产科院内多重耐药菌感染情况分析

Analysis of infection of multi drug resistant bacteria in obstetrics hospital

目的分析本院产科院内多重耐药菌感染情况及耐药性。方法收集2018年1月1日~2022年6月30日于本院产科住院的1958例产妇的临床资料,统计分析产妇发生院内感染的感染率、感染部位分布情况及院内感染患者抗菌药物使用情况。经诊断为院内感染者,采集其不同感染部位分泌物分别接种于不同培养基中进行培养分离,采用纸片扩散法对分离出的所有病原菌进行药敏试验。采用聚合酶链式反应对多重耐药大肠埃希菌的耐药基因进行扩增和分析。结果本次研究的1958例产妇中,68例合并产后多重耐药菌感染,感染率为3.47%。产后感染部位主要为手术切口(29.41%),其次为呼吸系统(26.47%)、生殖道(19.12%)、泌尿系统(11.76%)感染。共培养分离出病原菌75株,其中革兰阳性菌共21株,主要为金黄色葡萄球菌(11株)和粪肠球菌(4株)。革兰阴性菌54株,主要为大肠埃希菌(27株)、铜绿假单胞菌(10株)及肺炎克雷伯菌(7株)。27株大肠埃希菌对氨苄西林、头孢西丁、头孢他啶、亚胺培南、美罗培南、环丙沙星、加替沙星、复方新诺明、庆大霉素、妥布霉素和阿米卡星耐药率为100.00%、96.30%、48.15%、14.81%、18.52%、77.78%、55.56%、74.07%、85.19%、59.26%和37.04%。11株金黄色葡萄球菌对青霉素、红霉素、克林霉素、四环素、庆大霉素、环丙沙星、左氧氟沙星、莫西沙星和复方新诺明的耐药率为100.00%、100.00%、81.82%、72.73%、72.73%、63.64%、54.55%、45.45%和36.36%,未发现对糖肽类万古霉素、替考拉宁,呋喃类呋喃妥因的耐药株。对本次研究中的27株多重耐药大肠埃希菌进行耐药基因检测,21株携带Ⅰ类整合子(77.78%),11株携带TEM基因(40.74%),3株携带SHV基因(11.11%),3株携带OXA-1(11.11%),1株携带OXA-2(3.70),13株携带CTM-M-1(48.15%),1株携带CTM-M-2(3.70%),3株携带CTM-M-8和8株携带CTM-M-9(39.63%)。对比感染多重耐药菌的68例孕产妇与80例同期未发生感染的孕产妇妊娠结局,结果显示,感染多重耐药菌的孕产妇出现流产、早产、产前发热、产后发热、产后出血、会阴切口愈合不良、胎儿宫内窘迫等不良妊娠结局的占比高于未感染组孕产妇(均P<0.05)。结论本院产科院内多重耐药菌主要感染部位为手术切口与呼吸系统,病原菌以大肠埃希菌、铜绿假单胞菌及金黄色葡萄球菌为主。多重耐药菌金黄色葡萄球菌与大肠埃希菌对临床常见抗菌药物的耐药率较高,多重耐药大肠埃希菌携带多种耐药基因。

Objective The infection and drug resistance of multi drug resistant bacteria were analyzed in the obstetrics department of our hospital.Methods The clinical data of 1958 lying in women hospitalized in the obstetrics department of our hospital from January 1,2018 to June 30,2022 were collected,and the infection rate,the distribution of infection sites,and the use of antibacterial drugs in patients with nosocomial infection were statistically analyzed.For those diagnosed as hospital infection,the secretions from different infection sites were collected and inoculated in different culture media for culture and isolation.All the isolated pathogenic bacteria were tested for drug sensitivity by disk diffusion method.The drug resistant genes of multidrug resistant E.coli were am plified and analyzed by PCR.Results In 1958 cases of puerpera in this study,68 cases were complicated with postpartum multi drug resistant bacteria infection,the infection rate was 3.47%.Postpartum infection mainly occurred in surgical incision(29.41%),followed by respiratory system(26.47%),reproductive tract(19.12%)and urinary system(11.76%).75 strains of pathogenic bacteria were isolated by co culture,including 21 strains of gram-positive bacteria,mainly Staphylococcus aureus(11 strains)and Enterococcus faecalis(4 strains).54 strains of Gram negative bacteria,mainly E.coli(27 strains),Pseudomonas aeruginosa(10 strains)and Klebsiella pneumoniae(7 strains).The resistance rates of 27 strains of E.coli to ampicillin,cefoxitin,ceftazidime,imipenem,meropenem,ciprofloxacin,gatifloxacin,cotrimoxazole,gentamicin,tobramycin and amikacin were 100.00%,96.30%,48.15%,14.81%,18.52%,77.78%,55.56%,74.07%,85.19%,59.26%and 37.04%respectively.The drug resistance rates of 11 strains of Sta phylococcus aureus to penicillin,erythromycin,clindamycin,tetracycline,gentamicin,ciprofloxacin,levofloxacin,moxifloxacin,and cotrimoxazole were 100.00%,100.00%,81.82%,72..73%,72.73%,63.64%,54.55%,45.45%and 36.36%respectively.No resistant strains to glycopeptide vancomycin,teicoplanin and furantoin were found.The drug resistance genes of 27 multidrug resistant E.coli strains in this study were detected.21 strains carried class I integron(77.78%),11 strains carried TEM gene(40.74%),3 strains carried SHV gene(11.11%),3 strains carried OXA-1(11.11%),1 strain carried OXA-2(3.70),13 strains carried CTM-M-1(48.15%),1 strain carried CTM-M-2(3.70%),3 strains carried CTM-M-8 and 8 strains carried CTM-M-9(39.63%).Comparing the pregnancy outcomes of 68 pregnant women infected with multi-drug resistant bacteria and 80 pregnant women without infection in the same period,the results showed that the proportion of pregnant women infected with multi-drug resistant bacteria with adverse pregnancy outcomes such as abortion,premature delivery,prenatal fever,postpartum fever,postpartum hemorrhage,poor healing of perineal incision,fetal distress and so on was higher than that of non-infected pregnant women(P<0.05).Conclusion The main infection sites of multidrug-resistant bacteria in our obstetrics hospital were surgical incision and respiratory system,and pathogenic bacteria mainly including E.coli,P.aeruginosa and S.aureus.Multidrug resistant S.aureus and E.coli have high resistance rates to common clinical antibiotics,and multi drug resistant E.coli carries a variety of drug resistance genes.