会阴侧切产妇感染病原菌分布及感染途径临床分析

Clinical analysis of distribution of infectious pathogens and in-fection pathways in maternal infection of perineal side

目的探讨会阴侧切产妇感染发生率及感染途径、病原菌分布、抗菌药物耐药特点,为提高抗感染效果、严控耐药菌株产生提供参考.方法对584例会阴侧切产妇的临床资料进行回顾性分析.结果本组584例会阴侧切产妇发生感染19例,感染率3.25%,感染途径分布依次为外阴切口感染47.37%、呼吸道感染31.58%、泌尿道感染15.79%、其他5.26%,差异有统计学意义(P<0.01).送检标本共分离出98株病原菌,依次为革兰阴性菌57株(58.16%)、革兰阳性菌35株(35.71%)、真菌6株(6.12%),差异有统计学意义(P<0.01).主要革兰阳性菌中金黄色葡萄球菌、表皮葡萄球菌对头孢曲松、头孢吡肟耐药率最高,氧氟沙星耐药率次之,显著高于其他抗菌药物(P<0.01);革兰阴性菌中铜绿假单胞菌对头孢唑啉、氨苄西林、氨苄西林/舒巴坦、呋喃妥因耐药率最高,头孢曲松耐药率次之(P<0.01),大肠埃希菌对头孢唑林、氨苄西林耐药率最高,头孢曲松耐药率次之,显著高于其他抗菌药物(P<0.01).结论本地区会阴侧切产妇感染病原菌并未出现大量变化,但加强此类术式患者病原学检查,早期进行病原菌培养,根据药敏试验结果及时调整抗菌药物种类,有助于提高感染防控效果、降低耐药菌株产生.

Objective To investigate the incidence of infection and the path of infection, distribution of pathogens and antibiotic resistance of perineal side-cutting, and provide reference for improving anti-infec-tion effect and strict control of drug-resistant strains. Methods The clinical data of 584 cases of perineal cuts were retrospectively analyzed. Results Among 584 cases, 19 cases were infected by peritoneal episi- otomy and the infection rate was 3. 25%. The infection route included 47. 37% of vulva incision infection, 31. 58% higher than respiratory infection and 15. 79% of urinary tract infection, the difference was statisti-cally significant (P<0. 01). A total of 98 pathogenic bacteria were isolated from the samples, which were followed by 57 Gram-negative bacteria (58. 16%),35 Gram-positive bacteria (35. 71%),and 6 fungi (6. 12%). The difference was statistically significant (P<0. 01). Among the main Gram-positive bacteria, Staphylococcus aureus and Staphylococcus epidermidis had the highest resistance rate to ceftriaxone and cefepime, followed by infloxacin resistance rate, which was significantly higher than other antibacterial drugs (P<0. 01). Among the Gram-negative bacteria, Pseudomonas aeruginosa had the highest resistance rate to cefazolin, ampicillin, ampicillin/sulbactam and nitrofurantoin, and the resistance rate of ceftriaxone was the second (P<0. 01). Escherichia coli had the highest resistance rate to cefazolin and ampicillin, and the resistance rate of ceftriaxone was second, which was significantly higher than other antibacterial drugs (P<0. 01). Conclusions There are no significant changes in the pathogens of PM among maternal perine-um patients. The pathogen examination of such surgical patients should be strengthened, the pathogen culture should be carried out early, and the types of antibiotics vshould be adjusted according to the results of drug susceptibility test, which can improve the infection prevention and control effect and reduce the emergence of drug-resistant strains.