产科多重耐药菌感染107例临床分析

Clinical analysis of 107 cases of prenatal multidrug-resistant organism infection

目的探讨产科感染的多重耐药菌种类、感染部位、耐药性及临床特点。方法选取2020年1月至2021年10月浙江大学医学院附属妇产科医院产科住院分娩的107例多重耐药菌感染患者为研究对象,回顾性分析病例特点及多重耐药菌种类、感染部位及耐药性。结果107例多重耐药菌感染患者中,主要菌种为产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(61.68%,66/107)和高水平氨基糖苷类耐药粪肠球菌(HLARE)(15.89%,17/107);感染多见于宫颈(62.62%,67/107)和胎盘子面(14.02%,15/107)。产ESBLs大肠埃希菌对青霉素类、头孢菌素类抗菌药物耐药率达100%;HLARE对头孢菌素类抗菌药物天然耐药,对氨基糖苷类、大环内酯类抗菌药物耐药率达100%;感染病例多合并胎膜早破(28.04%,30/107)、妊娠期宫颈环扎或息肉摘除手术(14.95%,16/107)、采用辅助生殖技术(14.02%,15/107)。感染易导致母体高热(14.95%,16/107)、脓毒血症(2.80%,3/107);新生儿存活率为83.18%(89/107),败血症发生率为23.60%(21/89)。结论产科多重耐药菌菌株主要为产ESBLs大肠埃希菌和HLARE,是产科重症感染、流产早产及新生儿败血症的主要原因;主要感染部位为生殖道;胎膜早破、妊娠期宫颈手术是多重耐药菌感染的高危因素,需严格规范侵入性操作。

Objective To investigate the species,infection site,drug resistance and clinical diagnosis and treatment of prenatal multidrug-resistant organism infection.Methods 107 cases of multidrug-resistant organism infection in Women's Hospital,Medical school of Zhejiang University from January 2020 to October 2021 were selected as the research object.The characteristics of cases,the genus,infection site,drug resistance were analyzed retrospectively.Results 107 strains of multidrug-resistant bacteria were detected.The main strains were Escherichia coli producing ultra-broad spectrumβ-lactamase(ESBLs)(61.68%,66/107)and high-level aminoglycoside resistant Enterococcus faecalis(HLARE)(15.89%,17/107).Infection site were more common in the cervix(62.62%,67/107)and placenta(14.02%,15/107).The resistance rate of ESBLs-producing Escherichia coli to penicillin and cephalosporins was 100%.HLARE is naturally resistant to cephalosporin antibiotics,and its resistance rate to aminoglycosides and macrolides antibiotics was 100%.Most cases of infection were associated with premature rupture of membranes(28.04%,30/107),cervical cerclage and cervical polyp removed surgery during pregnancy(14.95%,16/107),and assisted reproduction(14.02%,15/107).The infection caused high maternal fever(14.95%,16/107)and sepsis(2.80%,3/107).The survival rate of neonates was 83.18%(89/107)and the incidence of sepsis was 23.60%(21/89).Conclusions Obstetric multidrug-resistant organism strains mainly include ESBLs-producing Escherichia coli and HLARE,which are also the main causes of severe obstetric infection,abortion,premature delivery and neonatal septicemia.The main infection site is the reproductive tract.Premature rupture of membranes and cervical surgery during pregnancy are high risk factors for multidrug-resistant organism infection,and invasive procedures should be strictly regulated.