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中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (05) : 583 -589. doi: 10.3877/cma.j.issn.1673-5250.2016.05.017

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论著

围生期孕产妇感染或定植的B族链球菌耐药情况、血清型、毒力基因及基因型分析
苏锦珍1, 吴伟元2, 丁璐1, 黄进洁1, 王少华3, 张杰生4, 吴本清1,()   
  1. 1. 518020 深圳,暨南大学第二临床医学院 深圳市人民医院新生儿科
    2. 518020 深圳,暨南大学第二临床医学院 深圳市人民医院检验科
    3. 518000 深圳市福田区妇幼保健院新生儿科
    4. 518020 深圳,暨南大学第二临床医学院 深圳市人民医院产科
  • 收稿日期:2016-03-13 修回日期:2016-07-13 出版日期:2016-10-01
  • 通信作者: 吴本清

Drug resistance, serotypes, virulence-associated genes and genotypes of infection or colonization of group B streptococcus in perinatal pregnant women

Jinzhen Su1, Weiyuan Wu2, Lu Ding1, Jinjie Huang1, Shaohua Wang3, Jiesheng Zhang4, Benqing Wu1,()   

  1. 1. Department of Neonatology, Shenzhen People′s Hospital, Shenzhen 518020, Guangdong Province, China
    2. Department of Clinical Laboratory, Shenzhen People′s Hospital, Shenzhen 518020, Guangdong Province, China
    3. Department of Obstetrics, 2nd Clinical Medical College of Jinan University, Shenzhen People′s Hospital, Shenzhen 518020, Guangdong Province, China
    4. Department of Neonatology, Women & Children Health Institute Futian, Shenzhen, Shenzhen 518000, Guangdong Province, China
  • Received:2016-03-13 Revised:2016-07-13 Published:2016-10-01
  • Corresponding author: Benqing Wu
  • About author:
    Corresponding author: Wu Benqing, Email:
引用本文:

苏锦珍, 吴伟元, 丁璐, 黄进洁, 王少华, 张杰生, 吴本清. 围生期孕产妇感染或定植的B族链球菌耐药情况、血清型、毒力基因及基因型分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2016, 12(05): 583-589.

Jinzhen Su, Weiyuan Wu, Lu Ding, Jinjie Huang, Shaohua Wang, Jiesheng Zhang, Benqing Wu. Drug resistance, serotypes, virulence-associated genes and genotypes of infection or colonization of group B streptococcus in perinatal pregnant women[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(05): 583-589.

目的

探讨围生期孕产妇感染或定植的B族链球菌(GBS)的耐药情况、血清型、毒力基因及基因型特点。

方法

选择2008年1月至2015年10月,从深圳市人民医院感染或定植GBS的孕产妇宫颈、阴道、血液及尿液样本中,分离获得的60株GBS菌株为研究对象。通过革兰染色及cAMP试验,进行GBS初步鉴定。采用全自动微生物鉴定、药敏分析(VITEK)系统鉴定GBS菌株。采用K-B纸片扩散法和E-test法测定GBS菌株耐药情况。应用乳胶凝集试验进行GBS血清学分型。聚合酶链反应(PCR)列阵技术检查GBS的红霉素耐药基因ermA、ermC、ermB、mefAEermTR,克林霉素耐药基因linB,四环素耐药基因tetL、tetK、tetT、tetS、tetOtetM,以及GBS主要毒力基因bac、bca、scpB、lmbhylB。采用多位点测序分型技术(MLST)进行GBS的基因分型。

结果

①60株GBS菌株对青霉素及万古霉素敏感度为100.0%,对四环素、红霉素、克林霉素及左氧氟沙星的耐药率分别为88.3%、70.0%、43.3%及35.0%。②本组产科GBS的主要血清型依次为Ⅰb型36.7%(22/60),Ⅰa型28.3%(17/60),Ⅲ型18.3%(11/60)及Ⅸ型10.0%(6/60)。③本组产科GBS的毒力基因主要为hylB、lmbscpB,其中100.0%(60/60)含有hylB基因,78.3%(47/60)含有lmb基因,75.0%(45/60)含有scpB基因。④产科GBS主要基因序列分型(ST)中ST19为30.0%(18/60),ST23为11.7%(7/60),ST12与ST103各为8.3%(5/60),ST485为6.7%(4/60),另外还包括ST1、4、10、17、27、28、86、199、221、325、651、653及未知型。

结论

标本收集医院孕产妇感染或定植的GBS,对红霉素及克林霉素的耐药率较高,治疗GBS感染时不建议使用;但是仍可选择青霉素。对青霉素过敏的孕产妇,可根据病情选择万古霉素或左氧氟沙星治疗GBS感染。产科孕产妇中,感染或定植GBS的主要血清型为Ⅰb及Ⅰa,主要含有hylB、lmbscpB毒力基因,以基因型ST19及ST23为主。

Objective

To study the characteristics of drug resistance, serotypes, virulence-associated genes and genotypes of infection or colonization of group B streptococcus(GBS)in perinatal pregnant women.

Methods

We collected 60 GBS strains which were isolated from cervix, vagina, blood and urine in perinatal pregnant women who were infected or colonized of GBS in Shenzhen People′s Hospital from January 2008 to October 2015. We preliminarily identified the GBS by Gram staining and cAMP test.The final identification of GBS strains was VITEK system.The drug resistance of GBS strains were detected by Kirby-Baue and E-test methods, Serotypes were performed by capsular serotyping.Multiplex polymerase chain reaction(PCR) was conducted to detect antimicrobial genes including ermA, ermC, ermB, mefAE and ermTR of erythromycin; linB gene of clindamycin; tetL, tetK, tetT, tetS, tetO and tetM genes of tetracycline; also main GBS virulence-associated genes of bac, bca, scpB, lmb and hylB.GBS genotypes were analyzed by multilocus sequence typing(MLST).

Results

①All the 60 GBS strains were sensitive to penicillin and vancomycin. GBS strains resistance rate of tetracycline, erythromycin, clindamycin and levofloxacin were 88.3%, 70.0%, 43.3% and 35.0%, respectively.②The main serotypes of type Ⅰb, followed by type Ⅰa, type Ⅲ and type Ⅸ in GBS strains were 36.7%(22/60), 28.3%(17/60), 18.3%(11/60)and 10.0%(6/60). ③The main virulence-associated genes were hylB, lmb and scpB. 100.0%(60/60) GBS have hylB gene, 78.3%(47/60) GBS have lmb gene, 75.0%(45/60) GBS have scpB gene. ④The 60 GBS strains represented mainly genotypes were 30.0%(18/60) of ST19, 11.7%(7/60) of ST23, 8.3%(5/60) of ST12 and ST103 for each, and 6.7%(4/60) of ST485.Other genotypes were ST1, 4, 10, 17, 27, 28, 86, 199, 221, 325, 651, 653 and unknown types.

Conclusions

With the high antimicrobial resistance rates of erythromycin and clindamycin, they were not recommended for the treatment of perinatal pregnant women who were infected or colonized of GBS in Shenzhen People′s Hospital.The penicillin was still the most appropriate antibiotic for GBS treatment.For pregnant women who were allergic to penicillin, could choose vancomycin or levofloxacin based on patient′s clinical symptoms.In this study, the main serotypes of GBS of pregnant women were serotype Ⅰb and Ⅰa, representing virulence-associated genes of hylB, lmb and scpB, the main genotypes were ST19 and ST23.

表1 围生期孕产妇感染或定植GBS耐药情况
表2 围生期孕产妇感染或定植GBS不同血清型的红霉素及四环素耐药基因分布[株数(%)]
表3 围生期孕产妇感染或定植GBS血清型、耐药情况、耐药基因、毒力基因及基因型特点
表4 围生期孕产妇感染或定植GBS不同血清型的毒力基因及基因ST分布[株数(%)]
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