孕产妇产后感染病原菌的构成及耐药性分析

Distribution and drug resistance of pathogens causing postpartum infection

目的了解孕产妇产后感染病原菌的分布及耐药现状,为临床抗感染治疗提供依据。方法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,采用WHONET5.6软件进行数据统计分析。结果 2012年1月至2015年12月我院产科病房孕产妇共60 229例,产后感染336例,感染主要部位为宫腔、切口、血液和尿液。主要病原菌依次为大肠埃希菌、粪肠球菌、B型链球菌和金黄色葡萄球菌。大肠埃希菌对头孢他啶、头孢吡肟、妥布霉素、阿米卡星、头孢替坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南耐药率均<15.00%;粪肠球菌和无乳链球菌对氨苄西林、青霉素耐药率为0.00%,耐甲氧西林金黄色葡萄球菌(MRSA)耐药率高达19.05%。结论我院产科病房感染主要部位为宫腔(43.18%),减少剖宫产率可以降低产后感染发生率,感染的主要病原菌为大肠埃希菌和粪肠球菌(63.23%),在预防用药的选择上应选择对大肠埃希菌和粪肠球菌均有效的抗生素以减少产后感染的发生率,同时了解孕产妇产后感染病原菌的构成和耐药性,有助于临床更快速有效地治疗产后感染。

Objective To investigate the distribution and resistance of the pathogens causing postpartum infection to provide evidence for clinical anti-infective treatment.Methods The VITEK-2 system was used to identify the strains and perform the susceptibility test.The WHONET 5.6 software was used to analyze the data.Results Totally 60,229 pregnant women in our hospital from Jan.2012 to Jun.2015 were included,including 336 cases of postpartum infection.Uterus,incision,blood and urine were the main infection sites.The main pathogens isolated were Escherichia coli,Enterococcus faecalis,Group B Streptococcus and Staphylococcus aureus.The resistance rates of E.coli to ceftazidime,cefepime,tobramycin,amikacin,cefotetan,piperacillin/tazobactam,cefoperazone/sulbactam and imipenem were lower than 15.00%.The resistance rates of E.faecalis and Group B Streptococcus to ampicillin and penicillin were 0.00%.The resistance rate of MethicUin-resistant Staphylococcus aureus（MRSA） was up to 19.05%.Conclusion Uterus is the main infection site（43.18%）.Reduction of cesarean birth can reduce the incidence of postpartum infections.The main pathogens isolated are Escherichia coli and Enterococcus faecalis（63.23%）.Antibiotics effective to Escherichia coli and Enterococcus faecalis can be used as prophylactics to reduce the incidence of postpartum infections.It is important to understand the distribution and drug resistance of the pathogens causing postpartum infection to treat postpartum infection efficiently and timely.