急性乳腺炎病原菌分布与耐药分析

The distribution and drug resistance of acute mastitis pathogens

目的调查导致急性乳腺炎感染的病原菌分布及其对常用抗生素的耐药情况以指导临床合理选用抗菌药物。方法穿刺法收集186例门诊和住院急性乳腺炎患者脓液标本进行细菌分离培养和药敏试验,采用全自动微生物分析仪进行菌种鉴定,药物敏感试验采用K-B纸片法。β-内酰胺酶检测采用头孢硝噻吩纸片法。结果标本细菌检出率为54.3%(101/186)。其中96株为需氧或兼性厌氧菌,以金黄色葡萄球菌为主(81.2%);5株为厌氧菌,均为口腔正常菌群。药敏结果显示葡萄球菌对复方新诺明、红霉素、阿齐霉素及左氧氟沙星有较高耐药率,尤其对青霉素有极高耐药率;而对苯唑西林、二代/三代头孢菌素、丁胺卡那及呋喃妥因较为敏感;未发现万古霉素耐药的菌株。葡萄球菌产β-内酰胺酶率为14.7%,其中凝固酶阴性葡萄球菌(MRCNS)产酶率(46.2%)远高于金黄色葡萄球菌(9.8%)。此外,MRCNS流行率亦远高于耐甲氧西林金黄色葡萄球菌(MRSA)。结论急性乳腺炎的主要病原菌为金黄色葡萄球菌,其对青霉素高度耐药,但对苯唑西林或二代以上头孢菌素较为敏感。因此,苯唑西林或二代以上头孢菌素是目前治疗急性乳腺炎的首选药物。

Objective To investigate the distribution and drug resistance of acute mastitis pathogens in order to guide the rational use of antibiotics.Methods 186 pus specimens were collected from the outpatients or inpatients with acute mastitis using a sterile needle for bacterial isolation.Automated microbial analyzer was used to identify the bacteria strain,and antibiotic sensitivity test was performed by K-B disk diffusion method.β-lactamases were detected by Nitrocefin slip method.Results The bacterial isolation rate was 54.3%（101/186）.96 strains were aerobic or facultative anaerobic bacteria,of which 81.2% was Staphylococcus aureus.The other 5 strains belong to anaerobic bacteria and were all of normal oral microbiota.Antibiotic sensitivity test showed staphylococci had a high resistance to cotrimoxazole,erythromycin,azithromycin,levofloxacin,and especially to penicillin.But it revealed a high sensitivity to oxacillin,cephalosporin of second/third generation,amikacin and nitrofurantoin.No vancomycin resistant strains were found.The rate of β-lactamases producing staphylococci was 14.7%,of which coagulase-negative staphylococci（46.2%） was higher than S.aureus（9.8%）.The prevalence of MRCNS was much higher than MRSA.Conclusion The major pathogen contributed to acute mastitis was S.aureus and it was highly resistant to penicillin.Oxacillin or second/third generation cephalosporin should be the first choice for acute mastitis treatment.