长沙地区围产期孕妇B族链球菌带菌状况分析及对妊娠结局的影响

摘要

目的 了解长沙地区围产期孕妇B族链球菌(GBS)带菌状况及对妊娠结局的影响.方法 对2016年10月至2017年3月在湖南省妇幼保健院产科就诊的2183例围产期孕妇分别采集阴道分泌物及直肠拭子应用显色培养法进行B族链球菌检测,以培养结果为GBS阳性的161例孕妇为观察组,随机抽取180例培养结果为GBS阴性的孕妇为对照组,比较两组的妊娠结局.结果 长沙地区围产期孕妇B族链球菌带菌率为7.4%.其中年龄<35岁孕妇GBS带菌率为7.8%,高龄孕妇(≥35岁)带菌率为5.6%,两者比较差异无统计学意义(P>0.05).分离培养的161株 GBS中未检出青霉素G、氨苄西林、利奈唑胺、美洛培南、头孢曲松、头孢吡肟、万古霉素耐药菌株,但GBS对红霉素、克林霉素和四环素耐药率较高,分别为62.73%、54.04%和65.84%.阳性观察组孕妇发生胎膜早破者67例(41.6%),阴性对照组孕妇发生胎膜早破者50例(27.8%),两组比较,差异有统计学意义(P<0.05).阳性观察组孕妇胎儿窘迫、早产、急性绒毛膜羊膜炎的发生率均高于阴性对照组,但差异无统计学意义(P>0.05).结论 显色培养法检测B族链球菌可有效缩短细菌鉴定时间,适宜基层医院推广.围产期孕妇携带GBS可增加胎膜早破、胎儿窘迫、早产及产褥感染的风险,导致不良妊娠结局.对于GBS阳性孕妇应及时进行抗菌药物干预治疗,保障母婴安全.%Objective To investigate group B streptococcus (GBS) of perinatal pregnant women and its influence on pregnancy outcome. Methods The 2183 cases of perinatal women hospitalized in Hunan Provincial Maternal and Child Health Care Hospital from October 2016 to March 2017 were selected. The vaginal secretions and rectal swab of cases were gathered and detected by color culture method in testing GBS. The 161 cases of perinatal pregnant women with GBS positive results were assigned into the observation group. The randomly selected 180 cases of perinatal pregnant women with GBS negative results were divided into the control group. The pregnancy outcomes of the two groups were compared. Results The carrier rate of GBS status among perinatal women in Changsha regions was 7.4%. The carrier rate among pregnant women under age 35 was 7.8%, and the maternal women (≥35 years old) was 5.6%, the differences between the two groups have no statistically significance (P>0.05). Drug resistant strains, penicillin G, ampicillin, linezolid, meropenem, ceftriaxone, cefepime and vancomycin were not detected in the 161 cases of isolation cultured GBS strains. However, GBS strains presented a high drug resistance rate on erythromycin, clindamycin and tetracycline, each with 62.73%, 54.04% and 65.84%. 67 cases (41.6%) in the positive observation group of pregnant women had premature rupture of membranes, while 50 cases (27.8%) in the negative control group occured premature rupture of membranes. The contrasting difference between two groups had statistical significance (P<0.05). The incidence rate of fetal distress, premature delivery and acute chorionic amnionitis in observation group was higher than that in negative control group, but the difference had no statistical significance (P<0.05). Conclusion The color culture method in detecting GBS is effective in shortening the examination period of bacterium, thus suitable to promote in basic level hospitals. The perinatal women carrying GBS increase the risk of premature rupture of membranes, fetal distress, premature delivery and puerperal infection, leading to harmful pregnancy outcome. In order to secure the safety of mother and child, pregnant women with positive GBS should be timely intervened with antibacterial drugs.