围产期孕妇B族链球菌感染情况和药敏性试验及其与不良妊娠结局的关系

目的  探讨孕妇妊娠期B族链球菌（GBS）感染情况及其药物敏感性，分析GBS感染与不良妊娠结局的关系及不同用药方案对GBS感染孕妇妊娠结局的影响。方法  选取2014年1月-2014年10月海口市中医医院妇产科行产前检查的428例孕35～37周孕妇为研究对象，收集孕妇阴道及肛周分泌物，应用实时定量PCR检测GBS感染情况，并对分离的菌株进行耐药试验。将GBS阳性患者分为A组（临产后采用敏感性抗生素静脉滴注至分娩结束，1次/4 h）及B组（发现感染即口服抗生素治疗7 d，其余治疗方法与A组相同），对比分析两种治疗方案妊娠结局。结果  GBS阳性组胎儿宫内感染、胎儿窘迫、羊水污染、早产、新生儿肺炎、产妇产后出血、产褥期感染发生率高于GBS阴性组（P <0.05）。GBS孕妇对万古霉素、头孢噻肟、青霉素、氨苄青霉素的敏感性为100%，而对克林霉素、阿奇霉素及红霉素的敏感率较低，分别为58.8%、44.1%及35.2%。B组胎儿宫内感染、胎儿窘迫、羊水污染、早产、新生儿肺炎、产妇产后出血、产褥期感染发生率低于A组（P <0.05）。  结论  GBS感染可增加孕妇不良妊娠结局的发生，在发现孕妇感染GBS后立刻采用敏感性的抗生素类药物治疗能有效改善孕妇不良妊娠结局，有利于孕妇预后。

Perinatal infection and drug sensitivity of GBS in pregnant women and their relationships with adverse pregnant outcomes

Objective To investigate the infection status and drug sensitivity of group B Streptococcus (GBS) in pregnant women, analyze the relationship between GBS infection and adverse pregnancy outcomes, and compare the influence of different treatment regimens on the outcomes of pregnant women with GBS infection. Methods Totally 428 cases of pregnant women with 35-37 weeks pregnancy were selected as the research subjects from January 2014 to October 2014. Vaginal and anal secretions of the pregnant women were collected, and real time quantitative PCR was used to detect GBS infection, and drug resistance test was carried out for the isolated strains. The GBS-positive patients were divided into group A (using sensitive antibiotics intravenously once every 4 hours from the beginning to the end of delivery) and group B (oral antibiotic treatment for 7 d once GBS infection was confirmed, the rest was the same as group A), and the pregnancy outcomes of the two treatment regimens were compared. Results The incidences of intrauterine infection, fetal distress, meconium, premature birth, neonatal pneumonia, postpartum hemo- rrhage and puerperal infection in the GBS-positive group were significantly higher than those in the GBS-negative group (P < 0.05). GBS-positive maternal sensitivity to Vancomycin, Cefotaxime, Penicillin and Ampicillin was 100%, while the sensitivity rates to Clindamycin, Azithromycin and Erythromycin was lower (58.8%, 44.1% and 35.2% respectively). The incidences of intrauterine infection, fetal distress, meconium, premature birth, neonatal pneumonia, postpartum hemorrhage and puerperal infection in the group B were significantly lower than those in the group A (P < 0.05). Conclusions GBS infection can increase the incidence of adverse pregnancy outcomes in pregnant women. Use of sensitive antibiotics immediately after diagnosis of GBS infection can effectively improve pregnancy outcomes.