Matani Chiara, Trezzi Michele, Matteini Alice, Catalani Carlotta, Messeri Daniela, Catalani Corrado
Degree course in Obstetrics, University of Florence, Florence, Italy.
Infectious Diseases Unit, Department of Internal Medicine, "San Jacopo" Hospital, Pistoia, Italy.
Infez Med. 2016 Sep 1;24(3):217-21.
Intrapartum antibiotic prophylaxis (IAP) reduces both the vertical transmission of Streptococcus agalactiae or Group B Streptococcus (GBS) and the early onset of neonatal sepsis. However, existing guidelines do not recommend that antimicrobial susceptibility testing (AST) be routinely performed. Penicillin or ampicillin are indicated as first-choice antibiotics, cefazolin being an alternative in the case of history of mild allergic reactions, and vancomycin or clindamycin an alternative in the event of severe reactions. We performed a cross-sectional analysis to identify the presence of any bacterial resistance towards the antibiotics most frequently used for IAP in pregnant women with GBS positive vaginal-rectal swabs, in the Pistoia area of central Italy. Of the 255 tested samples, 65 (25.5%) were positive for GBS. Sensitivity to glycopeptides was over 90%, but lower to ampicillin and penicillin (87.10% and 87.93% respectively). Resistance towards clindamycin and erythromycin was as high as 43.75% and 32.20%. All tested GBS proved susceptible to moxifloxacin, linezolid and tigecycline. Our observed prevalence is aligned or slightly higher than data reported in other series. The less than full effectiveness and low percentages of ampicillin and penicillin sensitivity observed give cause for concern. We confirmed the increase in clindamycin and erythromycin resistance. Glycopeptides can be used as second-line antibiotics, but the complete AST of GBS should always be performed before IAP. Given that gentamicin is used synergically with penicillin when treating chorioamnionitis, it needs to be always included in the AST. This is the first study on the GBS sensitivity profile in Tuscany. Further investigation on a larger scale is required prior to implementing any changes in the current guidelines.
产时抗生素预防（IAP）可降低无乳链球菌或B族链球菌（GBS）的垂直传播以及新生儿败血症的早发。然而，现有指南不建议常规进行抗菌药物敏感性试验（AST）。青霉素或氨苄西林被指定为首选抗生素，对于有轻度过敏反应史的患者，头孢唑林可作为替代药物，对于严重反应患者，万古霉素或克林霉素可作为替代药物。我们进行了一项横断面分析，以确定意大利中部皮斯托亚地区阴道直肠拭子GBS阳性的孕妇中，对IAP最常用抗生素的任何细菌耐药性的存在情况。在255个测试样本中，65个（25.5%）GBS呈阳性。对糖肽类的敏感性超过90%，但对氨苄西林和青霉素的敏感性较低（分别为87.10%和87.93%）。对克林霉素和红霉素的耐药率高达43.75%和32.20%。所有测试的GBS对莫西沙星、利奈唑胺和替加环素均敏感。我们观察到的患病率与其他系列报道的数据一致或略高。氨苄西林和青霉素观察到的有效性不足和低敏感性百分比令人担忧。我们证实了克林霉素和红霉素耐药性的增加。糖肽类可作为二线抗生素使用，但在IAP之前应始终对GBS进行完整的AST。鉴于治疗绒毛膜羊膜炎时庆大霉素与青霉素联合使用，因此在AST中应始终包括庆大霉素。这是托斯卡纳地区关于GBS敏感性概况的第一项研究。在对当前指南进行任何更改之前，需要进行更大规模的进一步调查。
