目的：了解妇产科医院2015年至2017年的无乳链球菌感染和耐药情况。方法：回顾分析上海市第一妇婴保健院2015年至2017年产科、妇科及男性科患者的无乳链球菌阳性率;选取2017年共374例无乳链球菌阳性病例进行药敏试验,并对红霉素耐药、克林霉素敏感的菌株进行D试验检测。结果：2015年我院产科、妇科及男性科患者无乳链球菌阳性率分别为2.69%（88/3 267）、3.10%（101/3 255）、5.93%（28/472）,2016年分别为3.94%（378/9 578）、3.42%（92/2 685）、7.49%（14/187）,2017年分别为3.90%（251/6 429）、4.10%（110/2 682）、7.22%（13/180）;2015年至2017年产科孕妇的无乳链球菌阳性率为3.72%（717/19 274）。2017年,无乳链球菌对红霉素、克林霉素、左氧氟沙星的耐药率分别为63.37%（237/374）、53.48%（200/374）和25.13%（94/374）,未发现对青霉素、头孢曲松、利奈唑胺、万古霉素耐药的菌株。结论：2015年至2017年,无乳链球菌感染有逐年严重的趋势,应受到重视;对孕妇进行无乳链球菌筛查有重要意义;需注重对非孕妇成人患者的无乳链球菌筛查;青霉素类抗生素仍是治疗无乳链球菌感染的首选药物。
Objective: To investigate the status of Streptococcus agalactiae（S.agalactiae）infection and drug resistance in Shanghai from 2015 to 2017. Methods: A retrospective analysis was performed on the positive rate of S.agalactiae in departments of obstetrics, gynecology and andrology at Shanghai First Maternal and Infant Hospital from 2015 to 2017, and antimicrobial susceptibility test was performed on 374 strains of S. agalactiae isolated in 2017. D-test was performed for strains resistant to erythromycin and susceptible to clindamycin. Results: In 2015, the positive rates of S.agalactiae at departments of obstetrics, gynecology and andrology were 2.69%（88/3 267）, 3.10%（101/3 255）, 5.93%（28/472）, respectively; in 2016 were 3.94%（378/9 578）, 3.42%（92/2 685）, 7.49%（14/187） respectively, and in 2017 were 3.90%（251/ 6 429）, 4.10%（110/2 682）, 7.22%（13/180）, respectively. The positive rates of S.agalactiae in department of obstetrics from 2015 to 2017 was 3.72% (717/19 274). In 2017, the resistance rates of S.agalactiae to erythromycin, clindamycin and levofloxacin were 63.37% (237/374), 53.48% (200/374) and 25.13% (94/374), respectively. None of the strains were found resistant to penicillin, ceftriaxone, linezolid and vancomycin. Conclusions: The infection of S.agalactiae has a trend of increasing from 2015 to 2017, which should be paid attention seriously. It is important to perform screening of S.agalactiae in pregnant women and non-pregnant adult patients. Penicillins are still the first choice for the treatment of S.agalactiae infection.
[1] Shore EM, Yudin MH.Choice of antibiotic for group B streptococcus in women in labour based on antibiotic sensitivity testing[J]. J Obstet Gynaecol Can,2012,34(3):230-235.
[2] Skoff TH, Farley MM, Petit S, et al.Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007[J]. Clin Infect Dis,2009,49(1):85-92.
[3] 漆洪波. 孕前和孕期保健指南[C]. 中华医学会杂志社指南与进展巡讲(产科)暨第四届两江母胎医学论坛论文汇编,2014.
[4] Committee on Infectious Diseases; Committee on Fetus and Newborn Baker CJ,et al. Policy statement—Recommendations for the prevention of perinatal group B streptococcal(GBS) disease[J]. Pediatrics,2011,128(3):611-616.
[5] 黄荣, 刘小平, 樊尚荣, 等. 孕35~37周妇女无乳链球菌携带状况及耐药性分析[J]. 中国妇产科临床杂志,2015(3):269-270.
[6] 何松芝, 孙雁群, 金月丹, 等. 义乌地区非孕女性生殖道无乳链球菌的感染筛查及耐药性分析[J]. 中国医院感染学杂志,2017,27(10):2310-2313.
[7] 郭燕东. 男性不育症患者精液中病原菌分布及耐药性分析[J]. 中国医药指南,2012,10(14):236-237.
[8] 胡付品, 朱德妹, 汪复, 等. 2015年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志,2016,11(6):685-694.
[9] 刘晶, 赵娟. 住院孕妇感染无乳链球菌的药物敏感性分析[J]. 中国实验诊断学,2015,19(12):2110-2111.
