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Abstract：
OBJECTIVE: To investigate the prevalence, antimicrobial susceptibility, and the effects on pregnancy and neonatal outcomes of Group A Streptococcal (GAS) infections in the vagina of perinatal women.
METHODS: From June 2020 to October 2022, 270 perinatal pregnant women underwent vaginal swabs for GAS culture. The antibiotic sensitivity of the positive strains was assessed. Based on GAS detection results, the patients were divided into an observation group (GAS positive) and a control group (GAS negative). Clinical data from both groups were collected to compare the vaginal microecological changes. The adverse outcomes for pregnancy and infants in both groups were retrospectively analyzed. Univariate and multivariate analyses were used to identify the risk factors for adverse outcomes.
RESULTS: Among the 270 pregnant women, 30 tested positive for GAS and 240 tested negative, with a colonization rate of 11.1%. No resistance to penicillin, ampicillin, linezolid, vancomycin, or tigecycline was found among the GAS strains. The resistance rates to tetracycline and clindamycin were 73.3% and 70.0%, respectively. Higher vaginal pH (≥4.5), and increased incidences of bacterial vaginitis, aerobic vaginitis, and microecological imbalances were observed in the observation group compared to the control group (all P<0.05). The observation group also experienced more adverse pregnancy and infant outcomes, such as chorioamnionitis, postpartum infections, fetal distress, and neonatal pneumonia (all P<0.05). Univariate and multivariate analyses indicated that a vaginal pH≥4.5 and microecological imbalance were positively associated with poor maternal and infant outcomes in women with GAS infections (all P<0.05).
CONCLUSIONS: The study found no β-lactam resistant GAS strains. Additionally, a higher vaginal pH (≥4.5) and microecological imbalance were linked to an increased risk of adverse pregnancy and infant outcomes in women with GAS infections.
METHODS: From June 2020 to October 2022, 270 perinatal pregnant women underwent vaginal swabs for GAS culture. The antibiotic sensitivity of the positive strains was assessed. Based on GAS detection results, the patients were divided into an observation group (GAS positive) and a control group (GAS negative). Clinical data from both groups were collected to compare the vaginal microecological changes. The adverse outcomes for pregnancy and infants in both groups were retrospectively analyzed. Univariate and multivariate analyses were used to identify the risk factors for adverse outcomes.
RESULTS: Among the 270 pregnant women, 30 tested positive for GAS and 240 tested negative, with a colonization rate of 11.1%. No resistance to penicillin, ampicillin, linezolid, vancomycin, or tigecycline was found among the GAS strains. The resistance rates to tetracycline and clindamycin were 73.3% and 70.0%, respectively. Higher vaginal pH (≥4.5), and increased incidences of bacterial vaginitis, aerobic vaginitis, and microecological imbalances were observed in the observation group compared to the control group (all P<0.05). The observation group also experienced more adverse pregnancy and infant outcomes, such as chorioamnionitis, postpartum infections, fetal distress, and neonatal pneumonia (all P<0.05). Univariate and multivariate analyses indicated that a vaginal pH≥4.5 and microecological imbalance were positively associated with poor maternal and infant outcomes in women with GAS infections (all P<0.05).
CONCLUSIONS: The study found no β-lactam resistant GAS strains. Additionally, a higher vaginal pH (≥4.5) and microecological imbalance were linked to an increased risk of adverse pregnancy and infant outcomes in women with GAS infections.
摘要：
目的：调查患病率，抗菌敏感性，以及围产期妇女阴道A组链球菌（GAS）感染对妊娠和新生儿结局的影响。
方法：从2020年6月至2022年10月，270名围产期孕妇接受阴道拭子进行GAS培养。评估阳性菌株的抗生素敏感性。根据GAS检测结果,将患者分为观察组(GAS阳性)和对照组(GAS阴性)。收集两组的临床数据，比较阴道微生态变化。回顾性分析两组妊娠及婴儿的不良结局。使用单变量和多变量分析来确定不良结局的危险因素。
结果：在270名孕妇中，30个GAS检测呈阳性，240个检测呈阴性，定殖率为11.1%。对青霉素没有抗药性,氨苄青霉素,利奈唑胺,万古霉素,或在GAS菌株中发现替加环素。对四环素和克林霉素的耐药率分别为73.3%和70.0%,分别。较高的阴道pH值（≥4.5），细菌性阴道炎的发病率增加，需氧性阴道炎,观察组微生态失衡与对照组比较差异均有统计学意义(均P<0.05)。观察组也经历了更多的不良妊娠和婴儿结局，比如绒毛膜羊膜炎,产后感染，胎儿窘迫,新生儿肺炎(均P<0.05)。单因素和多因素分析表明，GAS感染妇女的阴道pH≥4.5和微生态失衡与母婴结局不良呈正相关（均P<0.05）。
结论：本研究未发现β-内酰胺耐药GAS菌株。此外,较高的阴道pH值(≥4.5)和微生态失衡与GAS感染女性的不良妊娠和婴儿结局风险增加相关.
方法：从2020年6月至2022年10月，270名围产期孕妇接受阴道拭子进行GAS培养。评估阳性菌株的抗生素敏感性。根据GAS检测结果,将患者分为观察组(GAS阳性)和对照组(GAS阴性)。收集两组的临床数据，比较阴道微生态变化。回顾性分析两组妊娠及婴儿的不良结局。使用单变量和多变量分析来确定不良结局的危险因素。
结果：在270名孕妇中，30个GAS检测呈阳性，240个检测呈阴性，定殖率为11.1%。对青霉素没有抗药性,氨苄青霉素,利奈唑胺,万古霉素,或在GAS菌株中发现替加环素。对四环素和克林霉素的耐药率分别为73.3%和70.0%,分别。较高的阴道pH值（≥4.5），细菌性阴道炎的发病率增加，需氧性阴道炎,观察组微生态失衡与对照组比较差异均有统计学意义(均P<0.05)。观察组也经历了更多的不良妊娠和婴儿结局，比如绒毛膜羊膜炎,产后感染，胎儿窘迫,新生儿肺炎(均P<0.05)。单因素和多因素分析表明，GAS感染妇女的阴道pH≥4.5和微生态失衡与母婴结局不良呈正相关（均P<0.05）。
结论：本研究未发现β-内酰胺耐药GAS菌株。此外,较高的阴道pH值(≥4.5)和微生态失衡与GAS感染女性的不良妊娠和婴儿结局风险增加相关.
