背景:B组链球菌(GBS)或无乳链球菌的母体直肠阴道定植是围产期该疾病最常见的途径。这项荟萃分析旨在总结有关孕产妇定植的现有数据,血清型概况,以及中国的抗生素耐药性。
方法:在检索了6个数据库后,进行了系统的文献综述。应用Meta分析分析定植率,血清型,中国不同地区GBS临床分离株对抗菌药物的敏感性。汇总估计数使用表格列出,漏斗图,森林地块,直方图,小提琴情节,和线图。
结果:有关定植的数据集包括52篇文章和195303名孕妇。我们对中国母体GBS定植的估计为8.1%(95%置信区间[CI]7.2%-8.9%)。血清型Ia,Ib,III,和V占鉴定分离株的95.9%。血清型III,通常与高毒力克隆复合物有关,占46.4%。在使用多位点序列分型(MLST)的母体GBS分离株中,ST19(25.7%,289/1126)和ST10(25.1%,283/1126)是最常见的,其次是ST12(12.4%,140/1126),ST17(4.8%,54/1126),和ST651(3.7%,42/1126)。GBS对四环素(75.1%[95%CI74.0-76.3%])和红霉素(65.4%[95%CI64.5-66.3%])高度耐药,一般对青霉素敏感,氨苄青霉素,万古霉素,头孢曲松,和利奈唑胺.GBS对克林霉素和左氧氟沙星的耐药率差异很大(1.0-99.2%和10.3-72.9%,分别)。对中国抗菌药物耐药监测系统(CARSS)近5年发布的细菌耐药报告进行汇总分析,克林霉素,左氧氟沙星从2018年到2020年缓慢下降。然而,2021年GBS对所有3种抗生素的耐药率略有上升。
结论:中国总体定殖率远低于全球定殖率(17.4%)。与世界其他地区的许多原始和审查报告一致,GBS对四环素具有高度抗性。然而,中国分离株对红霉素和克林霉素的耐药性高于其他国家。本文提供了重要的流行病学信息,协助预防和治疗这些女性的GBS定植。
BACKGROUND: Maternal rectovaginal colonization with group B Streptococcus (GBS) or Streptococcus agalactiae is the most common pathway for this disease during the perinatal period. This meta-analysis aimed to summarize existing data regarding maternal colonization, serotype profiles, and antibiotic resistance in China.
METHODS: Systematic literature reviews were conducted after searching 6 databases. Meta-analysis was applied to analyze colonization rate, serotype, and antimicrobial susceptibility of GBS clinical isolates in different regions of China. Summary estimates are presented using tables, funnel plots, forest plots, histograms, violin plots, and line plots.
RESULTS: The dataset regarding colonization included 52 articles and 195 303 pregnant women. Our estimate for maternal GBS colonization in China was 8.1% (95% confidence interval [CI] 7.2%-8.9%). Serotypes Ia, Ib, III, and V account for 95.9% of identified isolates. Serotype III, which is frequently associated with the hypervirulent clonal complex, accounts for 46.4%. Among the maternal GBS isolates using multilocus sequence typing (MLST), ST19 (25.7%, 289/1126) and ST10 (25.1%, 283/1126) were most common, followed by ST12 (12.4%, 140/1126), ST17 (4.8%, 54/1126), and ST651 (3.7%, 42/1126). GBS was highly resistant to tetracycline (75.1% [95% CI 74.0-76.3%]) and erythromycin (65.4% [95% CI 64.5-66.3%]) and generally susceptible to penicillin, ampicillin, vancomycin, ceftriaxone, and linezolid. Resistance rates of GBS to clindamycin and levofloxacin varied greatly (1.0-99.2% and 10.3-72.9%, respectively). A summary analysis of the bacterial drug resistance reports released by the China Antimicrobial Resistance Surveillance System (CARSS) in the past 5 years showed that the drug resistance rate of GBS to erythromycin, clindamycin, and levofloxacin decreased slowly from 2018 to 2020. However, the resistance rates of GBS to all 3 antibiotics increased slightly in 2021.
CONCLUSIONS: The overall colonization rate in China was much lower than the global colonization rate (17.4%). Consistent with many original and
review reports in other parts of the world, GBS was highly resistant to tetracycline. However, the resistance of GBS isolates in China to erythromycin and clindamycin was greater than in other countries. This paper provides important epidemiological information, to assist with prevention and treatment of GBS colonization in these women.