B族链球菌产前筛查在母婴感染防控中的应用

目的建立产前筛查B族链球菌(GBS)检验方法,将其应用于孕晚期GBS携带的筛查,探讨妊娠晚期对孕妇进行GBS感染筛查的临床意义,并对GBS带菌者采取干预措施,观察其对母婴感染的防控作用。方法选取产科进行产前检查及分娩的35周以上的孕妇1 000例为研究对象,采集孕妇阴道口1/3处及肛周分泌物进行GBS筛查,采用已建立的细菌培养法检测GBS,将GBS阳性者根据其意愿分为干预治疗组和不干预治疗组,干预治疗组在临产后或破膜后预防性应用抗菌药物,不干预治疗组不作处理。对比各组产妇的妊娠结局。结果 1 000例受检孕妇经检测共发生GBS感染97例,感染率为9.7%;与GBS阴性组相比,干预治疗组胎膜早破、早产、宫内感染、胎儿窘迫、新生儿低体质量、Apgar评分及感染发生率差异均无统计学意义(P0.05);而与不干预治疗组相比,干预治疗组Apgar评分差异无统计学意义(P0.05),其他指标差异均有统计学意义(P0.05)。结论建立的筛查GBS方法可快速、敏感、特异地筛查出孕妇阴道及肛周样本中的GBS。孕晚期对孕妇进行GBS感染的筛查非常重要,及时采取干预措施可有效减少不良妊娠结局及母婴感染的发生率。     

孕晚期产妇生殖道B族链球菌感染与胎膜早破及新生儿结局的相关性

目的:探讨孕晚期产妇生殖道B族链球菌(group B Streptococcus,GBS)感染与胎膜早破及新生儿结局的相关性。方法:搜集2017年5月至2019年8月首都医科大学附属北京世纪坛医院产科门诊的2100例孕妇,选取其中122例孕晚期胎膜早破产妇作为观察组,另选取120例同期健康孕晚期产妇作为健康对照组,比较两组GBS感染率,依据观察组患者是否合并GBS感染,将其分为GBS阴性组与GBS阳性组,采用单因素和多因素logistic回归分析影响胎膜早破孕妇GBS感染的危险因素,观察不同组别不良妊娠情况及新生儿结局。结果:健康对照组GBS感染率显著低于观察组(P<0.05);两组孕妇胎位异常、双胎或多胎妊娠和巨大儿发生率比较差异具有统计学意义(P<0.05);经多因素logistic回归模型分析结果显示胎位异常、双胎或多胎妊娠和巨大儿为影响胎膜早破孕妇GBS感染的危险因素(P<0.05)。GBS阴性组早产、产后出血和宫内感染率均显著低于GBS阳性组(P<0.05);GBS阳性组新生儿窒息和新生儿肺炎感染发生率均高于GBS阴性组(P<0.05);两组新生儿感染率比较,差异无统计学意义(P>0.05)。结论:胎位异常、双胎或多胎妊娠和巨大儿均可影响孕晚期胎膜早破产妇GBS感染,GBS感染可致新生儿窒息、新生儿感染和新生儿肺炎的发生,同时引起早产、产后出血和宫内感染等不良妊娠结局的发生。临床需要对孕晚期产妇生殖道GBS感染进行及时监测和处理,以降低其不良母婴结局的发生率。     

B族链球菌对妊娠结局和新生儿的影响

探讨B族溶血性链球菌（GBS）对妊娠结局和新生儿的影响。对接受定期产检的孕妇进行围产期GBS感染检测,并探讨B族溶血性链球菌对妊娠结局和新生儿的影响。1580例孕妇中经取材培养法确认GBS阳性110例,阳性率为6.96%（110/1580）。选择同期GBS阴性者100例作为对照组,对比110例GBS阳性孕妇及100例GBS阴性孕妇的一般资料可以发现,两组孕妇的年龄、孕周及孕产次均无显著差异,具有可比性（P〉0.05）。 GBS阳性组在流产、早产、胎膜早破及产褥感染等方面的发生率明显高于GBS阴性组,差异具有统计学意义（χ2=5.02、5.85、7.36、3.92,P〈0.05）。GBS阳性组在新生儿肺炎、新生儿上呼吸道感染等方面的发生率明显高于GBS阴性组,差异具有统计学意义（χ2=4.66、7.29,P〈0.05）。两组均未发生新生儿死亡。妊娠晚期孕妇感染B族溶血性链球菌会增加流产、早产、胎膜早破、产褥感染、新生儿肺炎及新生儿上呼吸道感染的发生率,可对妊娠结局和新生儿预后造成不良影响。     

B族链球菌核酸检测在产前筛查中的应用

目的探索B族链球菌核酸检测在产前筛查中的应用价值。方法在来本院产检的孕妇中随机选出2000例作为观察对象,在孕周35~37周时采集孕妇的阴道分泌和肛周分泌物,对其进行细菌培养和PCR检测,对比分析两种方法的B族链球菌阳性率。并对B族链球菌阳性组(n=122)和阴性组(n=120,随机抽取)对象的分娩方式、产妇并发症、新生儿并发症进行对比。结果 PCR检测的阳性率为6.0%,明显高于采用细菌培养检测的阳性率4.45%(P0.05);且阳性组的产妇早产、产后出血、胎膜早破发生率均高于阴性组,阳性组新生儿的感染、败血症、窒息发生率均高于阴性组(P0.05)。结论对孕35~37周的孕妇采用PCR方法进行B族链球菌的检测检出率高,及早对B族链球菌阳性产妇进行干预,有助于减少母儿并发症,保障母婴健康。     

孕晚期生殖道B族链球菌感染临床干预后对胎膜早破的影响

选取2016年1月~2016年12月期间我院确诊治疗的孕晚期生殖道B族链球菌感染患者176例,依据是否接受治疗分为接受组和常规组,每组88例,常规组患者给予助产、引产等常规干预,接受组在此基础上于先兆临产后接受头孢唑啉治疗,统计分析所有患者的分娩方式、胎膜早破和新生儿感染情况。接受组患者阴道分娩率明显高于常规组,差异有统计学意义(P0.05);接受组患者胎膜早破、新生儿感染发生率明显低于常规组,差异有统计学意义(P0.05)。头孢唑啉临床干预可有效减少孕晚期生殖道B族链球菌感染患者胎膜早破的发生,有利于提高阴道分娩率及避免新生儿感染的发生,值得临床作进一步推广。     

妊娠期B族链球菌感染对新生儿早发性黄疸的影响

目的 本研究旨在探讨妊娠期GBS(B族链球菌,Group B streptococcus)感染对足月新生儿早发性黄疸及其临床结局的影响。方法 收集2021年1月至2021年6月期间在江西省妇幼保健院诊断为早发性黄疸的新生儿作为研究对象（n=139）,并收集同时期出生的正常新生儿作为对照组（n=135）,比较两组间的新生儿出生体重、Apgar评分、总胆红素值、住院时长、母亲GBS感染率。结果 研究组与对照组间母亲GBS的感染率分别为13.56%及6.06%,差异有统计学意义(P<0.001),研究组的总胆红素值与住院时长明显高于对照组（P<0.001）。早发性黄疸中,妊娠期间GBS感染的新生儿住院时长明显高于无感染史者,差异有统计学意义（P<0.001）,另外,GBS感染的母亲所生新生儿的体重明显低于无感染史的母亲所生新生儿（P=0.032）。结论 妊娠期间GBS感染对足月新生儿早发性黄疸有影响,且会增加患儿的住院时长及降低新生儿出生体重。     

3种B族链球菌筛查方法在孕晚期筛查中的应用

目的比较3种B族链球菌(GBS)的筛查方法在孕晚期孕妇GBS筛查中的临床应用价值。方法收集2017年9月至12月在厦门市妇幼保健院产科门诊产检的35～37孕周孕妇阴道/直肠拭子样本1 027例,用GBS运送增菌显色培养法、GBS运送增菌显色培养基联合哥伦比亚血琼脂培养法、GBS运送增菌显色培养基联合产胡萝卜素/β-γ乙型链球菌二分格营养琼脂培养法3种方法进行GBS筛查,分析GBS检出率差异;另选2018年5—6月分离的227株阳性菌株,采用质谱分析进行验证。结果 3种方法GBS检出率分别为8.67%、12.76%、13.63%。GBS运送增菌显色培养基联合血平板法和联合二分格培养法GBS检出率明显高于单独GBS运送增菌显色培养法(P0.05),但前两者检出率差异无统计学意义;GBS运送增菌显色培养基及二分格培养法检出的GBS菌株经质谱分析验证,符合率为98.7%。结论 GBS运送增菌显色培养联合产胡萝卜素/β-γ乙型链球菌二分格营养琼脂培养法能提高GBS检出率,且操作及判读较为简便,适合孕晚期GBS筛查。     

B族链球菌耐药机制研究进展

B族链球菌(GBS)也称为无乳链球菌,是一种条件致病菌,主要寄生在人体泌尿生殖道和下消化道。新生儿感染GBS可引起新生儿脑膜炎、肺炎、败血症等。孕妇感染GBS可引起绒毛膜炎和子宫内膜炎,增加胎膜早破、早产、产褥期感染等不良结局的风险。非妊娠期成年人感染GBS可引起皮肤、软组织、骨关节感染及心内膜炎等。青霉素是治疗GBS感染的首选药物,为了预防青霉素引起的严重过敏反应,大环内酯类药物如红霉素、林可霉素类药物如克林霉素可为二线替代药物。近年来,随着抗菌药物使用的增加,GBS对一线抗菌药物青霉素类的敏感性降低,对二线抗菌药物的耐药率也不断上升,甚至出现了对最后一道防线万古霉素耐药株。该文旨在综合分析GBS对抗菌药物的耐药情况以及概述GBS的耐药机制。     

B群链球菌免疫层析法的建立及其临床应用

目的建立一种B群链球菌(GBS)的胶体金免疫层析检测方法,并进行临床应用评价。方法收集202例阴道分泌物标本,采用细菌分离培养法作为金标准对标本的GBS进行检测,同时采用以双抗体夹心法为基础研制出B群链球菌胶体金免疫层析试纸条检测作为对照,分析其灵敏度、特异度,计算Kappa值分析两种方法的一致性。结果免疫层析法检测GBS的敏感度为97.50%,特异度为97.54%;与细菌分离培养法的总符合率为97.52%,Kappa值为0.948。结论免疫层析法检测GBS具有较高的敏感度和特异度,且简便准确,对GBS的筛查和快速诊断具有重要的临床应用价值。     

B族链球菌四种筛查方法的比较

目的评估B族链球菌肉汤增菌培养法(Todd-Hewitt型,T-H)、直接培养法、液体显色培养法及核酸环介导恒温扩增法(LAMP)在孕晚期妇女筛查中的临床应用。方法回顾性研究。采集2016年10月至2018年4月在广州医科大学附属广州市妇女儿童医疗中心产科门诊产检妊娠35~37周孕妇直肠阴道分泌物标本969份,采用双盲法,以T-H肉汤增菌培养法为参考方法,分3个研究阶段先后比较直接培养法、液体显色培养法及LAMP法的检验性能。以敏感度、特异度、符合率、阳性预测值、阴性预测值及尤登指数为评价指标,一致性用Kappa检验。结果增菌培养法共检测标本969份,阳性90份(9.3%)。以增菌培养法为参考,敏感度从高到低依次为LAMP法[100%(25/25)]、直接培养法[81.5%(22/27),95%CI:65.8%~97.1%]、液体显色培养法[71.1%(27/38),95%CI:55.9%~86.2%];特异度则依次为直接培养法[100%(282/282)]、液体显色培养法[98.1%(455/464),95%CI:96.8%~99.3%]、LAMP法[94.0%(125/133),95%CI:89.9%~98.1%];符合率依次为直接培养法[98.4%(22+282)/309]、液体显色培养法[96.0%(27+455)/502]、LAMP法[94.9%(25+125)/158]。而直接培养法(0.889)、LAMP法(0.832)与增菌培养法的一致性Kappa值均≥0.75,液体显色培养法则为0.708。直接培养法有18.5%(5/27)的漏检率,LAMP法漏检率为零、假阳性率为6.0%(8/133),液体显色培养法的漏检率、假阳性率分别为28.9%(11/38)、1.9%(9/464)。结论本研究所比较的几种GBS筛查方法中,仅LAMP法与增菌培养法在敏感度、特异度及符合率上均具较好的一致性,而其他两种方法存在一定的漏检。临床实验室可根据实际条件、技术力量选择使用,或参照欧美指南推荐的孕晚期增菌培养筛查与产时核酸检测相结合,以最大程度满足临床需求。     

Screening strategies for group B streptococcus in the third trimester of pregnancy

PURPOSE: To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review. DATA SOURCES: Selected research articles, texts, and Internet sources. CONCLUSIONS: Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached. IMPLICATIONS FOR PRACTICE: Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life-long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture-based or risk factor-based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease.     

Improving perinatal Group B streptococcus screening with process indicators

Rationale Group B streptococcus (GBS) neonatal infection can be prevented by screening pregnant women for GBS colonization from the 34th to the 38th week of gestation, as has been recommended in France since 2001. We assessed guideline adherence among midwives and obstetricians. Methods From 2006 to 2008, new and mandatory GBS data were added to the obstetric database. We merged the latter with a bacteriological database and a paediatric database and defined process indicators for pregnant women who delivered from the 37th week of gestation in the hospital of Poitiers and for neonates hospitalized for a GBS infection from 2006 to 2008. Results We abstracted 5997 pregnant women (1942 in 2006, 1975 in 2007 and 2080 in 2008) and 84 neonates (17 in 2006, 32 in 2007 and 35 in 2008). GBS pregnancy colonization prevalence was 15%, 13% and 18% respectively. Availability of GBS screening status was stable (96%, P = 0.15). The rate of GBS screening during pregnancy increased significantly (86% to 90%, P = 0.002). Percentage of correct‐term screening increased significantly (89% to 96%, P < 0.001). Percentage of women who received intra‐partum antibiotic prophylaxis decreased significantly (84% to 70%, P = 0.001). Percentage of women who received correct intra‐partum antibiotic prophylaxis was stable (75%, P = 0.65). Percentage of neonates whose mother had been correctly screened but negative was 77%, 67% and 68% respectively (P = 0.61). Conclusion Our mandatory database entailed guideline adherence over a short lapse of time and resulted in a significant increase of the screening rate at the correct term. However, circumstances where neonates are infected still remain. Screening test performance needs to be re‐evaluated.     

Group B streptococcal infections in the newborn infant and the potential value of maternal vaccination

Group B Streptococcus (GBS) is a leading cause of neonatal bacterial infections in developed countries. Early-onset disease (EOD) occurs at day 0–6 and late-onset disease occurs at day 7–89. Currently, the prevention of EOD relies upon intrapartum antibiotic prophylaxis (IAP) given to women who are GBS positive at prenatal screening or women with risk factors for EOD. Although successfully implemented, IAP has not fully eradicated EOD, and incidence rates of late-onset disease remain unchanged. Furthermore, antibiotic resistance may result from widespread antibiotic use. New prophylactic strategies are therefore of critical importance. A vaccine active against GBS, administered during pregnancy and combined with targeted IAP, could overcome these problems and reduce the mortality and morbidity associated with invasive diseases.     

围产期B族链球菌相关的研究进展

围产期孕妇B族链球菌感染会导致孕妇出现产后败血症、产褥感染以及泌尿系统感染情况,且与新生儿感染、胎儿生长受限、流产以及胎膜早破等不良妊娠结局有着很大关联,是一种围产期出现的重要致病菌类型.因为临床上普遍存在抗生素使用不合理的现象,导致耐药菌株的增长,对于四环素、克林霉素以及红霉素都有着较高的耐药性.孕晚期GBS筛查与产...     

Glycoconjugate vaccines to prevent group B streptococcal infections

Group B Streptococcus (GBS) is an opportunistic pathogen of humans. At-risk populations include neonates born to colonised mothers, peripartum women, diabetics, and the elderly with underlying illnesses. Vaccines to prevent GBS disease have been developed by coupling purified capsular polysaccharide (CPS) antigen of GBS with an immunogenic protein carrier. Glycoconjugate vaccines against all nine currently identified GBS serotypes have been synthesised and shown to be immunogenic in mice, rabbits and baboons in preclinical trials. Healthy adults have safely received conjugate vaccines prepared with GBS types Ia, Ib, II, III, and V CPSs in Phase I and II clinical trials. These vaccines elicited CPS-specific antibody that opsonised GBS for in vitro killing by human peripheral blood leukocytes in the presence of complement. Results from these preclinical and clinical studies strongly suggest that GBS conjugate vaccines will be effective in preventing diseases caused by GBS.     

Maternal carriage and neonatal colonisation of group B streptococcus in eastern Turkey: prevalence, risk factors and antimicrobial resistance

Our object is to determine the prevalence of group B streptococcus (GBS) carriage among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility to formulate a policy for treatment and prevention regarding perinatal GBS diseases in eastern Turkey. A total of 150 pregnant women were screened for GBS colonisation. Samples were collected from the vagina and the rectum of pregnant women, and the ear canal, throat and umbilicus of the neonates of colonised mothers. Antimicrobial susceptibility of the isolates was also investigated. GBS was isolated in at least one specimen from the 150 women in 48 cases; it was estimated that, overall, about 32% of the pregnant women and 17.3% of overall newborns were colonised with GBS. The overall rate of GBS vertical transmission was 54.2% in this study. Maternal colonisation rate was significantly higher in younger ages (p < 0.01) when maternal age of 20 years was taken as a cut-off point. All isolates were found to be sensitive to penicillin, ampicillin, cefazolin and vancomycin. Resistance to erythromycin and clindamycin were found to be 13.5 and 2.7%, respectively.     

Evaluation of the Xpert® group B streptococcus real-time polymerase chain reaction assay compared to StrepB Carrot Broth™ for the rapid intrapartum detection of group B streptococcus colonization

Xpert group B streptococcus (GBS) was compared to StrepB Carrot Broth™ (SCB) for the detection of intrapartum GBS colonization by dually collecting vaginal/rectal swabs from 231 women. Xpert GBS detected all of the cases (45, 19.5%), but 4 were missed by SCB. A rapid Xpert GBS service for women in labor would increase costs by ∼$55?000 per annum in our region.