宫腔镜术后盆腔感染病原菌分布特点及危险因素分析

Distribution characteristics and risk factors of pathogenic bacteria in pelvic infection after hysteroscopic surgery

目的分析宫腔镜合并术后盆腔感染患者的病原菌类型、耐药性及感染危险因素。方法选取本院接诊的118例宫腔镜术后盆腔感染患者为本次研究对象,同时随机选取同期宫腔镜术后未发生盆腔感染的80例患者为对照组。回顾性分析本次研究所有患者的临床资料,包括年龄、病原菌培养结果、药敏结果、手术时长、病史、阴道出血情况、预防使用抗菌药物情况等。对比感染组与未感染组患者的临床资料,分析宫腔镜术后发生盆腔感染的危险因素。结果感染组患者共分离病原菌118株。其中革兰阴性菌76株,以大肠埃希菌(38株)、肺炎克雷伯菌(21株)为主,革兰阳性菌34株,以金黄色葡萄球菌(16株)、表皮葡萄球菌(11株)为主,真菌8株,均为白色假丝酵母菌。大肠埃希菌、肺炎克雷伯菌对氨苄西林、左氧氟沙星的耐药率高于50%,对美罗培南、莫西沙星的耐药率低于20%,未产生对亚胺培南、阿米卡星的耐药株。金黄色葡萄球菌、表皮葡萄球菌对青霉素全部耐药,对苯唑西林、红霉素的耐药率高于50%,未产生对万古霉素、替考拉宁、利奈唑胺的耐药株。对相关影响因素进行单因素分析,结果显示,手术时长、术前合并贫血、既往宫腔镜手术史、糖尿病史、持续阴道出血、预防使用抗菌药物、术后引流、不良卫生习惯,两组患者差异有统计学意义(均P<0.05),年龄、流产史对比差异无统计学意义(均P>0.05)。进一步进行二元Logistic回归分析显示,手术时长>2 h、术前合并贫血、有既往宫颈镜手术史、有糖尿病史、持续阴道出血、术后引流、不良卫生习惯是宫腔镜合并盆腔感染的危险因素(P<0.05)。结论宫腔镜术后盆腔感染患者病原菌主要为革兰阴性菌,以大肠埃希菌、肺炎克雷伯菌为主,对临床常用抗菌药物的耐药率较高,应根据患者药敏试验结果选用适合抗菌药物,可以降低耐药菌株的产生。引发宫腔镜术后发生盆腔感染的相关因素较多,临床应针对相关危险因素采用预防和护理措施,降低术后感染率。

Objective The types of pathogens,drug resistance,and infection risk factors in patients with pelvic infection after hysteroscopy combined with surgery were analyzed.Methods 118 patients with pelvic infection after hysteroscopic surgery admitted to our hospital were selected as the study subjects,and 80 patients who did not experience pelvic infection after hysteroscopic surgery during the same period were randomly selected as the control group.Retrospective analysis of clinical data of all patients in this study,including age,pathogen culture results,drug sensitivity test results,surgical duration,medical history,vaginal bleeding,and prophylactic use of antibiotics.The clinical data of infected and uninfected patients were compared,and the risk factors for pelvic infection after hysteroscopy were analyzed.Results A total of 118 strains of pathogenic bacteria were isolated from patients in the infection group.Among them,there were 76 Gram negative bacteria,mainly Escherichia coli(38 strains)and Klebsiella pneumoniae(28strains).There were 34 Gram positive bacteria,mainly Staphylococcus aureus(16strains)and S.epidermidis(11strains).There were 8 fungi,mainly Candida albicans.The drug sensitivity test of E.coli and K.pneumoniae showed that the drug resistance rate of E.coli and K.pneumoniae to ampicillin and levofloxacin was higher than 50%,and the drug resistance rate to meropenem and moxifloxacin was lower than 20%.There was no drug resistance strain to imipenem and amikacin.The S.aureus and S.epidermidis were all resistant to penicillin,and the resistance rate to oxacillin and erythromycin was higher than 50%.There was no resistance to vancomycin,teicoplanin and linezolid.Single factor analysis of relevant influencing factors showed that there were significant differences between the two groups in terms of operation duration,preoperative anemia,previous hysteroscopic surgery history,diabetes history,continuous vaginal bleeding,prevention of use of antibiotics,postoperative drainage,and poor health habits(all P<0.05),while there were no significant differences in age and abortion history(all P>0.05).Further binary logistic regression analysis showed that the risk factors of hysteroscopy with pelvic infection were operation duration>2 h,preoperative anemia,previous cervical surgery,diabetes,continuous vaginal bleeding,postoperative drainage,and poor health habits(P<0.05).Conclusion The main pathogenic bacteria in patients with pelvic infection after hysteroscopy were Gram negative bacteria,mainly E.coli and K.pneumoniae.They had a high resistance rate to commonly used antibiotics in clinical practice.Therefore,suitable antibiotics should be selected based on the patient's drug sensitivity test results to reduce the production of drug-resistant strains.There were many related factors that lead to pelvic infection after hysteroscopy.Long operation time,preoperative anemia,previous cervical surgery,diabetes,continuous vaginal bleeding,postoperative drainage,and poor health habits were the risk factors for pelvic infection after hysteroscopy,and prevention and nursing measures should be taken in clinical practice to reduce the postoperative infection rate.