9例产科A族链球菌感染临床分析

doi:10.6040/j.issn.1671-7554.0.2023.0823

摘要/Abstract

摘要： 目的分析围产期感染高危孕妇筛查中发现的9例妊娠相关A族链球菌(GAS)感染患者的临床资料,探讨其防治策略。方法选取济南市妇幼保健院2018年1月至2022年6月间有围产期感染高危因素的孕妇基本资料,分析诊断为GAS感染的9例患者的病源体检出来源、临床特征、治疗经过、母胎结局及随访,探讨防治策略。结果细菌培养27 518项,检测出细菌阳性标本4 289项,其中GAS阳性标本检出15项(9例),占细菌培养总数的0.055%,来自阴道分泌物9项、咽拭子1项、尿培养1项、血培养2项、子宫内膜1项、会阴切口分泌物1项;产前发病的2例均在孕晚期,孕妇和胎儿均死亡,产后发病的7例,除1例因胎儿畸形引产外,其他6例经过积极治疗后母胎结局均好;7例产后随访,除1例在出院后8 d因会阴切口愈合不良培养GAS再次阳性外,其他6例均未发现复发感染;9例GAS感染患者首发症状均为发热,体温多达39 ℃以上,血分析中的中性粒细胞比率多在90%以上。结论 GAS感染与产科关系密切,妊娠期和产褥期妇女是高危人群;产科感染分产前和产后两型,产前感染相对严重,患者死亡率较高,围产期GAS感染是引起孕产妇严重感染和死亡的重要原因;筛查高危人群、早识别早治疗有助于改善母胎结局。

关键词: A族链球菌, 化脓性链球菌, 中毒性休克综合征, 妊娠期, 产褥期

Abstract: Objective Abstract: Objective To analyze the clinical data of pregnancy-associated group A streptococcus(GAS)infection in pregnant women with high risk of perinatal infection, and to explore the prevention and treatment strategies. Methods General data of pregnant women at high risk of perinatal infection treated in Jinan Maternal and Child Health Hospital during Jan. 2018 and Jun. 2022 were collected. The source of disease, clinical characteristics, treatment process, maternal and infant outcomes and follow-up of 9 patients diagnosed with GAS infection were analyzed and the prevention and treatment strategies were discussed. Results A total of 27,518 bacterial cultures were obtained. Of the 4,289 positive bacterial specimens, 15 were GAS positive(9 cases), accounting for 0.055% of the total number of bacterial cultures, including 9 from vaginal secretions, 1 from throat swab, 1 from urine culture, 2 from blood cultures, 1 from endometrium, and 1 from perineal incision secretion. Two cases of prenatal onset occurred in the third trimester, and both of the mother and fetus died. Six out of seven cases of postpartum onset had good maternal and infant outcomes after active treatment except for one with malformative induction. During the follow-up, except for 1 case who had another positive GAS culture due to poor perineal incision healing 8 days after discharge, the other 6 cases had no recurrent infections. The initial symptom was 39 ℃ fever, and the ratio of neutrophils in blood was over 90%. Conclusion GAS infection is closely related to obstetrics, and pregnant and postpartum women are at high risk. Obstetric infection can be divided into two types: prenatal and postpartum. Prenatal infection is relatively severe, resulting in a higher mortality rate. Perinatal GAS infection is an important cause of severe infection and death in pregnant and postpartum women. Screening high-risk populations and early identification and treatment can help improve the maternal and fetal outcomes.

Key words: Group A streptococcus, Streptococcus pyogenes, Toxic shock syndrome, Pregnancy, Puerperium

中图分类号:

R714

宋敏,曹鲁泉,吴利龙,吴淑霞,刘静,张娟,刘翠英. 9例产科A族链球菌感染临床分析[J]. 山东大学学报 (医学版), 2023, 61(11): 89-95.

SONG Min, CAO Luquan, WU Lilong, WU Shuxia, LIU Jing, ZHANG Juan, LIU Cuiying. Clinical analysis of 9 cases with group A streptococcus infection in obstetrics[J]. Journal of Shandong University (Health Sciences), 2023, 61(11): 89-95.

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