B族链球菌感染妊娠妇女产时 抗生素治疗临床效果评价

目的探讨沈阳地区孕晚期妊娠妇女B族链球菌(group B Streptococcus,GBS)的定植率及其耐药性,评估GBS感染妊娠妇女分娩期给予产时抗生素预防(intrapartum antibiotic prophylaxis,IAP)的临床效果。方法选择2017年9月至2017年12月在沈阳市妇婴医院行GBS筛查的691例怀孕35～37周的妊娠妇女为研究对象,将GBS筛查阳性妊娠妇女中采用顺产方式分娩的38例妊娠妇女作为研究组,638例GBS筛查阴性妊娠妇女作为对照组。研究组妊娠妇女给予IAP,对照组妊娠妇女不作处理。分析两组妊娠妇女GBS定植情况、GBS菌株耐药情况及给予IAP后新生儿不良事件发生率。结果 691例妊娠妇女中有53例GBS培养阳性,GBS定植率为7.67%。全部GBS菌株对青霉素、头孢唑林及万古霉素的敏感率均为100.00%;对红霉素、克林霉素耐药率分别为81.48%和73.95%。研究组中新生儿黄疸发生率为7.89%,新生儿窒息发生率为2.63%,脑膜炎、肺炎、败血症的发生率均为0.00%。对照组中新生儿黄疸发生率为3.13%,新生儿窒息发生率为0.63%,肺炎发生率为0.16%,新生儿脑膜炎及败血症发生率均为0.00%。两组新生儿在新生儿黄疸、新生儿窒息、脑膜炎、肺炎和败血症发生率方面比较差异无统计学意义(均P0.05)。结论沈阳地区妊娠妇女GBS带菌率较高,青霉素可作为治疗的首选药物。预防性使用抗生素治疗可以改善新生儿结局。

The clinical effect of antibiotic treatment during pregnancy and maternity of pregnant women with B group streptococcal infection

Abstract: Objective To study the colonization rate of group B Streptococcus (GBS) in late-term pregnancy, analyze the drug resistance, and evaluate the clinical effect of intrapartum antibiotic prophylaxis (IAP) during delivery in late-term pregnant women with GBS infection in Shenyang. Methods Six hundred and ninety-one pregnant women between 35 - 37 weeks of pregnancy who received GBS screening in our hospital from September 2017 to December 2017 were enrolled, among whom 38 GBS positive women with eutocia were divided into the Observation group and given IAP, with 638 GBS negative pregnant women as the control group without any treatment. The GBS colonization, GBS drug resistance and the incidence of neonatal adverse events in both groups were analyzed and compared. Results A total of 53 pregnant women were positive for GBS culture and the GBS colonization rate was 7.67% (53/691). The sensitivity rates of GBS to Penicillin, Cefazolin and Vancomycin were 100.00%, and the resistance rates to Erythromycin and Clindamycin were 81.48 % and 73.95 % respectively. The incidence rates of neonatal jaundice, asphyxiation and pneumonia were 7.89%, 2.63% and 0.00% in observation group vs 3.13%, 0.63% and 0.16% in control group, respectively, and those of meningitis and sepsis were all 0.00% in both groups. The differences were not statistically significant between the two groups of newborns (all P>0.05). Conclusion The infection rate of GBS in pregnant women in Shenyang area is high, and penicillin can be used as the first-choice drug for treatment. Prophylactic antibiotic treatment can improve neonatal outcomes.