867例妇科门诊女性生殖道分泌物病原菌分离鉴定及耐药情况

Distribution and drug resistance of pathogenic bacteria of 867 genital secretions from gynecological outpatients

目的回顾分析867例育龄女性生殖道分泌物病原菌分布和耐药情况,为临床用药提供参考。方法 2016年1—12月选取十堰市妇幼保健院867例育龄女性生殖道分泌物进行培养,用VITEK全自动细菌仪进行菌株分离鉴定和耐药试验分析。结果 867份样本中检出377份病原菌阳性,阳性检出率43.5%,不同婚姻状况和文化程度病人样本阳性检出率差异有统计学意义(P<0.05)。检出病原菌402株,其中革兰阳性菌139株(占34.6%,主要为葡萄球菌、粪肠球菌和无乳链球菌),革兰阴性菌160株(占39.8%,主要为大肠埃希菌、肺炎克雷伯菌和阴道加德纳菌),真菌103株(占25.6%,主要为白色假丝酵母菌和光滑假丝酵母菌)。革兰阳性菌对青霉素、复方新诺明和庆大霉素总体耐药性较高,对万古霉素敏感;革兰阴性菌对氨苄西林、头孢唑林和复方新诺明耐药性较高,对亚胺培南较为敏感;除对氟康唑和硝酸咪康唑耐药性接近40%外,真菌整体耐药性不高。结论该地区妇科门诊病人阴道分泌物病原菌阳性检出率较高,不同菌株对药物敏感性不同,临床上应结合药敏分析结果合理选择药物。

Objective To analyze retrospectively the pathogenic bacteria distribution and drug susceptibility of genital secretions in 867 gynecological outpatients,and to provide reference for clinical drug selection.Methods A total of 867 genital secretions collected from gynecological outpatients treated in Shiyan Maternal and Child Care Hospital from January to December 2016 were collected for bacteria culture,which were isolated and identified.Drug susceptibility was analyzed by VITEK automatic bacteria analyzer.Results Of 867 samples,377(43.5%) genital secretion samples were pathogenic bacteria positive;there was significant difference in detection rate among samples with different marital status and education level(P<0.05).Totally 402 bacteria strains were isolated,including 139 Gram-positive bacterium strains(34.6%,mainly Staphylococcus,Enterococcus faecalis and Streptococcus lactis),160 Gram-negative bacterium strains(39.8%,mainly Escherichia coli,Klebsiella pneumoniae,and Gardnerella vaginalis) and 103 fungus strains(25.6%,mainly Candida albicans and Candida glabrata).Drug sensitivity results showed that Gram-positive bacteria were sensitive to vancomycin but resistant to penicillin,trimethoprim and gentamicin,Gram-negative bacteria were sensitive to imipenem but resistant to cefazolin,ampicillin and cotrimoxazole,and fungus were sensitive to most antifungal agents but resistant to nearly 40% of fluconazole and miconazole nitrate.Conclusions The positive detection rate of vaginal secretion samples was high in gynecological outpatients,and the bacteria strains had different resistance to different drugs.Therefore,clinical drug choice should be based on the results of drug sensitivity.