25例。肛拭子或阴拭子任意一项检查阳性即认为孕妇合并GBS阳性率，全组孕妇的GBS阳性为7.9%（36/454）。②共分离出46株GBS，药敏结果显示，头孢克肟、万古霉素无耐药株出现，敏感性分别为97.83%、100%，罗红霉素、克林霉素、左氧氟沙星耐药严重，敏感性仅为21.74%、23.91%、19.57%。③与GBS阴性组相比，GBS阳性组孕妇的胎膜早破、绒毛膜羊膜炎、产后出血的发生率显著较高（P＜0.05）。④GBS定植对新生儿结局有明显的不良影响。与GBS阴性组相比，GBS阳性组孕妇的新生儿肺炎、新生儿败血症、肺透明膜病变、新生儿窒息、羊水粪染等不良结局的发生率明显较高（P＜0.05）。结论：GBS定植对妊娠结局、新生儿结局有明显的不良影响；头孢克肟对GBS敏感性高，可作为治疗感染的最佳选择。

Abstract:

Objective：To investigate the status of Group B Streptococcus（GBS） colonization in pregnant women in Chongqing and analyze the impact on pregnancy outcomes. Methods：A total of 454 pregnant women were selected as the research objects. The vaginal swabs and anal swabs were taken for examination，and GBS test and drug sensitivity test were performed. The impact of GBS col－onization on pregnant women and newborn outcomes was statistically analyzed. Results：①Among 454 pregnant women，33 were posi－tive anal swab，28 were positive vaginal swab and 25 were positive for both. Either swab is positive was regarded as pregnant women complicated with GBS positive rates and the GBS positive rate in the whole group of pregnant women was 7.9%（36/454）. ②A total of 46 strains of GBS were isolated. The susceptibility test showed that the sensitivity of cefixime and vancomycin were 97.83% and 100%，respectively. The sensitivity of roxithromycin，clindamycin and levofloxacin was only 21.74%. 23.91% and 19.57%. ③Com－pared with the GBS-negative group，the incidence of premature rupture of membranes，chorioamnionitis，and postpartum hemorrhage in the GBS-positive group were significantly higher（P<0.05）. ④GBS colonization had adverse influences on newborns. Compared with the GBS-negative group，the incidence of adverse outcomes such as neonatal pneumonia，neonatal sepsis，hyaline membrane disease，neonatal asphyxia，and amniotic fluid fecal infection in the GBS-positive group was significantly higher（P<0.05）. Conclusion：GBS colonization has obvious adverse effects on pregnancy outcome and neonatal outcome. Cefixime is more sensitive to GBS and can be used as the best choice for preventing infection.