坦桑尼亚达累斯萨拉姆穆希比利国家医院母婴 B 群链球菌定植：流行率、危险因素和抗菌药物耐药性。
Maternal and neonatal colonisation of group B streptococcus at Muhimbili National Hospital in Dar es Salaam, Tanzania: prevalence, risk factors and antimicrobial resistance.
机构信息
Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
BMC Public Health. 2009 Dec 1;9:437. doi: 10.1186/1471-2458-9-437.
BACKGROUND
Group B streptococcus (GBS), which asymptomatically colonises the vaginal and rectal areas of women, is the leading cause of septicemia, meningitis and pneumonia in neonates. In Tanzania no studies have been done on GBS colonisation of pregnant women and neonates. This study was conducted in Dar es Salaam, Tanzania to determine the prevalence of GBS colonisation among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility, thus providing essential information to formulate a policy for treatment and prevention regarding perinatal GBS diseases.
METHODS
This cross sectional study involved 300 pregnant women attending antenatal clinic and their newborns delivered at Muhimbili National Hospital (MNH) between October 2008 and March 2009. High vaginal, rectal, nasal, ear and umbilical swabs were cultured on Todd Hewitt Broth and in 5% sheep blood agar followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the Kirby-Bauer method.
RESULTS
GBS colonisation was confirmed in 23% of pregnant women and 8.9% of neonates. A higher proportion of GBS were isolated from the vagina (12.3%) as compared to the rectum (5%). Prolonged duration of labour (>12 hrs) was significantly shown to influence GBS colonisation in neonates P < 0.05. Other risk factors such as prolonged rupture of membrane, intrapartum fever, low birth weight and HIV infection did not correlate with GBS colonisation. All isolates were sensitive to vancomycin and ampicillin. Resistance to clindamycin, erythromycin and penicillin G was found to 17.6%, 13% and 9.4%, respectively.
CONCLUSION
Our findings seem to suggest that a quarter of pregnant women attending ANC clinic at MNH and approximately 10% of their newborns are colonised with GBS. All isolates were found to be sensitive to vancomycin and ampicillin which seem to be the most effective antibiotics for the time being. However there is a need for continuous antibiotics surveillance of GBS to monitor trend of resistance. The high isolation frequency of GBS among pregnant women suggests routine antenatal screening at 35 to 37 weeks of gestation in order to provide antibiotic prophylaxis to GBS carrier.
背景
B 组链球菌（GBS）无症状地定植于女性的阴道和直肠区域，是导致新生儿败血症、脑膜炎和肺炎的主要原因。在坦桑尼亚，尚未有针对孕妇和新生儿 GBS 定植情况的研究。本研究在坦桑尼亚达累斯萨拉姆进行，旨在确定孕妇 GBS 定植率、新生儿定植率和抗菌药物敏感性，从而为制定围产期 GBS 疾病的治疗和预防政策提供重要信息。
方法
本横断面研究纳入了 2008 年 10 月至 2009 年 3 月期间在穆希比利国家医院（MNH）接受产前检查的 300 名孕妇及其新生儿。采集高阴道、直肠、鼻、耳和脐拭子，接种于 Todd-Hewitt 肉汤和 5%绵羊血琼脂中，采用常规方法鉴定分离株，并采用 Kirby-Bauer 法检测其对抗菌药物的敏感性。
结果
23%的孕妇和 8.9%的新生儿被证实存在 GBS 定植。阴道（12.3%）分离的 GBS 比例高于直肠（5%）。分娩时间延长（>12 小时）与新生儿 GBS 定植显著相关（P<0.05）。其他危险因素，如胎膜破裂时间延长、产时发热、低出生体重和 HIV 感染，与 GBS 定植无关。所有分离株均对万古霉素和氨苄西林敏感。发现 17.6%、13%和 9.4%的分离株对克林霉素、红霉素和青霉素 G 耐药。
结论
我们的研究结果表明，MNH 产前检查门诊的四分之一孕妇和大约 10%的新生儿存在 GBS 定植。所有分离株均对万古霉素和氨苄西林敏感，这两种药物目前似乎是最有效的抗生素。然而，需要对 GBS 进行持续的抗生素监测，以监测耐药趋势。孕妇中 GBS 的高分离频率表明，应在 35 至 37 周妊娠时进行常规产前筛查，以便对 GBS 携带者进行抗生素预防。
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