孕妇生殖道B族链球菌的带菌状况分析

目的通过对孕妇生殖道B族链球菌(GBS)的带菌状况分析,为制定有效预防和治疗措施提供依据。方法 2013年1月至2015年1月,对1 590例孕妇生殖道分泌物进行GBS培养与鉴定,结果进行统计学分析。据孕龄及年龄分组,分为孕中期组与孕晚期组,30岁组与≥30岁组。结果 1 590例孕妇中共检出GBS携带者512例,带菌率为32.2%。孕中期组(30.9%)与孕晚期组(33.1%)的带菌率差异无统计学意义(χ2=0.756,P0.05);30岁组(29.0%)与≥30岁组(42.1%)的带菌率差异具有统计学意义(χ2=18.772,P0.01)。GBS阳性者与GBS阴性者的临床症状发生率(18.95%vs7.88%)差异具有统计学意义(χ2=42.427,P0.01)。结论孕妇GBS带菌率较高,与孕妇的孕龄无关,高龄者易于感染。对于GBS携带者,应采取积极有效的预防和治疗措施。     

慢性前列腺炎患者尿道分泌物微生物组学分析

目的:探讨慢性前列腺炎(CP)患者尿道分泌物中微生物菌群结构差异,为CP的诊治提供可靠的病原学依据。方法:运用高通量二代测序技术检测33例CP患者尿道分泌物中的微生物,同时以30例健康男性作为对照组;采用秩和检验进行组间显著性差异分析,使用生物信息学软件进行数据处理,以P<0.05为差异有统计学意义。结果:在种分类水平CP组尿道分泌物与健康对照组有17种菌存在显著性差异;LEFSe分析显示CP患者尿道分泌物中丰度差异显著的微生物是微球菌科、红蝽菌科、红蝽菌目、Coriobacteriia、Weeksellaceae、丛毛单胞菌科、肠杆菌科、肠杆菌目、黄单胞菌科、黄单胞菌目和银耳纲;PCA分析显示两组菌群结构差异显著。结论:CP与尿道菌群结构改变存在一定的相关性;CP可能不是由单一的微生物引起的,而是多种微生物共同作用的结果。     

线索细胞在男性泌尿生殖道感染的意义

目的:探讨线索细胞在男性泌尿生殖道感染的检出意义。方法:对264例门诊就诊的男性取尿道拭子或前列腺液,直接涂片在超高倍显微镜下找线索细胞,并对线索细胞阳性患者的配偶进行细菌性阴道病(BV)的检查诊断。结果:215例尿道拭子检出线索细胞11例(5.1%),49例前列腺液检出线索细胞1例(2.0%),11例配偶检查结果9例诊断为BV(81.8%)。结论:BV的病原体同样可侵犯并粘附于男性泌尿生殖道上皮细胞形成线索细胞,线索细胞阳性结合临床特征可诊断男性泌尿生殖道细菌感染。     

产妇经阴道分娩生殖道无乳链球菌感染情况及药敏分析

目的探讨产妇经阴道分娩生殖道无乳链球菌感染情况及抗生素敏感情况,为临床提供用药依据。方法本院回顾性分析2016年1月至2018年1月本院产科门诊及住院部的经阴道分娩怀疑为无乳链球菌感染的孕妇共计1354例的临床资料,取所有患者的阴道分泌物进行常规培养,鉴别菌种后,对分离所得无乳链球菌进行耐药性分析和培育。共检出无乳链球菌210株,95例患者阳性,阴道分泌物标本阳性率13.7%。抗菌药物敏感性试验结果显示,纳入菌群对青霉素类、复方新诺明、奎奴普丁/达福普丁、利奈唑胺、氯霉素、万古霉素、莫西沙星、替考拉宁、青霉素G和四环素耐药率较低,对环丙沙星、左旋氟氧沙星、红霉素和克林霉素具有一定耐药性。结论无乳链球菌是产妇经阴道分娩感染的主要菌类之一,目前青霉素仍可作为临床治疗无乳链球菌感染的首选药物;红霉素与克林霉素以及阿米卡星存在一定的耐药性,医院应合理、规范的使用抗菌药物,减少多重耐药菌的产生。     

实时荧光定量PCR检测妊娠晚期孕妇B族链球菌感染的临床价值

目的评价实时荧光定量PCR技术检测妊娠晚期孕妇B族链球菌(GBS)感染的临床效能,探讨GBS感染与不良妊娠结局的关系。方法对3 565例妊娠35~37周孕妇的阴道分泌物和直肠分泌物,采用实时荧光定量PCR法和细菌培养法进行GBS检测;根据GBS携带者意愿将其分为干预治疗组和未干预治疗组,干预治疗组进行预防性应用抗菌素,未干预治疗组不作处理;观察各组产妇的妊娠结局。结果 3 565例孕妇中,GBS携带率为9.87%;实时荧光定量PCR法诊断GBS感染的灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比和准确度分别为98.30%、99.50%、95.58%、99.81%、196.6、0.017和99.38%;未干预治疗组的胎膜早破、早产、宫内感染、胎儿窘迫和新生儿感染的发生率显著高于GBS阴性组和干预治疗组(P0.05),而干预治疗组与GBS阴性组无统计学差异(P0.05);各组新生儿均出现不同程度的GBS、金黄色葡萄球菌和表皮葡萄球菌等感染,未干预治疗组发生GBS感染数显著增高(P0.05),而干预治疗组与GBS阴性组无统计学差异(P0.05),其余菌种感染组间均无统计学差异(P0.05)。结论实时荧光定量PCR是一种快速准确筛查妊娠晚期GBS的方法;妊娠晚期孕妇GBS感染会导致胎膜早破、早产、宫内感染、胎儿窘迫和新生儿感染的发生率升高,及时采取干预措施可有效降低不良妊娠结局的发生。     

泌尿生殖系统无乳链球菌感染的临床病区分布及耐药性分析

目的分析泌尿生殖系统无乳链球菌感染的临床病区分布及耐药情况,为临床提供治疗依据及合理的用药方案。方法对临床送检的阴道分泌物标本及中段尿标本进行常规培养,检出的无乳链球菌株经由VITEK-2全自动细菌鉴定分析仪进行鉴定和药敏分析。结果 1 563例送检标本发现57例患者有无乳链球菌感染,感染率为3.64%;无乳链球菌的临床病区分布以妇产科最高,其次是神经内科和肾病内科;药敏结果显示所有检出的无乳链球菌对四环素的耐药率高达77.2%,其次是红霉素为49.1%、克林霉素为42.1%、环丙沙星40.4%、左氧氟沙星36.8%。结论国内无乳链球菌的感染率较高,尤其是在妇产科病区,临床上应加强对无乳链球菌的培养检测,及时并合理应用抗菌药物,以降低耐药率。     

白细胞介素6和磷酸化信号转导及转录活化因子3在B族链球菌阳性孕妇中表达

目的探讨B组链球菌（GBS）阳性的早产孕妇中白细胞介素6（IL-6）和磷酸化信号转导及转录活化因子3（p-STAT3）的表达及其与早产的关系。 方法选择深圳市福田区妇幼保健院2018年6月至2019年6月门诊产前检查至住院待产的孕妇1 950例中GBS阳性者共122例。对GBS阳性早产20例（早产组）、足月胎膜早破者33例（胎膜早破组）、足月阴道分娩孕妇66例（足月分娩组）、流产3例（流产组）及同期GBS阴性孕妇20例（GBS阴性对照组）的阴道分泌物制备悬浮液，采用ELISA法检测IL-6浓度，Western blot检测p-STAT3、p-Akt和NF-κB亚基p65的表达。 结果入组孕妇GBS阳性率为6.25%（122/1 950），其中流产、早产、足月胎膜早破和足月分娩孕妇分别占2.45%（3/122）、16.12%（20/122）、26.62%（33/122）和53.66%（66/122）。GBS阳性早产组孕妇IL-6表达[（0.065 ± 0.034）pg/ml]显著高于GBS阳性足月产者[（0.045 ± 0.021）pg/ml]（t =－3.192、P = 0.002）和GBS阴性者[（0.043 ± 0.020）pg/ml]（t =－2.494、P = 0.017），差异均有统计学意义。p-STAT3在GBS阳性早产病例中的表达（灰度值：0.06 ± 0.03）显著高于GBS阴性对照组（灰度值：0.04 ± 0.01），差异有统计学意义（t =－2.981、P = 0.005）；GBS阳性早产组和GBS阴性对照组p-Akt灰度值分别为（0.035 ± 0.02）和（0.07 ± 0.03），差异有统计学意义（t = 4.341、P = 0.001）；p65灰度值分别为（0.045 ± 0.02）和（0.085 ± 0.04），差异有统计学意义（t = 4.000、P = 0.003）。 结论GBS阳性病例早产可能与阴道分泌物中IL-6、p-STAT3、p-Akt和p65高表达有密切关系。     

二代测序技术在诊断假体周围感染中的应用

[目的]探讨二代测序技术在关节置换术后假体周围感染诊断中的应用价值。[方法]选取2018年1月～2018年12月在本院就诊的人工关节置换术后关节疼痛、红肿、怀疑假体周围感染的患者。依据美国肌肉、骨骼感染病学会(MSIS)诊断标准,最终共计22例患者确诊为人工关节置换术后假体周围感染。其中男10例,女12例;膝关节感染16例,髋关节感染6例。所有22例PJI患者均行关节液二代测序和细菌培养。分别记录二代测序及细菌培养结果,以检测或培养出微生物为阳性,未检测或培养出微生物为阴性,记录阳性例数。分别计算二代测序技术和细菌培养在PJI患者中的阳性检出率以及在髋膝不同部位的阳性检出率,并通过配对卡方检验进行统计学分析。[结果]总计22例PJI患者中,18例患者二代测序检出微生物,二代测序在PJI患者中的阳性检出率为18/22(81.82%);关节液细菌培养阳性9例,关节液细菌培养在PJI患者中的阳性检出率为9/22(40.91%)。配对卡方检验提示两种方法在PJI患者中的检出率差异有统计学意义(P=0.022)。[结论]二代测序技术在PJI患者的诊断中具有更高的细菌检出率,在PJI患者病原微生物学检查中有更大的诊断价值。     

119例非淋菌性泌尿生殖道感染支原体培养及药敏分析

目的:了解非淋菌性泌尿生殖道感染患者中解脲支原体(UU)和人型支原体(MH)感染情况及对9种常用抗生素的敏感性.方法:男性患者刮取尿道分泌物或取前列腺液;女性患者取宫颈分泌物送检.并采用Mycoplasma IES支原体分离、鉴定、药敏成套试剂盒检验.结果:119例患者中,支原体检出阳性者36例( 30.2%),其中UU单独感染者32例( 88.9%),另4例为MH、UU混合感染( 11.1%).男性支原体培养阳性者32例( 28.6%,32/112);女性支原体培养阳性者4例( 57.1%,4/7).结论:进行支原体感染进行药敏检测,对指导临床用药有重要意义.     

基因二代测序技术在假体周围感染诊断中的价值

目的通过与细菌培养及血清生物学标志对比,探讨二代测序技术(NGS)对人工关节置换术后假体周围感染(PJI)的诊断价值。 方法选取2017年7月到2019年12月在聊城市人民医院关节外科因假体周围感染或无菌性松动行关节翻修手术,排除初始关节液无法采集到,通过关节内注射生理盐水获得样本的患者及其他部位存在感染病灶的患者,共纳入患者35人(35例)根据美国肌骨骼感染协会(MSIS)的诊断标准,15例患者纳入感染组,20例患者纳入非感染组。术前两组患者常规检查血沉(ESR)、C反应蛋白(CRP)、降钙素原(PCT)、白介素6(IL-6)及D-二聚体(D-Dimer)。所有患者术前均行关节穿刺,穿刺液检测白细胞计数、白细胞分类、细菌培养及NGS。计算ESR、CRP、PCT、IL-6及D-Dimer的受试者操作特性曲线(ROC)的曲线下面积(AUC)。计算NGS、细菌培养及各项血清学标志物的诊断精确度、敏感性及特异性。 结果髋关节19例(54.3%),膝关节16例(45.7%)。男性21例(60.0%),女性14例(40.0%),年龄67.0(62.0,74.0)岁。感染组15例患者中NGS结果阳性14例(93.3%),细菌培养结果阳性7例(46.7%)。非感染组NGS结果阴18例(90.0%)。ESR及D二聚体的AUC分别为0.667和0.572(均为P>0.05)。CRP、IL-6及PCT的AUC分别为0.827、0.767及0.808(均为P<0.01)。NGS、细菌培养、CRP、IL-6及PCT的精确度分别为0.91、0.74、0.77、0.74及0.83。NGS与CRP、IL-6、PCT、细菌培养两两比较,总体检测结果差异有统计学意义(P<0.01)。NGS与CRP、IL-6、PCT、细菌培养两两比较,NGS敏感性更高(P<0.05)。NGS与CRP比较特异性更好(P<0.05)。NGS与IL-6、PCT及细菌培养比较,特异性差异无统计学意义(P>0.05)。 结论NGS比细菌培养及常用的血清学标志物有更高的精确度及敏感性,在PJI的诊断中具有更大的价值。     

Group B streptococcal spondylodiscitis in adults: 2 case reports

Streptococcus agalactiae, or group B streptococcus (GBS), has been traditionally considered an infrequent etiologic agent of disease in adults except for urinary tract infection in pregnant women. Attention has recently been drawn to other adult infections caused by GBS such as skin and soft tissue infections, bacteriemias, pneumonia, meningitis, endocarditis, peritonitis, and bone and joint infections. We present two adult patients with GBS spondylodiscitis and review 30 cases of GBS spinal infection previously reported in the literature. This series clearly illustrates that GBS has recently been recognized as an emerging cause of vertebral infections in adults, particularly in those with chronic underlying diseases, although it can also affect immunocompetent patients without debilitating conditions. Although uncommon, GBS should be considered in the differential diagnosis of infective spondylodiscitis in nonpregnant adults, whatever the patient's immunological status.     

The influence of pH on antimicrobial substances in canine vaginal and urethral secretions

Summary Trimethoprim and rosamicin (a new basic macrolide antibiotic) were administered to normal and oophorectomised female dogs by constant intravenous infusion before and after oestrogen and androgen administration. Their concentrations in plasma and in urethral and vaginal secretions were determined by bioassay and correlated with the pH values of vaginal and urethral secretions. Both compounds were concentrated in the vaginal and urethral secretions in reverse correlation with the pH of these fluids. Trimethoprim and rosamicin have antimicrobial spectra well suited for the treatment of bacterial urethritis and vaginitis and require further clinical investigation.     

Lactobacillus colonization status in infants with urinary tract infection

To explore the potential protective role of urogenital lactobacilli against urinary tract infection (UTI), lactobacillus cultures were performed on stool and urine specimens and periurethral/vaginal swabs of febrile infants who were suspected of having UTI. Those infants diagnosed with UTI based on the results of the suprapubic urine cultures were allocated to the UTI group (n = 60), and those who had a simple viral illness with negative urine cultures were allocated to the control group (n = 31). Lactobacilli were anaerobically cultured in lactobacillus-specific DifcoTM Rogosa SL agar for 48 h at 37°C and then counted. The lactobacillus colony counts for the stool and urine specimens and periurethral swabs from the UTI group were significantly lower than those for the control group (P < 0.05). The geometric means of stool, periurethra, and urine lactobacilli in the UTI group were significantly lower than those in the control group (P < 0.05). The colony count of the vaginal lactobacillus demonstrated an equivocal difference between the UTI and control group. In conclusion, this is the first prospective case–control study to demonstrate reduced lactobacillus urogenital colonization in infants with UTI. Our results support the view that less urogenital lactobacillus colonization may be a risk factor for UTI in infants even though there is an unclear possibility that the UTI itself could be the cause of the lower lactobacillus colonies.     

Long-term effect of ovariectomy and simulated birth trauma on the lower urinary tract of female rats

PURPOSE: Using an animal model we studied the long-term effects of ovariectomy and simulated birth trauma in the development of apoptosis as well as the urodynamic, histological and ultrastructural findings 9 months after such procedures. MATERIALS AND METHODS: A total of 24 pregnant Sprague-Dawley female rats were used. Immediately after delivery 14 animals underwent vaginal ballooning and ovariectomy, while the remaining 10 served as controls. At 9 months the animals underwent urodynamic evaluation, which included the urethral pressure profile. The rats were then sacrificed and urogenital tissue was obtained for immunostaining using terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end-labeling, histomorphometry evaluation and electron microscopy. RESULTS: Immunostaining demonstrated a significant increase in the apoptotic index in the urethra of castrated/ballooning rats with a predominance in the submucosa layer. Maximum urethral closure pressure was significantly lower in that group, although there was no correlation of apoptosis with maximum urethral closure pressure measurement. Urodynamic evaluation revealed only discrete alterations in cystometric parameters. Morphometric evaluation showed increased connective tissue in the vagina. Electron microscopy of urethral smooth muscle demonstrated altered cellular shape, increased intercellular space with collagen deposition and some degeneration of the mitochondria. CONCLUSIONS: Apoptosis in the urethra occurs 9 months after castration and simulated birth trauma. However, this finding was not seen in the muscle layers or in other urogenital tissues. Some ultrastructural changes also occurred that may explain some symptoms that women have after vaginal childbirth and menopause.     

Urethral striated muscle and extracellular matrix morphological characteristics among mildly diabetic pregnant rats: translational approach

Introduction and hypothesis

Diabetes mellitus (DM) during pregnancy is associated with high levels of urinary incontinence (UI) and pelvic floor muscle dysfunction. Mild DM can lead to changes in urethral striated muscle and extracellular matrix (ECM) in pregnant rats considering both structures as an entire system responsible for urinary continence.

Methods

Ninety-two female Wistar rats were distributed in four experimental groups: virgin, pregnant, diabetic, and diabetic pregnant. In adult life, parental nondiabetic female rats were mated with nondiabetic male rats to obtain newborns. At the first day of birth, newborns received citrate buffer (nondiabetic group) or streptozotocin 100 mg/kg body weight, subcutaneous route (mild DM group). At day 21 of the pregnancy, the rats were lethally anesthetized and the urethra and vagina were extracted as a unit. Urethral and vaginal sections were cut and analyzed by: (a) cytochemical staining for ECM and muscle structural components, (b) immunohistochemistry to identify fast- and slow-muscle fibers, and (c) transmission electron microscopy for ultrastructural analysis of urethral striated muscle.

Results

In comparison with the three control groups, variations in the urethral striated muscle and ECM from diabetic pregnant rats were observed including thinning, atrophy, fibrosis, increased area of blood vessels, mitochondria accumulation, increased lipid droplets, glycogen granules associated with colocalization of fast and slow fibers, and a steady decrease in the proportion of fast to slow fibers.

Conclusions

Mild DM and pregnancy can lead to a time-dependent disorder and tissue remodeling in which the urethral striated muscle and ECM has a fundamental function.     

Impact of pregnancy and childbirth on female rats’ urethral nerve fibers

This study aims to evaluate the urethral nerve fibers of adult female rats during pregnancy and after vaginal birth, cesarean section or simulated birth trauma. For immunohistochemical analysis of nerve fibers, 70 female rats were distributed in seven groups of ten female rats: group 1, control; group 2, pregnant; group 3, cesarean section; group 4, vaginal birth; group 5, virgin female rats with simulated birth trauma; group 6, cesarean section followed by simulation of birth trauma; and group 7, vaginal birth followed by simulation of birth trauma. The number of nerve fibers in groups 1, 2, and 3 were significantly higher than the other groups. Pregnancy and cesarean section did not cause alterations in the nerve fibers number. Vaginal birth and simulated birth trauma significantly decreased the number of nerve fibers in the female rats’ middle urethra.     

Urethroplasty and vaginoplasty by a single small bowel interposition graft: a novel technique for cloacal reconstruction

Despite the advances in surgical management of anorectal malformations, repair of cloacal malformations remains a challenging condition for many pediatric surgeons. Posterior cloaca is present where urogenital sinus deviates posteriorly to form a cloaca with rectum. Often, achieving adequate urethral and vaginal length can be challenging. We describe a novel technique where a loop of small bowel on a single mesenteric blood supply could be constructed in 2 functional tubular structures: one for urethral and the other for vaginal replacement.     

Spondylodiscites à streptocoque du groupe B chez l’adulte : 2 nouveaux cas et analyse des 32 cas publiés

Streptococcus agalactiae, or group B streptococcus (GBS), has been traditionally considered an infrequent etiologic agent of disease in adults except for urinary tract infection in pregnant women. Attention has recently been drawn to other adult infections caused by GBS such as skin and soft tissue infections, bacteremias, pneumonia, meningitis, endocarditis, peritonitis, and bone and joint infections. We present two adult patients with GBS spondylodiscitis and review 30 cases of GBS spinal infection previously reported in the literature. This series clearly illustrates that GBS has recently been recognized as an emerging cause of vertebral infections in adults, particularly in those with chronic underlying diseases, although it can also affect immunocompetent patients without debilitating conditions. Although uncommon, GBS should be considered in the differential diagnosis of infective spondylodiscitis in nonpregnant adults, whatever the patient’s immunological status.