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目的探讨围产期孕妇B族链球菌(GBS)的感染情况及耐药性,结合临床评估GBS感染对母婴预后的影响。方法选择2015年1月1日-12月31日间在株洲市中心医院进行常规产检、分娩住院且临床资料完整的单胎孕产妇1 028例为研究对象。选用无菌棉拭子采集阴道和直肠分泌物样本,进行病原菌培养,对分离培养出的GBS进行药敏试验。根据GBS细菌培养结果将研究对象分为感染组和非感染组。结果 1 028例孕妇GBS阳性者73例,阳性率为7.1%(73/1 028),GBS培养阴性者955例。在不同产次、流产次数、年龄方面GBS感染率差异均无统计学意义(分别χ~2=1.949,P=0.163;χ~2=1.187,P=0.276;χ~2=2.915,P=0.088)。73株GBS对青霉素G、氨苄青霉素、头孢曲松、利奈唑胺敏感率均为100%,对四环素、克拉霉素、克林霉素、红霉素、左氧氟沙星、万古霉素的耐药率分别为84.93%、79.45%、67.12%、65.75%、34.25和2.74%。GBS感染组孕妇胎膜早破(12.33%)、绒毛膜羊膜炎(8.22%)、剖宫产(15.1%)发生率显著高于非感染组,两组间差异有统计学意义(分别χ~2=9.089、9.580、8.769,均P<0.05);GBS感染组早产(6.8%)、胎儿窘迫(8.2%)、新生儿感染(20.1%)、新生儿窒息(9.6%)发病率显著高于非感染组,两组间差异有统计学意义(分别χ~2=9.668、9.825、8.928、9.542,均P<0.05)。结论围产期孕妇GBS的感染率较高,GBS感染能增加胎膜早破、绒毛膜羊膜炎、剖宫产、早产、胎儿窘迫、新生儿感染等的发生率,应加大对围产期孕妇GBS筛查力度。
Objective To investigate the prevalence and drug resistance of Streptococcus pneumoniae (GBS) in pregnant women during perinatal period and to evaluate the effect of GBS infection on prognosis in infants and young children. Methods A total of 1 028 singleton pregnant women who were admitted to Zhuzhou Central Hospital between January 1, 2015 and December 31, 2015 were enrolled in the study. Vaginal and rectal secretions samples were collected using sterile cotton swabs for pathogen culture and antibiotic susceptibility tests were performed on isolated and cultured GBS. According to GBS bacterial culture results, the subjects were divided into infected group and non-infected group. Results A total of 1 028 pregnant women with GBS were positive in 73 cases, with a positive rate of 7.1% (73/1 028) and 955 cases of negative GBS. There was no significant difference in the prevalence of GBS infection between different births, the number of abortions and the age (χ ~ 2 = 1.949, P = 0.163; χ ~ 2 = 1.187, P = 0.276; ). The susceptibilities of 73 strains of GBS to penicillin G, ampicillin, ceftriaxone and linezolid were all 100%. The rates of resistance to tetracycline, clarithromycin, clindamycin, erythromycin, levofloxacin and vancomycin were respectively 84.93%, 79.45%, 67.12%, 65.75%, 34.25 and 2.74%. The incidence of premature rupture of membranes (12.33%), chorioamnionitis (8.22%) and cesarean section (15.1%) in pregnant women with GBS infection was significantly higher than that in non-infected patients (χ ~ 2 = 9.089,9.580,8.769, all P <0.05). The incidence of premature delivery (6.8%), fetal distress (8.2%), neonatal infection (20.1%) and neonatal asphyxia (9.6%) in GBS infection group was significantly higher than Non-infected group, the difference between the two groups was statistically significant (χ ~ 2 = 9.668,9.825,8.928,9.542, all P <0.05). Conclusion The prevalence of GBS in perinatal pregnant women is high, and GBS infection can increase the incidence of premature rupture of membranes, chorioamnionitis, cesarean section, premature birth, fetal distress and neonatal infection, Pregnant women GBS screening efforts.