哺乳期急性乳腺炎发展为乳腺脓肿的病原学特征及相关因素分析

Pathogenic characteristics and related factors analysis of lactational acute mastitis developing into breast abscess

目的探讨哺乳期急性乳腺炎发展为乳腺脓肿的病原学分布、耐药性及相关危险因素,指导临床医师早期干预和合理用药。方法回顾性分析2017年1月-2018年12月在本院乳腺外科收治的哺乳期急性乳腺炎患者328例病历资料。根据哺乳期急性乳腺炎有无进展为乳腺脓肿,分为乳腺炎组276例和乳腺脓肿组52例,采用Logistic回归分析确定哺乳期急性乳腺炎发展为乳腺脓肿的危险因素,并分析其病原学分布和药敏结果。结果328例哺乳期急性乳腺炎患者发展为乳腺脓肿52例,发生率为15.8%;共分离出64株病原菌,其中金黄色葡萄球菌53株,占89.8%。MSSA和MRSA均对呋喃妥因、复方新诺明、庆大霉素、万古霉素等药物具有较高的敏感性。经Logicstic回归分析,初产、乳头(或乳晕)区发病、非医务人员按摩史等为哺乳期急性乳腺炎患者发生乳腺脓肿的独立危险因素(P<0.05),乳头(或乳晕)区发病者进展为乳腺脓肿的风险最高(OR=4.33,P=0.000)。结论哺乳期急性乳腺炎患者发生乳腺脓肿危险因素较多,其主要病原菌为金黄色葡萄球菌,临床应针对高危因素采取有效措施,并结合细菌耐药结果,选择敏感抗菌药物,减少乳腺脓肿的发生率。

Objective To investigate the pathogenic distribution,drug resistance and related risk factors of acute mastitis in lactation,and to guide the early intervention and rational use of drugs by clinicians.Methods The medical records of 328 patients with lactation acute mastitis admitted to our hospital from January to February 2018 were retrospectively analyzed.According to whether lactation acute mastitis processed into mammary abscess,the patients were divided into mastitis group(276 cases)and breast abscess group(52 cases).Logistic regression analysis was used to determine the risk factors of breast mastitis developed into breast abscess in lactation,the pathogens distribution and drug susceptibility results were analyzed.Results Fifty two out of 328 patients with acute mastitis in lactation developed into breast abscess,the incidence rate was15.8%.A total of 64 pathogenic bacteria were isolated,of which 53 strains of Staphylococcus aureus accounted for 89.8%.Both MSSA and MRSA had high sensitivity to nitrofurantoin,cotrimoxazole,gentamicin,and vancomycin.According to Logistic regression analysis,primipara,nipple(or areola)and non-medical massage history were independent risk factors for breast abscess in patients with lactation acute mastitis(P<0.05),The risk of lactation acute mastitis in nipple(or areola)area progressing to breast abscess was the highest(OR=4.33,P=0.000).Conclusion There are many risk factors for breast abscess in patients with acute mastitis during lactation.The main pathogen is Staphylococcus aureus.The clinical measures should be taken for high-risk factors,combined with bacterial resistance results,sensitive antibiotics should be selected to reduce the occurrence of breast abscess rate.