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孕妇定植抗菌药物耐药菌(AMRB)和甲氧西林敏感金黄色葡萄球菌(MSSA)的临床意义。

Clinical relevance of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin susceptible Staphylococcus aureus (MSSA) for mothers during pregnancy.

机构信息

Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.

Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany.

出版信息

Arch Gynecol Obstet. 2019 Nov;300(5):1303-1316. doi: 10.1007/s00404-019-05287-6. Epub 2019 Sep 17.

Abstract

PURPOSE

The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated.

METHODS

From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included.

RESULTS

Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p < 0.05). MSSA colonization was significantly associated with self-reported respiratory diseases during pregnancy (p < 0.05), but AMRB/MSSA colonization was not statistically associated with other types of infection.

CONCLUSION

Our results demonstrate a low overall rate of colonization with AMRB/MSSA, as well as a low percentage of colonized pregnant women who developed infections. Multiparous women are at higher risk for colonization with MSSA/MRSA or ESBL. Because the prevalence of AMRB/MSSA is low, this study suggests that general screening of pregnant women without risk factors is not recommended.

摘要

目的

在德国,健康孕妇群体中,抗生素耐药菌(AMRB)和甲氧西林敏感金黄色葡萄球菌(MSSA)定植的影响尚未详细描述。在本研究中,我们筛查了 MSSA 和 AMRB,尤其是耐甲氧西林金黄色葡萄球菌(MRSA)和产超广谱β-内酰胺酶(ESBL)的大肠杆菌。我们还调查了 AMRB/MSSA 定植的潜在危险因素,以及这些定植对产科人群的潜在影响。

方法

2013 年 10 月至 2015 年 12 月,我们在分娩前筛查了来自乳头、鼻腔、肛周和阴道区域的 AMRB/MSSA 定植情况。在分娩前,由经过培训的访谈员向孕妇发放标准化访谈问卷。同时还纳入了入院记录中的数据。

结果

分析了 651 名孕妇的样本。14.3%(n=93)的孕妇检测出 MSSA 定植,3.5%(n=23)的孕妇检测出 AMRB定植[MRSA:n=3/ESBL:n=20]。与初产妇相比,经产妇中 AMRB/MSSA 的定植明显更多(p<0.05)。MSSA 定植与孕妇报告的妊娠期间呼吸道疾病显著相关(p<0.05),但 AMRB/MSSA 定植与其他类型的感染无统计学关联。

结论

我们的结果表明,AMRB/MSSA 的总体定植率较低,且发生感染的定植孕妇比例也较低。经产妇发生 MSSA/MRSA 或 ESBL 定植的风险更高。由于 AMRB/MSSA 的流行率较低,因此本研究建议对于无危险因素的孕妇,一般不建议进行常规筛查。

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