产前B族链球菌筛查对妊娠结局及新生儿的影响

目的研究妊娠期B族链球菌(GBS)感染对妊娠结局和新生儿的影响,探讨GBS筛查的临床意义。方法选取2016年1月至2017年6月在我院进行GBS筛查的800例孕妇为受试对象,实时荧光定量PCR技术检测GBS携带情况,根据GBS筛查结果及是否愿意接受干预治疗分为治疗组、非治疗组和GBS阴性组,对比三组妊娠结局、新生儿情况。结果 800例受试对象中,GBS阳性136例(17.0%);治疗组胎膜早破、早产、宫内感染、胎儿窘迫及新生儿肺炎、窒息、败血症、病理性黄疸发生率与GBS阴性组相比,差异均无统计学意义(Ps0.05);而与非治疗组相比,除新生儿脑膜炎差异无统计学意义(P0.05)外,其他指标差异均有统计学意义(Ps0.05)。结论妊娠期进行GBS感染的筛查具有重要意义,及时采取干预措施可有效减少不良妊娠结局及新生儿感染的发生率。     

围产期孕妇生殖道B族链球菌感染高危因素分析及母婴结局探讨

目的调查沈阳地区围产期孕妇生殖道B族链球菌(group B streptococcus,GBS)定植率和感染高危因素及对母婴结局的影响,以便预防和控制围产期妇女GBS感染,优化母婴结局。方法对2017年9—11月在医院作孕期检查的31～40周孕晚期孕妇691例取阴道拭子及直肠拭子进行GBS培养、分离鉴定,分析GBS定植率;采用卡方检验进行GBS感染的单因素分析,采用多因素二元Logistic回归进行GBS感染的高危因素分析;对比两组孕妇及新生儿结局。结果沈阳地区孕晚期孕妇生殖道GBS定植率为7.67%(53/691),其中阴道试子阳性率为4.63%(32/691),直肠试子阳性率为6.22%(43/691);孕妇GBS感染的危险因素显示,在教育程度、生产史、分娩方式、甲状腺异常、妊娠期高血压、妊娠期贫血和妊娠期糖尿病,组间差异均无统计学意义(P>0.05);孕妇GBS感染危险因素,年龄、体质量、流产史和生殖道感染,组间比较,差异均有统计学意义(P<0.05);经多因素二元Logistic回归分析结果显示,年龄、体重、流产史和生殖道感染为影响GBS感染发生的独立危险因素,两组比较差异均有统计学意义(P<0.05);感染组孕妇胎膜早破、早产发生率高于对照组,经比较差异有统计学意义(P<0.05);产后出血发生率经比较差异无统计学意义(χ2=0.624,P>0.05);感染组新生儿胎儿窘迫、绒毛膜羊膜炎、新生儿黄疸发生率高于对照组,经比较差异有统计学意义(P<0.05)。结论沈阳市孕妇生殖道GBS定植率较高,建议对孕晚期孕妇开展GBS常规筛查。年龄、体重、流产史和生殖道感染为GBS感染发生的独立危险因素,有必要对本地区的围产期孕妇进行健康宣教,减少GBS感染的发生,进而改善母婴结局。     

孕妇生殖道B族链球菌感染与胎膜早破的关系及其对母婴预后和新生儿听力筛查的影响

目的:探讨孕妇生殖道B族链球菌(GBS)感染与胎膜早破(PROM)的关系及其对母婴预后和新生儿听力筛查的影响。方法:选取2017年1月到2019年1月期间在我院接受治疗的PROM患者100例作为PROM组,另选取同期住院的正常妊娠孕妇100例作为对照组,PROM组患者根据是否合并GBS感染分为GBS阳性组和GBS阴性组。比较PROM组和对照组的GBS阳性率,比较GBS阳性组和GBS阴性组早产、胎儿窘迫、新生儿窒息、新生儿肺炎、产褥感染的发生率及新生儿听力筛查的通过率。结果:PROM组的GBS阳性率高于对照组,差异有统计学意义(P0.05)。GBS阳性组早产、胎儿窘迫、新生儿窒息、新生儿肺炎、产褥感染的发生率均明显高于GBS阴性组,差异均有统计学意义(P0.05),GBS阳性组在初筛和复筛时听力筛查通过率均低于GBS阴性组,差异均有统计学意义(P0.05)。结论:孕妇生殖道GBS感染与PROM密切相关,并可增加不良妊娠结局发生的风险,在一定程度上影响了新生儿的听力功能,对母婴预后造成不良影响。     

围产期B族链球菌感染对妊娠结局的影响

目的:调查妊娠35~37周孕妇B族链球菌(GBS)带菌情况,探讨GBS感染与不良妊娠结局的关系。方法:收集妊娠35~37周孕妇265例,取阴道下段1/3分泌物和直肠分泌物,采用实时荧光定量PCR法进行GBS检测,观察其妊娠结局。结果:265例孕妇中GBS阳性者42例,阴性者223例,带菌率约为15.84%;GBS阳性孕妇的宫内感染、胎儿窘迫和新生儿肺炎发生率高于GBS阴性组(P0.05)。结论:围产期妇女GBS感染会导致宫内感染、胎儿窘迫及新生儿肺炎的发生率升高,对妊娠结局会产生不良影响。     

无乳链球菌的研究进展

无乳链球菌亦称B群链球菌（Group B streptococcus,GBS）,一直是新生儿和女性生殖道受感染的重要病菌,尤其是新生儿时期的感染是危及生命的重要原因,其病发症包括败血症、肺炎和脑膜炎等。在成年妇女的阴道和直肠内有15％～40％可以检出无乳链球菌,因此,这类女性所分娩的新生儿感染该菌的机率会比较高。     

口服微生态制剂对孕妇肠道和阴道大肠杆菌K1和B族链球菌定殖的干预

【目的】本研究主要从临床探讨口服益生菌对孕妇微生态环境(阴道和肠道)中Escherichia coli K1和B族链球菌(GBS)定殖率的影响以预防新生儿血流播散性细菌性脑膜炎。【方法】收集2011年至2017年期间在广东省范围门诊就诊的2539例妊娠健康孕妇的阴道、直肠分泌物。选择符合要求的32孕周孕妇47例随机分成两组,其中益生菌组22例,对照组25例,用荧光定量PCR检测不同组孕妇体内服药前、后的微生态环境中大肠埃希菌的变化。然后选择50例GBS筛查阳性的35孕周孕妇,随机分成益生菌组和对照组,荧光定量PCR检测不同分组孕妇体内微生态环境中GBS定量变化。同时使用荧光PCR筛查对临床收集的2539例孕晚期(35周)孕妇生殖道、直肠分泌物标本进行GBS检测并计算携带率。【结果】研究前对不同组别孕妇的基本资料进行差异分析,结果显示两组在年龄差别、经产妇比例和受教育水平3个方面比较均无差异(P0.05),证明不同组间孕妇具有可比性。然后观察上述不同组别的孕妇服用益生菌体内微生态状况,用荧光定量PCR方法进行检测,结果显示用益生菌组在服药前后,阴道和直肠分泌物中大肠杆菌数量显著下降(F=32.866,P0.001),孕妇服用益生菌后E. coli K1的数量显著低于服用益生菌前(P0.05),且益生菌组与对照组相比大肠杆菌数量显著下降(P0.05,F=41.546,P0.001);同时检查服益生菌组孕妇体内GBS的变化,荧光定量PCR检测结果显示服用益生菌前后GBS的定殖数量有降低趋势,且与对照组相比有下降趋势。最后我们用荧光定量PCR筛查孕晚期妇女B族链球菌带菌状况,其GBS携带率为8.07%。【结论】本研究结果提示本文筛查的广东省孕晚期孕妇的B族链球菌平均携带率为8.07%,GBS可能是新生儿发生细菌性脑膜炎的危险因素之一;口服益生菌疗法可能通过抑制E. coli K1在孕妇肠道和生殖道的定殖以预防血流播散性新生儿细菌性脑膜炎。     

晚期孕妇生殖道感染无乳链球菌与新生儿感染的相关性研究

目的探讨妊娠晚期妇女生殖道感染无乳链球菌（GBS）与新生儿感染的关系。方法在慈溪市妇幼保健院1192例胎膜早破妊娠晚期妇女进行宫颈分泌物培养,同时对其分娩的1196个新生儿进行鼻咽分泌物培养作为观察组,同时选择同期无胎膜早破的妊娠晚期妇女500例作为对照组进行比较。观察胎膜早破合并GBS阳性妊娠晚期妇女与新生儿感染的相关性。结果观察组分离无乳链球菌比例为16．1％（192／1192）,对照组分离无乳链球菌比例为6．0％（30／500）,两组比较无乳链球菌感染与胎膜早破差异有统计学意义（P〈0．05）。早破合并GBS阳性的妊娠晚期妇女新生儿感染率与破膜时间和分娩产程有关,破膜时间〈24h与〉24h的妊娠晚期妇女,其新生儿感染率与破膜时间成正比,产程〈24h的妊娠晚期妇女新生儿感染率明显低于24h以上的妊娠晚期妇女。结论妊娠晚期妇女无乳链球菌感染与胎膜早破有关,从而引起新生儿感染,为了早期预防新生儿感染,应对GBS阳性的妊娠晚期妇女及时治疗,并严格控制早破时间和缩短分娩产程。     

彩色多普勒超声用于评估妊娠高血压缺氧程度的临床价值

目的:探讨彩色多普勒超声用于评估妊娠高血压缺氧程度的临床价值。方法:将我院自2017年6月至2019年6月收治的妊娠高血压患者106例作为研究组及同期产检正常孕妇103例作为对照组,采用彩色多普勒超声检查仪监测两组孕妇的子宫动脉血流动力学情况,并分析新生儿的缺氧程度。结果:研究组孕妇脐血流搏动指数(pulsatility index,PI)、脐血流阻力指数(resistance index,RI)和脐动脉血流收缩期/舒张期(S/D)水平均明显高于对照组(P0.05),舒张早期切迹发生率为47.17%,亦明显高于对照组8.74%(P0.05)。研究组孕妇平均孕周、新生儿体重和体重指数均明显少于对照组(P0.05),其早产率为19.81%、剖宫产率为64.15%、胎儿窘迫发生率为15.09%,均明显高于对照组(5.83%、19.42%、4.85%,P0.05)。研究组中切迹组孕周、新生儿体重均明显小于非切迹组(P0.05)。研究组羊水异常发生率为16.00%,早产率为40.00%,新生儿窒息率为14.00%,胎儿窘迫发生率为26.00%,均明显高于对照组(5.36%、1.79%、1.79%、5.38%,P0.05)。结论:采用彩色多普勒超声仪检测孕妇子宫动脉血流频谱可作为了解子宫-胎盘-胎儿循环的检查方式,评估妊娠并发症的发生风险,监测胎儿宫内生长发育。     

围产期生殖道菌群检测和B群链球菌筛查

目的 调查孕妇生殖道菌群情况,减少不良妊娠结果;筛查B群链球菌（GBS）定植状态,预防新生儿GBS病.方法 产前取阴道分泌物进行细菌培养,并对结果进行回顾性分析.结果 1464例孕妇阴道分泌物标本,872例乳酸杆菌和（或）少量其他菌种生长,占59.6%（872/1464）;592例乳酸杆菌未生长,检出“＋”以上生长菌株820株,其中194例有2种菌生长,34例有3种菌生长,占40.4%（592/1464）.共检出B群链球菌68株,检出率为4.6%（68/1464）.结论 围产期生殖道菌群种类复杂,耐药率高,妇幼保健工作人员应加强检测,采取切实可行的适宜技术,提供进一步的干预措施和保健服务.     

妊娠期妇女生殖道大肠埃希菌感染与妊娠不良结局分析

目的探讨妊娠期妇女生殖道大肠埃希菌感染对妊娠不良结局的影响。方法回顾性分析2011年1月至2013年12月在石家庄市第四医院住院孕产妇共2 053例,进行阴道分泌物细菌培养,对大肠埃希菌培养阳性组与正常对照组的妊娠结局进行分析,以探讨妊娠合并生殖道大肠埃希菌感染与围产期并发症的关系。结果在2 053例围产期妇女中,无致病菌组（对照组）为1230例,大肠埃希菌培养阳性组（感染组）为103例,总患病率为5.02%。感染组与对照组的绒毛膜羊膜炎的发生率分别为78.64%、12.20%（P〈0.01）,产褥感染率分别为24.27%、3.41%（P〈0.01）,新生儿黄疸的发生率58.25%、12.36%（P〈0.01）,胎膜早破率分别为11.65%、10.57%（P〉0.05）,早产率分别为3.88%、3.09%（P〉0.05）,胎儿窘迫的发生率2.91%、2.76%（P〉0.05）,低体重儿的发生率1.94%、2.03%（P〉0.05）。结论妊娠期妇女生殖道大肠埃希菌感染与绒毛膜羊膜炎、产褥感染及新生儿黄疸的发生相关,孕期及早发现、诊断、治疗妊娠期妇女生殖道大肠埃希菌感染是有重要意义。     

Mutagenesis of a bacteriophage lytic enzyme PlyGBS significantly increases its antibacterial activity against group B streptococci

Group B streptococci (GBS) are the leading cause of neonatal meningitis and sepsis worldwide. Intrapartum antibiotic prophylaxis (IAP) is the current prevention strategy given to pregnant women with confirmed vaginal GBS colonization. Due to antibiotic resistance identified in GBS, we previously developed another strategy using a bacteriophage lytic enzyme, PlyGBS, to reduce vaginal GBS colonization. In this study, various DNA mutagenesis methods were explored to produce PlyGBS mutants with increased lytic activity against GBS. Several hyperactive mutants were identified that contain only the endopeptidase domain found in the N-terminal region of PlyGBS and represent only about one-third of the wild-type PlyGBS in length. Significantly, these mutants not only have 18–28-fold increases in specific activities compared to PlyGBS, but they also have a similar activity spectrum against several streptococcal species. One of the hyperactive mutants, PlyGBS90-1, reduced the GBS colonization from >5 logs of growth per mouse to <50 colony-forming units (cfu) 4 h post treatment (∼4-log reduction) using a single dose in a mouse vaginal model. A reduction in GBS colonization before delivery should significantly reduce neonatal GBS infection providing a safe alternative to IAP.     

Prevalence and significance of vaginal group B streptococcus colonization in pregnant women from Osijek, Croatia

The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th-37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th-41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (Chi2 = 1.480489; p < 0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (r(s) = 0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (Chi2 = 88.68; p < 0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia.     

Increasing Streptococcus agalactiae colonization of pregnant women and newborns in south-eastern region of Poland

Streptococcus agalactiae, group B streptococci (GBS) are a constituent of normal vaginal bacterial microflora which often do not give any clinical symptoms. On the other hand, during pregnancy there are optimal conditions for GBS multiplication in the vagina, which may have very serious consequences for both the mother and her child. The women (n = 563) that participated in our study were in their 3rd trimester and they were divided into groups: normal pregnancy or high risk pregnancy. We also examined their newborns. GBS identification was done basing on traditional culture method and its modification recommended by the CDC. We showed a slightly improved (about 4%) effectiveness of GBS detection in pregnant women using the CDC method. In high risk pregnancy GBS colonization was 20% (among them 35% newborns were colonized) and in normal pregnancy it was found to be 17.2% (among them 26.7% newborns were colonized). Both in the high risk group and their newborns we confirmed a higher and statistically significant frequency of detection of GBS strains which had MLS(B) mechanism of antibiotic resistance. In newborns we confirmed two cases which were fatal. The results of our study show the need and necessity for implementing unified procedures recommended by the CDC in Poland.     

Influence of intrapartum antibiotic prophylaxis against group B Streptococcus on the early newborn gut composition and evaluation of the anti-Streptococcus activity of Bifidobacterium strains

Several factors are known to influence the early colonization of the gut in newborns. Among them, the use of antibiotics on the mother during labor, referred to as intrapartum antibiotic prophylaxis (IAP), has scarcely been investigated, although this practice is routinely used in group B Streptococcus (GBS)-positive women. This work is therefore aimed at verifying whether IAP can influence the main microbial groups of the newborn gut microbiota at an early stage of microbial establishment. Fifty-two newborns were recruited: 26 born by mothers negative to GBS (control group) and 26 by mothers positive to GBS and subjected to IAP with ampicillin (IAP group). Selected microbial groups (Lactobacillus spp., Bidobacterium spp., Bacteroides fragilis, Clostridium difficile, and Escherichia coli) were quantified with real-time PCR on DNA extracted from newborn feces. Further analysis was performed within the Bidobacterium genus by using DGGE after amplification with genus-specific primers. Results obtained showed a significant decrease of the bifidobacteria counts after antibiotic treatment of the mother. Bifidobacteria were found to be affected by IAP not only quantitatively but also qualitatively. In fact, IAP determined a decrement in the frequency of Bidobacterium breve, Bidobacterium bifidum, and Bidobacterium dentium with respect to the control group. Moreover, this study has preliminarily evaluated that some bifidobacterial strains, previously selected for use in infants, have antibacterial properties against GBS and are therefore potential candidates for being applied as probiotics for the prevention of GBS infections.     

妊娠晚期阴道B族链球菌的感染对肠道菌群和妊娠结局的影响

目的探究妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)的感染对肠道菌群和妊娠结局的影响。方法选取2018年3月至2019年11月大连市中心医院孕检并分娩的妊娠妇女744人为对象,调查并统计B族链球菌的感染率;筛选有和没有B族链球菌感染妊娠妇女各47人,调查不良妊娠结局的发生率;选取信息匹配的妊娠晚期阴道B族链球菌感染和未感染的妊娠妇女,采集粪便样本,提取菌群DNA,用16S rDNA方法分析菌群变化。结果744名妊娠妇女中B族链球菌检出49例,感染率为6.59%;B族链球菌感染组总的不良妊娠发生比例为76.6%,正常组发生比例为27.7%(χ^2=5.491,P<0.05)。B族链球菌感染组妊娠妇女胎膜早破(χ^2=16.177,P<0.01)、难产(χ^2=21.134,P<0.01)和羊水异常(χ^2=22.989,P<0.05)的发生率与未感染组比较显著增高。B族链球菌感染组妊娠妇女肠道菌群发生显著变化。结论妊娠晚期阴道B族链球菌的感染可能引起肠道菌群紊乱,增加不良妊娠结局。     

孕妇生殖道B族链球菌及其他病原微生物感染情况调查

目的了解孕妇生殖道B族链球菌（GBS）、霉菌、细菌性阴道病（BV）、支原体感染情况及关系。方法对1 129例产科门诊孕检的孕妇进行阴道分泌物GBS、霉菌、BV和支原体筛查。结果 1 129例孕妇分泌物GBS、霉菌、BV和支原体阳性者676例（59.9%）。GBS感染126例（11.2%）,其中GBS阳性伴解脲支原体（Uu）或霉菌阳性65例占GBS多重感染达95.6%;一年之中孕妇GBS感染率高峰在7月（30.0%）;霉菌感染率高峰在6月（48.3%）;解脲支原体感染有两个高峰在4月（43.1%）和10月（47.0%）。结论孕妇生殖道GBS、BV、支原体和霉菌感染是孕妇生殖道感染中较为常见的病原微生物,感染的病原微生物种类在一年中有一定变化规律。