肉芽肿性乳腺炎棒状杆菌检测对临床用药的指导意义

Identification and clinical significance of corynebacterium from abscess in granulomatous mastitis

目的早期明确肉芽肿性乳腺炎患者脓液中是否感染棒状杆菌,并根据结果制定不同的治疗方法指导早期临床抗菌用药方案。方法回顾性分析2016年6月至2017年3月在广东省妇幼保健院乳腺中心诊治并随访资料完整的患者共42例,应用PCR方法检测患者脓液中的棒状杆菌。阳性组患者治疗方法分别为单纯抗生素、抗生素+激素及单纯激素,阴性组患者治疗方法分别为抗生素+激素及单纯激素。观察不同组别患者的术后复发率及治愈率。结果治疗感染棒状杆菌的肉芽肿性乳腺炎患者的抗生素方案包括短效左氧氟沙星、阿奇霉素及长效抗分枝杆菌三联药物。42例患者,PCR检测脓液明确棒状杆菌阳性21例,术后复发率23.5%。单纯抗生素组、抗生素+激素组及单纯激素组对感染棒状杆菌的肉芽肿性乳腺炎患者间疗效差异有统计学意义(χ2=5.494,P=0.036)。PCR检测棒状杆菌阴性21例,术后复发率16.7%,抗生素+激素组及单纯激素组对无细菌感染的GM患者间疗效差异无统计学意义(χ2=1.129,P=0.719)。结论GM患者及早发现棒状杆菌的感染对临床指导亲脂抗生素的应用有意义。

Objective To make the early clinical antibiotic regimen by finding out the infection of corynebacterium in the pus of patients with granulomatous mastitis in the early stage.Methods A total of 42 patients who were diagnosed and treated in the Breast Center of Guangdong Maternal and Child Health Hospital from Jun.2016 to Mar.2017 with complete follow-up data were retrospectively analyzed.PCR method was used to detect corynebacterium in the patients’pus.Patients in the positive group were treated with antibiotics alone,antibiotics+hormones and hormones alone,while patients in the negative group were treated with antibiotics+hormones and hormones alone.The postoperative recurrence rate and cure rate of different groups of patients were observed.Results The antibiotic regimen for granulomatous mastitis in patients with corynebacterium infection included a combination of short-acting levofloxacin and azithromycin and long-acting anti-mycobacterium drugs.Among the 42 patients in the subgroup,21 patients were confirmed positive for corynebacterium by PCR detection of pus,and the postoperative recurrence rate was 23.5%.There was a statistically significant difference between the antibiotic group,the antibiotic+hormone group and the hormone group in treatment of granulomatous mastitis infected with corynebacterium(χ2=5.494,P=0.036).PCR detection shouwed corynebacterium negative in 21 cases,and postoperative recurrence rate of 16.7%.No statistically significant difference in efficacy was found between antibiotic+hormone group and hormone only group for GM patients without bacterial infection(χ2=1.129,P=0.719).Conclusion Early detection of corynebacterium infection in GM patients is significant for clinical guidance of the application of lipophilic antibiotics.