细菌感染在肉芽肿性小叶性乳腺炎发病中的作用及病原菌分布和药敏性分析

Role of bacterial infection in pathogenesis of granulomatous lobular mastitis and pathogenic bacteria distribution as well as drug sensitivity analysis

目的探讨细菌感染在肉芽肿性小叶性乳腺炎发病中的作用及病原菌分布情况和药敏性。方法选取解放军第230医院2014年8月至2016年8月期间收治通过手术或粗针穿刺后病理确诊的肉芽肿性小叶性乳腺炎患者200例,采集其组织块、脓液、分泌物制成标本,细菌培养分离后鉴定,并采取纸片琼脂扩散法行药敏试验。结果 200例肉芽肿性小叶性乳腺炎患者标本中有72例(36.00%)病原菌呈阳性,分离出棒状杆菌53例(73.61%)。其中水生棒状杆菌17例(32.08%),微小棒状杆菌8例(15.09%),G群棒杆菌7例(13.21%),杰氏棒杆菌6例(11.32%),A群棒杆菌4例(7.55%),I群棒杆菌4例(7.55%),F群棒杆菌4例(7.55%),库氏棒杆菌4例(7.55%),牛棒状杆菌3例(5.36%)。该病1、2、3年后再次培养棒状杆菌,显示棒状杆菌的阳性率随着时间增长而显著增长,1年后棒状杆菌阳性10例(13.89%),2年后43例(59.72%),3年后53例(73.61%),主要棒状杆菌对大多数抗生素药敏实验敏感率较高。其中庆大霉素53例(100.00%)、万古霉素53例(100.00%)、利福平53例(100.00%)、利奈唑胺53例(100.00%)等较敏感,而对苯唑西林13例(24.53%)、呋喃妥因12例(22.64%)、克林霉素8例(15.09%)、红霉素10例(18.87%)等敏感率较低。结论棒状杆菌是肉芽肿性小叶性乳腺炎的主要致病菌,可用敏感率较高的抗生素进行治疗。

Objective To investigate the role of bacterial infection in the pathogenesis of granulomatous lobular mastitis and pathogenic bacteria distribution as well as drug sensitivity analysis. Methods A total of 200 patients diagnosed with granulomatous lobular mastitis by surgery or needle biopsy in People＇s Liberation Army 230 th Hospital from August 2014 to August 2016 were selected. Their tissue,pus and secretion were collected and made into specimens. Bacteria was identified after being cultured and separated,and disc agar diffusion method was used in drug sensitive test. Results Among 200 specimens of patients with granulomatous lobular mastitis,pathogenic bacteria in 72 cases（ 36. 00%） was positive. Corynebacterium was isolated from 53 specimens（ 73. 61%）,among which corynebacterium aquaticum was in 17 cases（ 32. 08%）,corynebacterium minutissimum in 8 cases（ 15. 09%）,corynebacterium G in 7 cases（ 13. 21%）,corynebacterium jeikeium in 6 cases（ 11. 32%）,corynebacterium A in 4 cases（ 7. 55%）,corynebacterium I in 4 cases（ 7. 55%）,corynebacterium F in 4 cases（ 7. 55%）,corynebacterium kutscheri in 4 cases（ 7. 55%）,and corynebacterium bovis in 3 cases（ 5. 36%）. Corynebacterium culture in 1,2 and 3 years after diagnosis of the disease showed that corynebacterium positive rate significantly increased with time. Corynebacterium positive rate in 1 year after disease diagnosis was 13. 89%（ 10 cases）,59. 72%（ 43 cases） in 2 years and 73. 61%（ 53 cases） in 3 years. Sensitivity of major corynebacterium was high in most antibiotics susceptibility tests. Sensitivity to gentamicin（ 53 cases,100. 00%）,vancomycin（ 53 cases,100. 00%）,rifampicin（ 53 cases,100. 00%）,and linezolid（ 53 cases,100. 00%） was high,while that to oxacillin（ 13 cases,24. 53%）,nitrofurantoin（ 12 cases,22. 64%）,clindamycin（ 8 cases,15. 09%） and erythromycin（ 10 cases,18. 87%） was low. Conclusion Corynebacterium is the major pathogenic bacteria in granulomatous lobular mastitis and can be treated with antibiotics of high sensitivity.