乳腺导管扩张积乳合并感染的病原学和药敏试验及超声图像特征分析

Etiological characteristics,drug susceptibility testing and ultrasonic image characteristics of mammary duct ectasia patients complicated with infections

目的分析乳腺导管扩张积乳合并感染患者的病原学、药敏试验及超声图像特征,为乳腺导管扩张积乳患者诊断和治疗方案的选择提供参考。方法回顾性分析医院2013年2月-2016年2月收治的96例乳腺导管扩张积乳合并感染患者的临床资料,所有患者均有明确的感染病原学及药敏试验结果,治疗前均行超声检查,整理患者病原菌分布情况及药敏试验结果及超声图像特征。结果 96例患者共检出病原菌124株,其中革兰阳性菌占59.67%,以表皮葡萄球菌、金黄色葡萄球菌为主,革兰阴性菌占40.33%,以嗜麦芽窄食单胞菌为主;药敏结果显示,革兰阳性菌对喹诺酮类(左氧氟沙星、莫西沙星)及四环素类(替加环素、四环素、万古霉素、利奈唑胺、呋喃妥因)耐药率较低,均<30%,对青霉素类和头孢菌素类抗菌药物的耐药率较高,均>30%,革兰阴性菌对氨基糖甙类、氟喹诺酮类抗菌药物敏感率较高,对氨苄西林、头孢唑林、头孢西丁耐药率较高;患者治疗前乳腺超声图像以出现肿块、肿块无明显包膜、边界呈毛玻璃状、肿块内部呈低回声且不均匀、周边高回声壁、部分病灶有冒泡征为主。结论乳腺导管扩张积乳合并感染患者感染病原菌主要为革兰阳性菌,其对喹诺酮类和四环素类抗菌药物较敏感,患者超声图像有较高的特异性,在对其鉴别诊断中具有一定价值。

OBJECTIVE To investigate the etiological characteristics,drug susceptibility testing and ultrasonic image characteristics of mammary duct ectasia patients complicated with infections so as to provide guidance for diagnosis and treatment of the mammary duct ectasia patients complicated with infections.METHODS The clinical data of 96 mammary duct ectasia patients complicated with infection who were treated in hospitals from Feb 2013 to Feb 2016 were retrospectively analyzed,all of the patients had definite etiological characteristics and results of drug susceptibility testing and received ultrasonic examination before treatment.The distribution of pathogens,results of drug susceptibility testing and ultrasonic image characteristics were observed.RESULTS A total of 124 strains of pathogens were isolated from 96 patients,59.67% of which were gram-positive bacteria,and 40.33%were gram-negative bacteria;Staphylococcus epidermidis and Staphylococcus aureus were the predominant species of gram-positive bacteria;Stenotrophomonas maltophilia was dominant among the gram-negative bacteria.The results of drug susceptibility testing indicated that the drug resistance rates of the gram-positive bacteria to quinolones（levofloxacin,moxifloxacin）and tetracylines（tigecycline,tetracycline,vancomycin,linezolid,nitrofurantoin）were less than 30%,the drug resistance rates to penicillins and cephalosporins were more than 30%;the gram-negative bacteria were highly susceptible to aminoglycosides and fluoroquinolones but were highly resistant to ampicillin,cefazolin and cefoxitin.The breast ultrasonic images of the patients were characterized by mass,mass without obvious envelope,frosted glassy borders,uneven echo inside the mass,mass surrounded by high-level echo and some lesions with bubble sign.CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the infections in the patients with mammary duct ectasia and are highly susceptible to quinolones and tetracyclines.The patients show specific ultrasonic images,which have certain value in differential diagnosis.