围产期B族溶血性链球菌的筛查与处理

doi:10.3877/cma.j.issn.2095-3259.2017.03.005

B族溶血性链球菌(group B streptococcus, GBS)感染是导致新生儿重症感染性疾病的最主要致病菌。对有GBS携带的孕妇在分娩期或胎膜早破后进行抗生素预防性治疗，可有效降低新生儿发病率及死亡率，预防治疗的时机和抗生素的选择是决定治疗效果的关键。生殖道感染、孕期出血、肥胖和糖尿病是GBS定植的高危因素，破膜时间>18 h、产程中阴道检查次数多、早产和未足月胎膜早破是母婴感染的高危因素。目前国内尚缺乏规范化的预防和诊治措施，建议有条件的医疗单位在孕35～37周进行普遍筛查，筛查方法可以应用针对GBS的培养基的细菌培养法，也可以应用PCR方法，同时重视早产和未足月胎膜早破的GBS母婴感染的防治。

关键词: 链球菌，肺炎, 妊娠并发症，感染性

Group B Streptococcus(GBS) is identified as the leading cause of neonatal severe infectious disease. Intrapartum antibiotic prophylaxis demonstrates can effectively reduce neonatal morbidity and mortality in GBS-colonized mothers during labor or complicating with premature rupture of membrane. The timing of prevent treatment and choice of antibiotics are the key points of the effectiveness. The high-risk factors of GBS-colonized pregnant women are reproductive tract infections, bleeding during pregnancy, obesity and diabetes. The high-risk factors of mother-child GBS infections are rupture of fetal membrane more than 18 hours, too many vaginal examination, premature birth and preterm premature rupture of membranes. At present, there is a lack of standardized measures for prevention and treatment of GBS in China. In good conditional hospital, pregnant women should take GBS screening at gestation of 35-37 weeks. Prevention of maternal and fetal infection in premature birth and preterm premature rupture of membranes patients should be taken seriously.

Key words: Streptococcus pneumoniae, Complications, infectious

图1 早产孕妇GBS筛查和临产时GBS预防治疗方案^[4]

图2 未足月胎膜早破GBS筛查和临产时GBS预防治疗方案^[4]

图3 新生儿早发型GBS感染预防(针对母体GBS携带者)的处理流程^[4]

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Screening and treatment of Group B streptococcus in pregnancy

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