腹腔镜卵巢囊肿剔除术后盆腔感染的病原菌特点及hs⁃CRP、PCT、NLR水平

Pathogen characteristics and hs⁃CRP,PCT and NLR levels of pelvic infection after laparoscopic ovarian cyst removal

目的探讨腹腔镜卵巢囊肿剔除术后盆腔感染的病原菌特点及超敏C⁃反应蛋白(hs⁃CRP)、降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)水平。方法收集2017年7月至2020年12月于廊坊市人民医院行腹腔镜卵巢囊肿切除术的145例患者临床资料,统计术后盆腔感染率,分析其病原菌分布构成比及主要病菌耐药特点。分析术后盆腔感染者及未感染者hs⁃CRP、PCT、NLR水平,探讨以上指标对盆腔感染的诊断效能。结果145例患者中,36例出现盆腔感染,52株致病菌中包含14株革兰阳性菌、34株革兰阴性菌、4株真菌。金黄色葡萄球菌、表皮葡萄球菌对青霉素G完全耐药;大肠埃希菌对头孢唑林、阿莫西林完全耐药率;肺炎克雷伯菌对头孢噻肟、磺胺甲噁唑完全耐药。盆腔感染者hs⁃CRP、PCT、NLR水平均显著高于未感染者,差异有统计学意义(P<0.05)。联合hs⁃CRP、PCT、NLR诊断术后盆腔感染敏感性(80.56%)、特异性(88.99%)、AUC(0.881)显著优于单项检测(P<0.05)。结论革兰阴性菌为腹腔镜卵巢囊肿剔除术后盆腔感染的主要病原菌,临床需根据耐药试验进行针对性给药治疗,联合hs⁃CRP、PCT、NLR水平可为盆腔感染诊断提供有效价值。

Objective To investigate the characteristics of pathogenic bacteria of pelvic infection,and the levels of high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT) and neutrophil to lymphocyte ratio(NLR)after laparoscopic ovarian cyst removal. Methods The clinical data of 145 patients who underwent laparoscopic ovarian cyst removal in Langfang People’s Hospital were collected between July2017 and December 2020. The postoperative pelvic infection rate was counted,and the distribution of pathogenic bacteria and drug resistance of main bacteria were analyzed. The levels of hs-CRP,PCT and NLR in patients with postoperative pelvic infection and those without infection were analyzed. The diagnostic efficiency of the above indicators for pelvic infection were discussed. Results Among the 145 patients,36 had pelvic infection,and 52 pathogens included 14 gram-positive bacteria,34 gram-negative bacteria,and 4 fungi.Staphylococcus aureus and Staphylococcus epidermidis were completely resistant to penicillin G. Escherichia coli was completely resistant to cefazolin and amoxicillin. Klebsiella pneumoniae was completely resistant to cefotaxime and sulfamethoxazole. The levels of hs-CRP,PCT and NLR in patients with pelvic infection were significantly higher than those in patients without infection(P<0.05). The sensitivity,specificity,and AUC of combination of hs-CRP,PCT and NLR to diagnose postoperative pelvic infection were 80.56%,88.99% and0.881,better than single detection. Conclusion Gram-negative bacteria are the main pathogenic bacteria of pelvic infection after laparoscopic ovarian cyst removal. Clinical treatment should be targeted according to drug resistance test. The combination of hs-CRP,PCT and NLR levels can provide effective value for the diagnosis of pelvic infection.