继发不孕患者阴道常见致病菌及耐药性分析

The association of lower genital infection with secondary infertility and antimicrobial susceptibility analysis of microflora

目的:分析继发不孕患者下生殖道的致病菌感染及耐药情况,明确导致女性下生殖道感染的主要致病菌及其对常用抗菌素的敏感状况,以有效指导临床抗感染用药。方法:收集确诊为继发不孕且阴道分泌物培养菌阳性的606例患者的临床资料,回顾分析其致病菌分布及抗菌素耐药情况,研究从该人群中病原体的高分离率与女性生殖道的并发症是否存在联系。结果:继发不孕患者中,引起生殖道炎症的病原菌排名前三者为大肠埃希菌、粪肠球菌和白色念珠菌,支原体培养阳性率为48.8%。大肠埃希菌、肺炎克雷伯菌等肠杆菌科细菌对氨苄西林、头孢噻肟、头孢他啶、复方新诺明等耐药率较高,而对亚胺培南、美洛培南、阿米卡星等耐药率低。革兰阳性球菌等对万古霉素、呋喃妥因、利奈唑烷等有较高的敏感性,粪肠球菌对氨苄西林的敏感性较高,解脲支原体对多西环素/强力霉素和美满霉素等敏感性高。结论:万古霉素、呋喃妥因、利奈唑烷等可作为革兰阳性菌球菌治疗的首选;氨苄西林可作为粪肠球菌治疗的首选;多西环素/强力霉素和美满霉素可作为治疗支原体感染的一线药物。

Objective：To analyze the causative pathogenic infection with respect to the antimicrobial susceptibility vaginal microbes in secondary infertile patients, to identify the main pathogens which caused female lower genital infection and the corresponding antimicrobial susceptibility of these anaerobes, which would provide guidance for treating clinical antimicrobial infection more effectively. Methods： A total of 606 pathogens isolated from vaginal discharge of secondary infertile female inpatients at Fudan Obstetrics and Gynaeeology Hospital from January 2010 to December 2012. A retrospective analysis was conducted to determine the distribution of causative organisms from the vagina of these patients and their antimicrobial resistance pattern. The genital microflora infection present in secondary infertile female patients and the antimicrobial susceptibility testing of pathogens isolated assists in rational use of medicine. It also aims to appraise whether the high prevalence of pathogens from this population is associated with reproductive sequelae. Results：The prevalent pathogens isolated from secondary infertile patients are Eschenchla coil （E coli）, Enterococcus faecalis and Candidia albicans. Mycoplasma infection consists of 48.8%. Enterobacteriaceae such as E coli and Klebsiella pneumoniae have high antibiotic resistance to ampicillin, cefotaxime, ceftazidime, sulfamethoxazole. However, a lower resistance is seen for imipeniem, menorpenum, amixicillin. Gram positive cocci has a higher sensitivity towards vancomycin, nitrofurantoin, linezolid. E coli has a higher sensitivity to ampicillin. None of the Staphylococcus aureus strains are vancomycin-resistant. Ureaplasma urealyticum is highly sensitive to doxycycline and minocycline. Conclusions： Vancomycin, nitrofurantoin, linezolid can be used as the first-line treatment for Gram positive cocci. Meanwhile, ampicillin should be recommended as the first-line treatment for E coll. Doxycycline and minocycline can be used for mycoplasma infection.