医院体检育龄妇女生殖系统感染病原菌分布及耐药状况分析

Analysis of distribution and drug resistance of pathogenic bacteria in reproductive system of women of childbearing age when hospital checkup

目的:探讨医院体检育龄妇女生殖系统感染病原菌分布及耐药状况。方法:回顾性收集2013年1月—2017年12月于海南医学院第一附属医院妇科门诊体检,阴道分泌物异常的19~49岁妇女426例为研究对象,拭取阴道或宫颈分泌物做生殖系统的感染检测并分泌物病原菌培养,采用MIC法或Kirby-Bauer纸片扩散法对细菌培养阳性标本进行药敏试验,统计育龄期女性生殖系统感染发生率、病原菌种类、构成及耐药情况。结果:426例妇女中检出生殖系统感染382例(89.7%),共检出菌株415株,其中革兰阳性菌206株(49.6%),革兰阴性菌71株(17.1%),真菌138株(33.3%),以凝固酶阴性葡萄球菌、大肠埃希菌、白色假丝酵母为主,凝固酶阴性葡萄球菌对氨苄西林、青霉素、红霉素、克林霉素耐药,对阿米卡星、万古霉素、替考拉宁敏感;大肠埃希菌对氨苄西林、环丙沙星、左氧氟沙星耐药,对亚胺培南、阿米卡星敏感;白色假丝酵母两性霉素B、氟胞嘧啶敏感,对氟康唑、伏立康唑、伊曲康唑有一定程度的耐药。单因素分析表明,育龄妇女生殖道感染者年龄、生育史、避孕方式、流产史及既往生殖道感染史为生殖道感染的相关因素(P<0.05),多因素回归分析同样表明为生殖道感染独立危险因素。结论:育龄妇女生殖系统感染因素较多,病原菌群复杂,对常规抗生素存在一定的耐药现象,临床应重视病原菌的检查,针对性合理用药。

Objective： To investigate the distribution and drug resistance of pathogenic bacteria in reproductive system of women of childbearing age when hospital checkup. Methods： Data of 426 women of childbearing age （19 to 49 years old） from gynecological outpatient clinics in the first affiliated hospital of Hainan medical college from January 2013 to December 2017 were retrospective analyzed. All of included women had abnormal vaginal discharge, and their vaginal or cervical secretions were collected for infection detection and secretion pathogen culture. The antimicrobiai suscepti- bility test of bacterial culture positive samples were conducted by MIC method or Kirby Bauer paper diffusion method. The incidence of reproductive system infection, pathogen type and its composition ratio, and situation of drug resistant of women of childbearing age were statistics analyzed. Results： 382 women with reproductive system infection were di- agnosed in 426 included women, which accounted for 89.7%. A total of 415 strains were detected, of which 206 strains （49.6%） were Gram positive bacteria, 71 strains （17.1%） were Gram negative bacteria, and 138 strains （33.3%） were fungi, and which mainly included coagulase negative staphylococci, Escherichia toll, and Candida albieans. Coag- ulase negative staphylococci were resistant to ampicillin, penicillin, erythromycin, and clindamycin, and were sensitive to amikaein, vancomycin, and teicoplanin. Escherichia coli were resistant to ampicillin, ciprofloxacin and levofloxacin, and were sensitive to imipenem and amikaein. Candida albicans amphotericin B, flucytosine sensitive, but had a certain degree of resistance to fluconazole, voriconazole, itraconazole. Univariate analysis showed that age, birth history,contraception, history of abortion, and history of previous reproductive tract infection were the relevant factors of geni- tal iract infection （P〈0.05）. Multivariate regression analysis showed age, birth history, contraception, abortion his- tory, or the history of previous reproductive tract infections was also the independent risk factor for genital tract infec tion. Conclusion： There are many related factors to reproductive system infection of women of childbearing age. And the pathogen flora is complex, and there is a certain resistance to conventional antibiotics. So clinical pathogens exami- nation should be paid attention to, and drugs should be targeted and rational used.