子宫内膜异位症术后感染病原学研究

Study on etiology of postoperative infection of endometriosis

目的研究本地区子宫内膜异位症术后感染病原菌分布和流行特点,为合理使用抗生素进行预防和治疗提供依据。方法收集本地区子宫内膜异位症术后感染患者临床标本,采用全自动微生物鉴定仪进行菌种鉴定,采用K-B纸片法进行药敏试验,并筛选MRSA和产ESBLs酶的大肠埃希菌和肺炎克雷伯菌。采用PCR热扩增对产ESBLs酶的大肠埃希菌进行分型研究。结果共计分离出38株革兰阳性菌,分别为金黄色葡萄球菌16株、表皮葡萄球菌9株、肠球菌8株、肺炎链球菌5株;59株革兰阴性菌,分别为大肠埃希菌23株、肺炎克雷伯菌15株,铜绿假单胞菌11株,鲍曼不动杆菌6株、其他G^(-)4株;真菌共计3株,全部为白色假丝酵母菌。其中MRSA检出5株,检出率31.25%;产ESBLs大肠埃希菌检出11株,检出率47.83%;产ESBLs肺炎克雷伯菌检出5株,检出率33.33%。革兰阳性菌对红霉素、青霉素G、四环素、头孢呋辛酯、头孢噻肟、庆大霉素、阿米卡星、哌拉西林、哌拉西林-他唑巴坦和左氧氟沙星耐药率为68.42%、52.63%、55.26%、44.74%、39.47%、55.26%、10.53%、57.89%、10.53%和28.95%,未产生对对替考拉宁和万古霉素产生耐药性;革兰阴性菌对头孢他啶、头孢吡肟、哌拉西林、哌拉西林-他唑巴坦、左氧氟沙星、美罗培南和亚胺培南耐药率为38.98%、15.25%、66.10%、8.47%、28.81%、5.08%和5.08%。11株产ESBLs大肠埃希菌中检出7株携带CTX-M-1基因,4株携带TEM基因,3株携带CTX-M-14基因,携带SHV基因、CTX-M-8基因、CTX-M-9基因、OXA1基因和OXA2基因各1株。结论金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌是本次研究中的主要致病菌,CTX-M型是产ESBLs大肠埃希菌的主要基因型。

Objective To study the distribution and epidemic characteristics of postoperative infection pathogens of endometriosis in this area,so as to provide basis for the rational use of antibiotics for prevention and treatment.Methods The clinical specimens of patients with postoperative endometriosis infection in this region were collected.K-B disk method was used for drug sensitivity test.MRSA and ESBLs producing E.coli and K.pneumoniae were screened.The typing of ESBLs producing E.coli was studied by PCR thermal amplification.Results Specimen isolation:a total of 38 strains of Gram-positive bacteria were isolated,including 16 strains of S.aureus,9 strains of S.epidermidis,8 strains of Enterococcus and 5 strains of S.pneumoniae;59 strains of Gram-negative bacteria were isolated,including 23 strains of E.coli,15 strains of K.pneumoniae,11 strains of Pseudomonas aeruginosa,6 strains of Acinetobacter baumannii and other G^(-)4 strains;3 strains of fungi were isolated,all of which are Candida albicans.Among them,5 strains were detected by MRSA,and the detection rate was 31.25%;11 strains of ESBLs producing E.coli were detected,and the detection rate was 47.83%;5 strains of K.pneumoniae producing ESBLs were detected,and the detection rate was 33.33%.Drug sensitivity:the resistance rates of Gram-positive bacteria to erythromycin,penicillin G,tetracycline,cefuroxime,cefotaxime,gentamicin,amikacin,piperacillin,piperacillin tazobactam and levofloxacin were 68.42%,52.63%,55.26%,44.74%,39.47%,55.26%,10.53%,57.89%,10.53%and 28.95%,and there was no resistance to teicoplanin and vancomycin;The resistance rates of Gram-negative bacteria to ceftazidime,cefepime,piperacillin,piperacillin tazobactam,levofloxacin,meropenem and imipenem were 38.98%,15.25%,66.10%,8.47%,28.81%,5.08%and 5.08%.Among the 11 ESBLs producing E.coli strains,7 strains carried CTX-M-1 gene,4 strains carried TEM gene,3 strains carried CTX-M-14 gene,and 1 strain each carried SHV gene,CTX-M-8 gene,CTX-M-9 gene,OXA1 gene and OXA2 gene.Conclusion S.aureus,E.coli and K.pneumoniae are the main pathogens in this study.CTX-M type is the main genotype of ESBLs producing E.coli.