剖宫产患者产褥感病原菌的分布、耐药性以及细胞因子分析

Analysis of pathogenic bacteria,their drug resistance,and cytokines in 60 patients with a puerperal infection after a Cesarean section

目的了解剖宫产患者产褥感染的病原菌种类及耐药性,分析患者细胞因子水平的变化。方法将2018年5月至2019年4月本院剖宫产术后产褥感染的60例患者作为感染组,选取同期剖宫产术后未感染的40例作为未感染组,取相应临床标本进行病原菌的培养及耐药性检测;采集患者血液,分离血清,采用ELISA检测细胞因子及氧化能力和氧化应激物水平的变化。结果60例产褥期感染患者中,14例(23.33%)为子宫内膜炎,13例(21.67%)为子宫切口感染,10例(16.67%)为盆腔腹膜炎,9例(15.00%)为输卵管炎宫颈炎,7例(11.67%)为外阴及阴道炎,3例(5.00%)为盆腔结缔组织炎,4例(6.67%)为混合感染。共检出88株病原菌,主要为大肠埃希菌(42株,47.73%)、阴道加德纳菌(20株,22.73%)、链球菌(12株,13.64%)。大肠埃希菌、阴道加德纳菌对青霉素、阿奇霉素、头孢唑啉、氨苄青霉素耐药性均>80%;链球菌对青霉素、环丙沙星的耐药性均为100.00%。感染组产妇血清IL-6(12.23±1.23)pg/mL,IL-8(48.52±18.92)pg/mL,CRP(3.46±0.43)mg/mL,PCT(1.42±0.24)ng/mL,TNF-α(96.27±27.65)pg/mL,MDA(2.76±0.41)mmol/L,均显著高于未感染组(均P<0.05);TAC(8.15±1.21)kU/mL,SOD(75.62±5.32)nU/mL,均显著低于未感染组(均P<0.05)。结论剖宫术患者产褥感染病原菌种类多,应根据其耐药性特征选用抗生素治疗。产褥感染患者相关炎症因子水平升高,可为该病的诊断提供参考。产褥感染的部位广泛,应采取针对性预防措施以减少感染的发生。

Objectives To investigate pathogenic bacteria,their drug resistance,and changes in levels of cytokines in patients with a puerperal infection after a Cesarean section.Methods Sixty patients who developed a puerperal infection after a Cesarean section at this Hospital from May 2018to April 2019served as the infected group,and 40patients without an infection after a Cesarean section during the same period served as the uninfected group.The corresponding clinical samples were collected to culture pathogenic bacteria and detect their drug resistance.The changes in cytokines,oxidative capacity,and oxidative stress were detected using ELISA.Results Of the 60patients with a puerperal infection,14(23.33%)had endometritis,13(21.67%)had a uterine incision infection,10(16.67%)had pelvic peritonitis,9(15.00%)had salpingitis/cervicitis,7(11.67%)had vulvovaginitis,3(5.00%)had inflammation of pelvic connective tis-sue,and 4(6.67%)had a mixed infection.A total of 88strains of pathogenic bacteria were detected,including Escherichia coli(42,47.73%),Gardnerella vaginalis(20,22.73%),and Streptococcus(12,13.64%).The resistance of E.coli and G.vaginalis to penicillin,azithromycin,cefazolin,and ampicillin was higher than 80%.The resistance of Streptococcus to penicillin and ciprofloxacin was 100.00%.In parturient patients with an infection,the serum level of IL-6was 12.23±1.23pg/mL,the serum level of IL-8was 48.52±18.92pg/mL,the serum level of CRP was 3.46±0.43 mg/mL,the serum level of PCT was 1.42±0.24ng/mL,and the serum level of TNF-αwas 96.27±27.65pg/mL.In parturient patients without an infection,the serum level of IL-6was 6.23±0.44pg/mL,the serum level of IL-8was 38.61±15.43pg/mL,the serum level of CRP was 2.64±0.51mg/mL,the serum level of PCT was 0.58±0.17ng/mL,and the serum level of TNF-αwas 40.83±14.37pg/mL.The serum levels of IL-6,IL-8,CRP,PCT and TNF-αin pa-tients with an infection were significantly higher than those in patients without an infection(P<0.05).In patients with an infection,the serum TAC level was 8.15±1.21kU/mL,the serum SOD level was 75.62±5.32nU/mL,and the serum MDA level was 2.76±0.41mmol/L.In patients without an infection,the serum TAC level was 11.14±0.87kU/mL,the serum SOD level was 79.36±7.67nU/mL,and the serum MDA level was 1.86±0.34mmol/L.The levels of TAC and SOD in patients with an infection were significantly lower than those in patients without an infection(P<0.05),and the level of MDA inpatients with an infection was significantly higher than that in patients without an infection(P<0.05).Conclusion Antibiotics can be used to treat a puerperal infection in patients after a Cesarean section depending on the characteristics of pathogenic bacteria and their drug resistance,and inflammatory factors in patients with a puerperal infection have certain characteristics.Symptomatic treatment can effectively control the risk of infection and im-prove the effectiveness of treatment.