Cardines Rita, Daprai Laura, Giufrè Maria, Torresani Erminio, Garlaschi Maria Laura, Cerquetti Marina
Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
Unit of Microbiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Med Microbiol. 2015 Jul;64(7):724-730. doi: 10.1099/jmm.0.000083. Epub 2015 May 14.
Recent reports have hypothesized that colonization of the maternal genital tract with non-capsulated Haemophilus influenzae could result in neonatal invasive disease. In this study, genital carriage of the genus Haemophilus was investigated in 510 pregnant women attending an Italian hospital for routine controls. Overall, vaginal carriage of the genus Haemophilus was 9.0 % (46/510). A high colonization rate with Haemophilus parainfluenzae (37/510, 7.3 %) was found; other species, such as Haemophilus pittmaniae (7/510, 1.4 %) and Haemophilus haemolyticus (2/510, 0.4 %), were detected for the first time in the genital flora by 16S rRNA gene sequencing. Notably, no H. influenzae was identified, in agreement with previous investigations indicating that this species is rarely isolated from the genito-urinary tract of pregnant women. No antibiotic resistance was detected in H. pittmaniae and H. haemolyticus, but quite a high degree of ampicillin (10/37, 27 %) and ciprofloxacin (3/37, 8.1 %) resistance was observed in H. parainfluenzae. Five ampicillin-resistant isolates were β-lactamase producers, whereas five isolates exhibited a β-lactamase-negative ampicillin-resistant (BLNAR) phenotype. Sequencing of penicillin-binding protein 3 revealed that Val511Ala, Asn526Ser, Ala530Ser and Thr574Ala changes were associated with BLNAR phenotypes. Two ciprofloxacin-resistant isolates carried substitutions in both GyrA (Ser84Phe and Asp88Tyr) and ParC (Ser84Tyr and Met198Leu); the other ciprofloxacin-resistant isolate had substitutions in ParC, only (Ser138Thr and Met198Leu). In conclusion, ∼10 % of pregnant women carried a species of Haemophilus in their genital tract. The emergence of non-β-lactamase-mediated resistance in genital H. parainfluenzae is a matter of concern because of the risk of mother-to-baby transmission.
最近的报告推测，非荚膜型流感嗜血杆菌在母体生殖道的定植可能导致新生儿侵袭性疾病。在本研究中，对一家意大利医院进行常规检查的510名孕妇的生殖道携带嗜血杆菌情况进行了调查。总体而言，嗜血杆菌属的阴道携带率为9.0%（46/510）。发现副流感嗜血杆菌的定植率很高（37/510，7.3%）；通过16S rRNA基因测序首次在生殖道菌群中检测到其他菌种，如皮特曼嗜血杆菌（7/510，1.4%）和溶血嗜血杆菌（2/510，0.4%）。值得注意的是，未鉴定出流感嗜血杆菌，这与先前的调查结果一致，表明该菌种很少从孕妇的泌尿生殖道分离出来。在皮特曼嗜血杆菌和溶血嗜血杆菌中未检测到抗生素耐药性，但在副流感嗜血杆菌中观察到相当高的氨苄西林耐药率（10/37，27%）和环丙沙星耐药率（3/37，8.1%）。5株氨苄西林耐药菌株是β-内酰胺酶产生菌，而5株菌株表现出β-内酰胺酶阴性氨苄西林耐药（BLNAR）表型。青霉素结合蛋白3的测序显示，Val511Ala、Asn526Ser、Ala530Ser和Thr574Ala的变化与BLNAR表型相关。2株环丙沙星耐药菌株在GyrA（Ser84Phe和Asp88Tyr）和ParC（Ser84Tyr和Met198Leu）中均有替换；另一株环丙沙星耐药菌株仅在ParC中有替换（Ser138Thr和Met198Leu）。总之，约10%的孕妇生殖道携带一种嗜血杆菌。由于存在母婴传播风险，生殖道副流感嗜血杆菌中非β-内酰胺酶介导的耐药性的出现令人担忧。
