【摘要】 目的 分析不同B群链球菌(GBS)筛查策略对感染发生的影响以及婴幼儿侵袭性GBS感染特征，探讨婴幼儿侵袭性GBS感染菌株药物敏感性、血清型及分子分型之间的关系，为预防和治疗GBS相关疾病提供参考依据。方法 收集广西壮族自治区妇幼保健院2015年1月—2020年12月不同阶段(部分筛查期和完全筛查期)孕产妇GBS筛查数据及从婴幼儿(<90天)无菌体液(血液或脑脊液)中分离的非重复GBS菌株，分析婴幼儿侵袭性GBS菌株耐药性、血清型及多位点序列分型(MLST)的特征。结果 88 607例孕晚期妇女共检出GBS 10 016例，阳性率为11.3%;其中肛拭子GBS分离率(9.45%)较阴道分泌物分离率(7.29%)高，差异有统计学意义(P<0.05)。2015—2020年各年婴幼儿侵袭性GBS总发病率分别为0.252‰、0.352‰、0.111‰、0.111‰、0.211‰、0.055‰。其中2015—2020年早发型GBS发病率分别为0.189‰、0.352‰、0.056‰、0.111‰、0.106‰、0.055‰。完全筛查期婴幼儿侵袭性GBS早发型发病率较部分筛查期低(P<0.05)。37株婴幼儿侵袭性GBS感染株药敏结果显示对青霉素、氨苄西林、头孢曲松、利奈唑胺、万古霉素、美罗培南敏感率为100.0%。对红霉素、克林霉素、四环素及左氧氟沙星的耐药率分别为76.7%、73.3%、86.7%、13.3%。侵袭性GBS最常见的是血清型Ⅲ(76.5%),MLST分型共获得4种ST型，其中ST17型(CC17)最为常见(47.1%)。结论 产前常规筛查GBS并对筛查阳性者产时进行抗生素预防治疗可有效降低婴幼儿早发型侵袭性GBS感染。GBS感染可选青霉素、氨苄西林、头孢曲松、利奈唑胺、万古霉素和美罗培南治疗。研究单位婴幼儿侵袭性GBS感染分离株中存在高传播力和侵袭力强的Ⅲ型、ST17型GBS株，需引起医疗机构高度重视。更多还原

【Abstract】 Objective To analyze the effects of different group B streptococcus(GBS) screening strategies on the occurrence of infection and the characteristics of invasive GBS infection in infants, and to explore relationship between drug sensitivity, serotype and molecular typing of invasive GBS infection strains in infants, so as to provide reference for the prevention and treatment of GBS-related diseases. Methods The GBS screening data of pregnant women in different periods(partial screening period and complete screening period) from January 2015 to December 2020, and non-repeated GBS strains isolated from sterile body fluids(blood or cerebrospinal fluid) of infants(<90 days) in Maternal and Child Health Hospital in Guangxi Zhuang Autonomous Region were collected. And then, the characteristics of antibiotic resistance, serotype, and multilocus sequence typing(MLST) of invasive GBS strains in infants were analyzed. Results A total of 10 016 cases of GBS were detected in 88 607 late pregnant women, and positive rate was 11.3%. The GBS isolation rate of anal swabs(9.45%) was higher than that of vaginal secretions(7.29%), and difference was statistically significant(P<0.05). The total incidence of invasive GBS in infants from 2015 to 2020 were 0.252‰, 0.352‰, 0.111‰, 0.111‰, 0.211‰ and 0.055‰, respectively. Among which, the incidence of early-onset GBS from 2015 to 2020 were 0.189‰, 0.352‰, 0.056‰, 0.111‰, 0.106‰ and 0.055‰, respectively. The incidence of early onset of invasive GBS in infants during the complete screening period was lower than that during the partial screening period(P<0.05). Drug susceptibility test of 37 invasive GBS infection strains in infants showed that GBS were 100.0% sensitive to penicillin, ampicillin, ceftriaxone, linezolid, vancomycin and meropenem. The resistance rates to erythromycin, clindamycin, tetracycline and levofloxacin were 76.7%, 73.3%, 86.7% and 13.3%, respectively. The most common type of invasive GBS was serotype Ⅲ(76.5%). 4 ST types were obtained by MLST, and ST17(CC17) was the most common type(47.1%). Conclusion Routine prenatal screening for GBS and prenatal antibiotic prophylaxis for screening positive patients can effectively reduce early-onset invasive GBS infection in infants. GBS infection can be treated with penicillin, ampicillin, ceftriaxone, linezolid, vancomycin and meropenem. Type Ⅲ and ST17 GBS strains with high transmission and strong invasion are isolated from invasive GBS infection in infants in the research unit, which should be highly valued by medical institutions.更多还原