胎膜早破孕妇生殖道感染病原菌分布特点及耐药分析

Distribution Characteristics and Drug Resistance of Pathogens in Genital Tract Infection of Pregnant Women with Premature Rupture of Membranes

目的:了解胎膜早破(PROM)孕妇生殖道感染病原菌的分布特点及耐药现状,为临床合理使用抗生素及进行有效的PROM管理提供参考。方法:对2015年1月-2019年12月笔者所在医院产科PROM孕妇送检的32 620份宫颈分泌物的常规细菌培养进行回顾性分析,均采用法国生物梅里埃VITEK-2全自动细菌鉴定分析仪进行鉴定和药敏试验,并采用WHONET 5.6软件进行数据分析。结果:32 620份宫颈分泌物共分离菌株2 196株(6.72%),其中革兰阴性菌971株(42.21%),革兰阳性菌1 068株(48.63%),主要病原菌依次为无乳链球菌、大肠埃希菌、粪肠球菌、肺炎克雷伯菌、金黄色葡萄球菌和奇异变形杆菌;检出真菌157株(7.15%),以白色假丝酵母、光滑假丝酵母为常见。检出的病原菌对临床中大部分常用药物均具有较低的耐药性。结论:PROM孕妇生殖道感染病原菌以无乳链球菌最常见,临床应根据药敏结果合理用药,以有效预防产后感染及新生儿感染。

Objective:To understand the distribution characteristics and drug resistance status of pathogens in genital tract infection of pregnant women with premature rupture of membranes (PROM),so as to provide reference for rational use of antibiotics and effective PROM management in clinic.Method:A retrospective analysis was conducted on the routine bacterial culture of 32 620 cervical secretions from obstetrical pregnant women with PROM in our hospital from January 2015 to December 2019.The identification and drug sensitivity tests were conducted with the French Biomerieux VITEK-2 automatic bacterial identification analyzer,and the data were analyzed with WHONET 5.6 software.Result:A total of 2 196 strains (6.72%) were isolated from 32 620 cervical secretions,of which 971 strains (42.21%) were Gram-negative bacteria and 1 068 strains (48.63%) were Gram-positive bacteria.The major pathogens in turn were Streptococcus agalactiae,Escherichia coli,Enterococcus faecalis,Klebsiella pneumoniae,Staphylococcus aureus and Proteus mirabilis.And 157 strains (7.15%) of fungi were detected,and Candida albicans and Candida glabrata were common.The detected pathogens had low drug resistance to most of the commonly used drugs in clinical practice.Conclusion:Streptococcus agalactiae is the most common pathogens in genital tract infection of pregnant women with premature rupture of membranes.In order to effectively prevent postpartum infection and neonatal infection,clinical administration should be rational according to drug sensitivity results.