Antibiotic Susceptibility Pattern of Anovaginal Isolates of Streptococcus Agalactiae from Pregnant Women in Their Late Third Trimester

B 群鏈球菌造成新生兒敗血症常導致新生兒死亡，幸存者中百分之三十有神經系統的後遺症，對新生兒之傷害非常大。美國疾病管制中心建議懷孕婦女在懷孕第三期接受 B 群鏈球菌篩檢，並使用抗生素於生產中預防新生兒感染。本研究的目的是找出帶菌者的孕婦，計算並了解帶菌者的比率，及找出最適合的抗生素以供將來生產時使用。我們自民國九十一年一月至十二月於婦幼綜合醫院婦產科門診，產前檢查的孕婦懷孕三十五週以上建議做 B 群鏈球菌篩檢。檢體自婦孕陰道外側及肛門直腸取出。檢體以特製之培養基培養 B 群鏈球菌。培養並分辨出 B 群鏈球菌後，檢體再做 azithromycin，clindamycin，erythromycin，ofloxacin，penicillin G，tetracycline，trimethoprim/sulfamethoxazole，vancomycin 等抗生素的敏感試驗。總共 374 位孕婦接受採樣檢查，56 位（15%）呈 B 群鏈球菌陽性反應。培養出菌種對各抗生素之敏感試驗結果如下：azithromycin 44.6%，clindamycin 66.1%，erythromycin 70.5%，ofloxacin 70.5%，penicillin G 60.7%，tetracycline 39.3%，trimethoprim/sulfamethoxazole 35.7%，vancomycin 100%。有愈來愈多的 B 群鏈球菌對抗生素產生抗藥性，美國疾病管制中心建議使用的抗生素 penicillin G，erythromycin，clindamycin 之抗藥性比率也不少。因此有必要對菌種做抗生素敏感試驗，找出最佳選擇之抗生素供產程中使用。對預防 B 群鏈球菌造成新生兒敗血症，孕婦第三期行 B 群鏈球菌培養，並做抗生素敏感試驗是有意義且有必要的。

關鍵字

B群鏈球菌；抗菌性；陰道肛門陪養；新生兒敗血症

並列摘要

Group B streptococcus (GBS) neonatal sepsis is a serious disease causing newborn mortality and long-term neurologic sequelae. The Centers for Disease Control and Prevention (CDC) recommend third-trimester GBS screening and intrapartum antibiotic prophylaxis for high-risk women. The aim of our study was to identify colonized pregnant women and assess the prevalence of GBS in pregnancy and the susceptibility pattern of GBS in southern Taiwan. We performed the study at the Department of Obstetrics and Gynecology, Kaohsiung Women and Children’ Hospital, between January and December 2002. Distal vaginal and anorectal swabs were obtained from pregnant women at 35 or more weeks’ gestation. Swabs were used to inoculate selected medium, which was subcultured onto sheep’s blood agar after 24 hours. Sensitivity to azithromycin, clindamycin, erythromycin, ofloxacin, penicillin G, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin was tested using the disc diffusion method. Of the 374 pregnant women enrolled in the study, 56 (15%) had positive cultures for GBS. Antibiotic susceptibility was as follows: azithromycin 44.6%, clindamycin 66.1%, erythromycin 70.5%, ofloxacin 70.5%, penicillin G 60.7%, tetracycline 39.3%, trimethoprim/sulfamethoxazole 35.7%, and vancomycin 100%. The CDC recommend penicillin as the first choice for intrapartum prophylaxis, with erythromycin and clindamycin as alternatives for penicillin-allergic patients. There has been increasing resistance to these antibiotics among GBS. Third-trimester GBS screening and susceptibility testing for pregnant women should be considered.

並列關鍵字

group B streptococci ； antibiotic resistance ； anovaginal culture ； neonatal sepsis

國際替代計量

Antibiotic Susceptibility Pattern of Anovaginal Isolates of Streptococcus Agalactiae from Pregnant Women in Their Late Third Trimester

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